Is supracervical better than total hysterectomy during colorectal resection?

Undergoing supracervical hysterectomy during colorectal resection seems to reduce the duration of the procedure, the need for blood transfusion, as well as the length of hospital stay, according to a study presented at the 2023 SGO Annual Meeting on Women’s Cancer.

“However, patients who underwent supracervical hysterectomy had an increased likelihood of readmission and did not differ with respect to rates of anastomotic leak and perioperative morbidity or mortality compared to those who underwent total hysterectomy,” said the investigators, led by Dr Rosa M Polan from Barbara Ann Karmanos Cancer Institute in Detroit, Michigan, US.

Patients who chose to undergo supracervical hysterectomy rather than total hysterectomy were usually driven by the need for less invasive surgery with decreased operative morbidity, according to the investigators, noting, however, that the benefit of this less invasive approach in the setting of complex pelvic surgery, including concurrent colorectal resection, was speculative.

Thus, Polan and her team conducted this study to compare perioperative outcomes between supracervical and total hysterectomy performed with concurrent colorectal resection. They abstracted variables form the targeted colectomy, proctectomy, and hysterectomy databases of the National Surgical Quality Improvement Program from 2014‒2020.

The investigators then identified patients who underwent concurrent hysterectomy and colorectal resection and stratified them based on resection or retention of the cervix. Outcomes were compared using multivariate linear and logistic regression.

A total of 5,997 women were identified, of whom 78.7 percent underwent supracervical hysterectomy and 21.3 percent total hysterectomy. [SGO 2023, abstract 1202]

Pros and cons

Multivariate analysis revealed the association of supracervical hysterectomy in addition to colorectal resection with decreased operative time (26 min less than total hysterectomy; p<0.001), length of hospital stay (difference, 0.18 days; p=0.002), and need for perioperative blood transfusion.

No significant differences were observed in the rates of anastomotic leak, surgical or medical morbidity, and mortality between supracervical and total hysterectomy. However, the investigators saw an increase in the rate of readmission for patients who underwent supracervical instead of total hysterectomy.

“It is important to remember that the decision whether to remove or retain the cervix belongs to the patient,” according to the researchers of an earlier study headed by Dr Miłosz Wilczyński from Polish Mother's Memorial Hospital Research Institute, Lodz, Poland. [Wideochir Inne Tech Maloinwazyjne 2014;9:207-212]

“The surgeon should inform the woman about all advantages and disadvantages [of the procedure],” they added. [Best Pract Res Clin Obstet Gynaecol 2011;25:133-152]

Hysterectomy is a commonly performed gynaecologic intervention for benign diseases and has three main approaches: abdominal, vaginal, and laparoscopic. The procedure can be done by either removing the uterus, including the cervix (total hysterectomy), or excising only the body of the uterus and leaving the cervix intact (supracervical hysterectomy). [BMJ 2004;328:129-133; Best Pract Res Clin Obstet Gynaecol 2011;25:133-152]