Laparoscopic Surgery in a Patient With Endometrial Cancer After Laparoscopic Sacrocolpopexy.

Abstract

In patients undergoing laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) repairs, occult uterine endometrial cancer may be discovered later. However, its detection poses unique surgical and oncological challenges, particularly when a mesh is involved. This case report describes a laparoscopic pelvic reconstruction with trachelectomy and bilateral salpingo-oophorectomy for occult uterine endometrial cancer in resected specimens after LSC. A 51-year-old female with stage III uterine prolapse and cystocele presented at our center. She subsequently underwent LSC and a laparoscopic supracervical hysterectomy. The patient had no atypical genital bleeding. Cervical and endometrial cytology performed one year earlier showed no evidence of malignancy. However, pathological examination revealed stage IA, grade 1 endometrioid adenocarcinoma. The patient underwent trachelectomy, bilateral salpingo-oophorectomy, and laparoscopic surgery for reconstruction 41 days after the initial procedure. Part of the mesh was removed using a cervical stamp, while the remaining mesh was sutured together. Twelve months after the second surgery, no recurrence of uterine endometrial cancer or POP was observed. This case highlights the importance of preoperative screening for endometrial malignancy in POP surgery and demonstrates a feasible approach for oncologic surgery with selective mesh preservation.