Occult Uterine Malignancy at the Time of Surgery for Pelvic Organ Prolapse: A Systematic Review

Study Objective To conduct a systematic review to estimate the prevalence of occult uterine malignancy, of any subtype, among women undergoing surgery for pelvic organ prolapse. Design Systematic review Setting N/A Patients or Participants Women undergoing surgery for pelvic organ prolapse. Interventions Hysterectomy Measurements and Main Results The PRISMA guidelines were followed in this systematic review. The search terms used were “occult malignancy” or “occult uterine pathology” paired with “morcellation” or “hysterectomy.” March 25, 2019 was the last date that articles were searched. We did not restrict articles based on language or publication date. Inclusion criteria included any peer-reviewed journal articles reporting occult uterine malignancy rates at the time of surgery for benign conditions, regardless of whether morcellation was used or not. We excluded articles that were reported exclusively on women with pre-operatively diagnosed or suspected uterine malignancies. Our search yielded a total of 233 journal articles, of which 53 met the criteria for a full-text review and 27 were included in the final systematic review. Of these 27 studies, 9 studies provided specific data on occult uterine malignancy among women undergoing surgery for pelvic organ prolapse. Among the 9 studies examined, the total number of patients combined was 35,880 and there were 144 total occult uterine malignancies. The overall crude prevalence of occult uterine malignancy was 0.40% (95% CI 0.30 – 0.47%). Among the 9 studies, the occult uterine malignancy rate ranged from a low 0% to a high of 3.17%. The largest of these 9 studies incorporated 31,567 patients and the occult uterine malignancy rate was 0.40% in that study. Conclusion This is the first attempt to synthesize data on occult uterine malignancies among women specifically undergoing surgery for pelvic organ prolapse. Based on this systematic review incorporating over 35,000 patients, the crude prevalence of occult uterine malignancy among this population is approximately 0.40%.