HYSTERECTOMY IN INVASIVE CERVICAL-CANCER - A NATIONAL PATTERNS OF CARE STUDY OF THE AMERICAN-COLLEGE OF SURGEONS

BACKGROUND: As the use of Papanicolaou cytologic screening became wide spread in the United States of America, there was a shift toward diagn osis of earlier clinical stages in patients with carcinoma of the cerv ix. This increase in early stage disease has also resulted in increase d use of surgery as the primary treatment. Thus, it seems appropriate to investigate the role of hysterectomy in the modern treatment of pat ients with invasive carcinoma of the cervix, including survival rates and the role of the gynecologic oncologist. STUDY DESIGN: Approximatel y 1,800 hospitals were sent invitations to submit data on a standard c ollection form designed by a multidisciplinary committee of specialist s. Cancer registrars at 703 hospitals submitted anonymous data on 11,7 21 patients with carcinoma of the cervix who were diagnosed or treated , or both, in 1984 and 1990. RESULTS: There were 6,570 (56.1 percent) women who had major operations. An operation with curative intent, eit her total hysterectomy (TAH) or radical type II or III hysterectomy wi th pelvic node dissection PND (RHPND), was carried out in 5,105 (43.6 percent) women, constituting 38.9 percent of the patients in 1984, and 48.2 percent of the patients in 1990. Overall (both years), 66.5 perc ent of patients had squamous cell carcinomas and 21.1 percent had aden ocarcinomas. The type of operation performed was judged appropriate in 95.6 percent of the patients who underwent RHPND, but in only 80.0 pe rcent of the patients who underwent TAH. Gynecologic oncologists perfo rmed 46.8 percent of the hysterectomies in 1984, and 63.8 percent in 1 990. Recurrence and long-term survival data are available for the 1984 patients; five-year survival rates for women who underwent TAH (n=1,0 13) and RHPND (n=1,279) were 89 and 85 percent, respectively. A RHPND with negative nodes resulted in a 90 percent five-year survival rate ( n=916) as compared to 70 percent in those with positive nodes (n=194). CONCLUSIONS: The use of hysterectomy as definitive therapy increased markedly from 1984 to 1990 and was associated with low complication an d high five-year survival rates. Gynecologic oncologists now perform t he majority of hysterectomies for this type of carcinoma, with general gynecologists playing a lesser role than in the earlier study year, g uidelines should be developed for the use of TAH in patients with inva sive carcinoma of the cervix.