Incidence of cervical stump metastasis after subtotal hysterectomy done to cases proved later by histopathology to be endometrial cancer in Al Shatby university maternity hospital patients


  • Hossam El Sokkary Department of Obstetrics and Gynecology, Faculty of Medicine, Al Shatby University Maternity Hospital, Alexandria, Egypt
  • Eman Abd El Zaher Department of pathology, Faculty of Medicine, Alexandria University Hospital, Alexandria, Egypt



Subtotal hysterectomy, Cervical stump invasion, Type 1 and 2 endometrial cancer


Background: Subtotal hysterectomy is associated with lesser complication, lesser time consuming than total one, but total hysterectomy has advantage of radicality of its management in cases of accidentally undiagnosed endometrial cancer proved later on by histopathology, that why hysterectomy should be total even in apparently benign causes that indicate it. The aim of this study was to access incidence of cervical stump invasion by malignancy in endometrial cancer cases and its relation to pathological types after subtotal hysterectomy done to cases proved later by histopathology to be endometrial cancer.

Methods: Following approval by our institutional ethics committee a prospective and retrospective observational descriptive study was done on 100 patients recruited from gyne-oncological outpatient clinic of Shatby university hospital of Alexandria from August 2018 to June 2021 with past history of subtotal hysterectomy. All these cases were proved later after histopathological examination of the uterine body to have type 1 or type 2 endometrial cancer. Stumpectomy was done to all patients after a written informed consent were taken from them before the study. Histopathological examinations of the cervical stumps were done and incidence of stump invasion with cancer in relation to its type was analyzed.

Results: Histopathological examination of the stump of all cases revealed that only 13 cases showed microscopic stump invasion. 7 cases with stump invasion were type 1 endometrial cancer, 4 cases were grade 1 and 3 cases were grade 2 in relation to 6 cases of stump invasion were type 2 endometrial cancer with papillary serous adenocarcinoma. Regarding relation between stump invasion and pathological types of endometrial cancer there was a significant statistical difference between them as type 2 are associated by higher number of stump invasion (p=0.0001).

Conclusions: The present study concluded that cases subjected to subtotal hysterectomy with undiagnosed endometrial cancer are associated with considerable incidence of cervical stump invasion and type 2 endometrial cancer have higher incidence of cervical stump invasion in relation to type 1 endometrial cancer.


Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Søgaard M. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. Am J Obstet Gynecol. 2015;213(1):23-9.

Lundholm C, Forsgren C, Johansson ALV, Cnattingius S, Altman D. Hysterectomy on benign indications in Sweden 1987-2003: a nationwide trend analysis. Acta Obstet Gynecol Scand. 2009;88(1):52-8.

Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318-25.

Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BWJ, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;8:003677.

Dorsey JH, Holtz PM, Griffiths RL, McGrath M, Steinberg EP. Costs and charges associated with three alternative techniques of hysterectomy. N Engl J Med. 1996;335(7):475-82.

Evert J, Smeenk J, Dijkhuizen F, Kruif JHD, Kluivers KB. Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience. Gynecol Surg. 2010;7(1):9-12.

McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J, et al. Severe complications of hysterectomy: the VALUE study. BJOG. 2004;111(7):688-94.

Feinberg J, Albright B, Black J, Lu L, Passarelli R, Gysler S, et al. Ten-year comparison study of type 1 and 2 endometrial cancers: risk factors and outcomes. Gynecol Obstet Invest. 2019;84(3):290-7.

Lavie O, Uriev L, Gdalevich M, Barak F, Peer G, Auslender R, et al. The outcome of patients with stage I endometrial cancer involving the lower uterine segment. Int J Gynecol Cancer. 2008;18(5):1079-83.

Limbachiya DJ. Surgicopathological outcomes and survival in carcinoma body uterus: a retrospective analysis of cases managed by laparoscopic staging surgery in Indian women. Gynecol Minim Invasive Ther. 2020;9(3):139-44.

Masuda K, Banno K, Yanokura M. Carcinoma of the lower uterine segment (LUS): clinicopathological characteristics and association with lynch syndrome. Curr Genomics. 2011;12(1):25-9.






Original Research Articles