Perioperative management of hysterectomies performed for benign indications with unexpected malignant findings: A systematic review

Manejo perioperatorio de histerectomías realizadas por indicación benigna con resultado inesperado de malignidad: Revisión sistemática

Abstract

Introduction: Hysterectomy is one of the most common gynecological surgeries, primarily indicated to treat benign conditions such as uterine fibroids, adenomyosis, or abnormal uterine bleeding. However, in a small percentage of cases, postoperative histopathological examination reveals a previously unsuspected malignant neoplasm, leading to significant changes in the patient’s clinical management. Objective: This systematic review aimed to describe preoperative diagnostic methods, surgical implications, and subsequent therapeutic approaches in patients undergoing hysterectomy for benign indications with an unexpected finding of malignancy. Methods: A literature search was conducted in PubMed and Wiley databases to identify studies published in the last five years. Descriptive and analytical studies addressing the prevalence of occult malignancy, the accuracy of preoperative diagnostic methods, and postoperative management strategies were included. The selection and analysis process followed the PRISMA 2020 guidelines. Results: The incidence of occult malignancy ranged from 0.1% to 2%, with endometrial carcinoma and uterine sarcomas being the most frequent findings. The lack of adequate preoperative evaluation—such as endometrial biopsy or advanced imaging studies—was associated with a higher risk of delayed diagnosis. Postoperative management included surgical reintervention in some cases and adjuvant therapy depending on tumor type and stage. Conclusions: The identification of unexpected malignancy following hysterectomy underscores the need to improve preoperative assessment protocols and to establish postoperative management pathways to prevent delays in medical care.