Hysteroscopic Transcervical Resection for Atypical Polypoid Adenomyoma of the Uterus: A Valid, Fertility-Preserving Option

Tatsuyuki Chiyoda, Bao Liang Lin, Keiko Saotome, Shunki Kiyokawa, Sakura Nakada

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5 Citations (Scopus)

Abstract

Study Objective: To evaluate hysteroscopic transcervical resection (TCR) for atypical polypoid adenomyoma of the uterus (APA). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Single tertiary hospital. Patients: Women who underwent TCR for APA at Kawasaki Municipal Hospital between 2003 and 2015. Interventions: Clinical records were obtained. Measurements and Main Results: Thirty-five patients with APA were evaluated. The median patient age was 35 years (range, 23-43 years), and the median tumor diameter was 22 mm (range, 9-51 mm). The median duration of observation after the first TCR was 34.0 months (range, 4.2-133.7 months). In 19 patients, the tumor recurred after the first TCR. A second TCR was performed in 13 patients, 11 of whom experienced recurrence. A third TCR was performed in 7 patients, all 7 of whom experienced recurrence. A fourth TCR was performed in 4 patients, 3 of whom experienced recurrence. The recurrence rate after the second TCR was higher than that after the first TCR (71.4%-84.6% vs 54.3%; p < .01, t test). The median disease-free interval was 12.4 months after the first TCR, 15.3 months after the second TCR, 10.5 months after the third TCR, and 10.9 months after the fourth TCR. Seven patients progressed to endometrial cancer; however, there was no mortality. Six of the 35 patients conceived, and 4 had a normal spontaneous delivery. Conclusion: Owing to disease-free intervals that follow treatment, TCR is a promising treatment modality as a fertility-preserving option for patients with APA under careful observation. Twenty percent of patients with APA develop cancer; however, the present study showed no mortality.

Original languageEnglish
JournalJournal of Minimally Invasive Gynecology
DOIs
Publication statusAccepted/In press - 2017 Jan 1
Externally publishedYes

Fingerprint

Adenomyoma
Uterus
Fertility
Recurrence
Observation
Municipal Hospitals
Uterine Neoplasms
Mortality
Advisory Committees
Endometrial Neoplasms
Tertiary Care Centers

Keywords

  • APA
  • Hysteroscopy
  • Pregnancy
  • Recurrence rate
  • Uterine cancer

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{86211e7606604a84beed484e40b4acb7,
title = "Hysteroscopic Transcervical Resection for Atypical Polypoid Adenomyoma of the Uterus: A Valid, Fertility-Preserving Option",
abstract = "Study Objective: To evaluate hysteroscopic transcervical resection (TCR) for atypical polypoid adenomyoma of the uterus (APA). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Single tertiary hospital. Patients: Women who underwent TCR for APA at Kawasaki Municipal Hospital between 2003 and 2015. Interventions: Clinical records were obtained. Measurements and Main Results: Thirty-five patients with APA were evaluated. The median patient age was 35 years (range, 23-43 years), and the median tumor diameter was 22 mm (range, 9-51 mm). The median duration of observation after the first TCR was 34.0 months (range, 4.2-133.7 months). In 19 patients, the tumor recurred after the first TCR. A second TCR was performed in 13 patients, 11 of whom experienced recurrence. A third TCR was performed in 7 patients, all 7 of whom experienced recurrence. A fourth TCR was performed in 4 patients, 3 of whom experienced recurrence. The recurrence rate after the second TCR was higher than that after the first TCR (71.4{\%}-84.6{\%} vs 54.3{\%}; p < .01, t test). The median disease-free interval was 12.4 months after the first TCR, 15.3 months after the second TCR, 10.5 months after the third TCR, and 10.9 months after the fourth TCR. Seven patients progressed to endometrial cancer; however, there was no mortality. Six of the 35 patients conceived, and 4 had a normal spontaneous delivery. Conclusion: Owing to disease-free intervals that follow treatment, TCR is a promising treatment modality as a fertility-preserving option for patients with APA under careful observation. Twenty percent of patients with APA develop cancer; however, the present study showed no mortality.",
keywords = "APA, Hysteroscopy, Pregnancy, Recurrence rate, Uterine cancer",
author = "Tatsuyuki Chiyoda and Lin, {Bao Liang} and Keiko Saotome and Shunki Kiyokawa and Sakura Nakada",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jmig.2017.08.659",
language = "English",
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TY - JOUR

T1 - Hysteroscopic Transcervical Resection for Atypical Polypoid Adenomyoma of the Uterus

T2 - A Valid, Fertility-Preserving Option

AU - Chiyoda, Tatsuyuki

AU - Lin, Bao Liang

AU - Saotome, Keiko

AU - Kiyokawa, Shunki

AU - Nakada, Sakura

PY - 2017/1/1

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N2 - Study Objective: To evaluate hysteroscopic transcervical resection (TCR) for atypical polypoid adenomyoma of the uterus (APA). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Single tertiary hospital. Patients: Women who underwent TCR for APA at Kawasaki Municipal Hospital between 2003 and 2015. Interventions: Clinical records were obtained. Measurements and Main Results: Thirty-five patients with APA were evaluated. The median patient age was 35 years (range, 23-43 years), and the median tumor diameter was 22 mm (range, 9-51 mm). The median duration of observation after the first TCR was 34.0 months (range, 4.2-133.7 months). In 19 patients, the tumor recurred after the first TCR. A second TCR was performed in 13 patients, 11 of whom experienced recurrence. A third TCR was performed in 7 patients, all 7 of whom experienced recurrence. A fourth TCR was performed in 4 patients, 3 of whom experienced recurrence. The recurrence rate after the second TCR was higher than that after the first TCR (71.4%-84.6% vs 54.3%; p < .01, t test). The median disease-free interval was 12.4 months after the first TCR, 15.3 months after the second TCR, 10.5 months after the third TCR, and 10.9 months after the fourth TCR. Seven patients progressed to endometrial cancer; however, there was no mortality. Six of the 35 patients conceived, and 4 had a normal spontaneous delivery. Conclusion: Owing to disease-free intervals that follow treatment, TCR is a promising treatment modality as a fertility-preserving option for patients with APA under careful observation. Twenty percent of patients with APA develop cancer; however, the present study showed no mortality.

AB - Study Objective: To evaluate hysteroscopic transcervical resection (TCR) for atypical polypoid adenomyoma of the uterus (APA). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Single tertiary hospital. Patients: Women who underwent TCR for APA at Kawasaki Municipal Hospital between 2003 and 2015. Interventions: Clinical records were obtained. Measurements and Main Results: Thirty-five patients with APA were evaluated. The median patient age was 35 years (range, 23-43 years), and the median tumor diameter was 22 mm (range, 9-51 mm). The median duration of observation after the first TCR was 34.0 months (range, 4.2-133.7 months). In 19 patients, the tumor recurred after the first TCR. A second TCR was performed in 13 patients, 11 of whom experienced recurrence. A third TCR was performed in 7 patients, all 7 of whom experienced recurrence. A fourth TCR was performed in 4 patients, 3 of whom experienced recurrence. The recurrence rate after the second TCR was higher than that after the first TCR (71.4%-84.6% vs 54.3%; p < .01, t test). The median disease-free interval was 12.4 months after the first TCR, 15.3 months after the second TCR, 10.5 months after the third TCR, and 10.9 months after the fourth TCR. Seven patients progressed to endometrial cancer; however, there was no mortality. Six of the 35 patients conceived, and 4 had a normal spontaneous delivery. Conclusion: Owing to disease-free intervals that follow treatment, TCR is a promising treatment modality as a fertility-preserving option for patients with APA under careful observation. Twenty percent of patients with APA develop cancer; however, the present study showed no mortality.

KW - APA

KW - Hysteroscopy

KW - Pregnancy

KW - Recurrence rate

KW - Uterine cancer

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