UTILITY OF PREOPERATIVE FIBEROPTIC FLEXIBLE SIGMOIDOSCOPY IN THE EVALUATION OF PATIENTS WITH SUSPECTED GYNECOLOGIC MALIGNANCY

Background: Fiberoptic flexible sigmoidoscopy (FFS) is routinely reque sted preoperatively as part of evaluation of pelvic masses to exclude colonic involvement by the tumor or concurrent colonic neoplasm. The a im of our study was to evaluate the utility of preoperative FFS in pat ients with suspected gynecologic malignancy. Methods: FFS, performed u sing a 60 cm sigmoidoscope, evaluated (1) presence of bowel involvemen t by the tumor, (2) extrinsic compression by the tumor, and (3) presen ce of colonic neoplasms. FFS findings were correlated with; surgical f indings. Results: A total of 107 women underwent preoperative FFS and subsequent surgery. Eleven patients (11%) had lower gastrointestinal s ymptoms. At surgery, 63% of pelvic tumors were malignant and 37% were benign. The most common abnormality at FFS was colonic polyps in 23 pa tients (21%). Colonic adenomas were found in 11 patients (10%). Extrin sic compression by the tumor without mucosal abnormalities was seen in 15 patients (14%). The most common intraoperative finding was tumor a dhering to the bowel in 18 patients requiring dissection, but only 1 p atient required bowel resection. Eight of these 18 patients had preope rative lower gastrointestinal symptoms. All 15 patients with extrinsic compression at FFS had tumor adhering to the bowel. Conclusions: Pelv ic masses cause extrinsic compression at FFS in 14% of patients. This is suggestive of tumor adherent to the bowel at surgery. However, bowe l resection is rarely required because of tumor involvement. Most pati ents with bowel adherence by tumor have lower gastrointestinal symptom s. Colonic adenomas are found in one tenth of patients, mostly in pati ents older than 50 years of age. Preoperative FFS does not change the surgical management of pelvic tumors. Screening FFS is indicated in al l patients with pelvic tumors over age 50, as in persons with average risk, but is otherwise unnecessary in evaluation of pelvic masses.