MODIFIED TYPE IV-V RADICAL HYSTERECTOMY WITH SYSTEMATIC PELVIC AND AORTIC LYMPHADENECTOMY IN THE TREATMENT OF PATIENTS WITH STAGE-III CERVICAL-CARCINOMA - FEASIBILITY, TECHNIQUE, AND CLINICAL-RESULTS

BACKGROUND, Due to the high prevalence of perioperative major morbidit y and the difficulties in achieving surgical disease free margins, sur gery has had no role in the treatment of patients with Stage III cervi cal carcinoma. METHODS, Forty-two women with International Federation of Gynecology and Obstetrics (FIGO) Stage III cervical carcinoma respo nding to platinum-based neoadjuvant chemotherapy underwent the maximum surgical effort, comprised of a modified type IV-V radical hysterecto my (37 patients) or anterior pelvectomy (5 patients) with systematic p elvic and aortic lymphadenectomy. Feasibility, modifications of surgic al technique, and pathologic and clinical data were analyzed. RESULTS, Surgery was feasible in all 42 patients intraoperatively selected. Di sease free margins were achieved in all but one patient. The median op erating time was 390 minutes, and the median estimated blood loss was 800 mL. In the last series of patients, these figures declined to 320 minutes and 600 mL, respectively. Major morbidity consisted of severe intraoperative hemorrhage in two patients, pulmonary embolism in four, ureteral fistula in three, and laparocele in three. The number of lym ph nodes removed ranged from 30 to 117 with a median of 56. The mean l engths of vagina and lateral parametrium resected were 55 and 48 mm, r espectively. Despite perioperative chemotherapy, lymph node metastasis was present in 36% of patients, parametrial disease in 38%, and vagin al disease in 45%. After a median follow-up of 53 months, the 5-year o verall and disease-free survival rates of radically operated patients were 70% and 58%, respectively. CONCLUSIONS, Thanks to improved surgic al technique and perioperative care, extended radical surgery appears to be feasible with acceptable morbidity in chemosensitive women with Stage III cervical carcinoma and may constitute a valid alternative to radiotherapy in these patients. (C) 1996 American Cancer Society.