E. Lawitz et Sc. Kadakia, UTILITY OF PREOPERATIVE FIBEROPTIC FLEXIBLE SIGMOIDOSCOPY IN THE EVALUATION OF PATIENTS WITH SUSPECTED GYNECOLOGIC MALIGNANCY, Gastrointestinal endoscopy, 47(5), 1998, pp. 350-353
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.