TREATMENT OF CERVICAL-CARCINOMA BY WERTHEIM-MEIGS SURGERY - LONG-TERMFOLLOW-UP RESULTS IN A WELL-DEFINED SWEDISH REGION

In a retrospective analysis of a complete geographic series of cervica l carcinomas treated by Wertheim-Meigs radical surgery, a number of im portant prognostic factors were evaluated and long-term survival data are presented. In all, 367 women with FIGO stage I-II tumors were incl uded. The main histopathologic types were squamous cell carcinoma in 8 4% and adenocarcinoma in 12%. The mean age of the patients was 42.5 (r ange 19-68) years. In 125 women (34%), adjuvant radiotherapy was admin istered pre- or postoperatively. The median period of follow-up was 12 (range 2-27) years. In 88% of the specimens surgery (93% in stage I a nd 66% in stage II) was classified as radical with regard to the excis ion margins. This was an important and highly significant prognostic f actor. If the margins were wide and free of tumor, the 10-year surviva l rate was 93%, but if margins were infiltrated by the tumor, the surv ival rate was 14%. Pelvic lymph node involvement was recorded in 52 ca ses (14%). The frequency of lymph node spread was associated with tumo r stage (IA O%, IB 14%, IIA 32%). The probability of survival of the c omplete series was 93% at 5 years and 84% at 10 years. In cases of lym ph node involvement, the 10-year survival rate was 57%. The preoperati ve tumor stage had a highly significant influence on long-term tumor-s pecific survival. Tumor grade was also a significant prognostic factor , but not the histologic type (squamous, adenosquamous, or adenocarcin oma). Age and parity were also insignificant prognostic factors. The t umor recurred in 59 cases (16%). The mean time to relapse was 28 month s. The 10-year survival was 29% for this group of patients. Peroperati ve complications were recorded in 50 patients (14%). Excessive bleedin g (11%) and urinary tract injuries (3%) were most frequent. Postoperat ively, 101 patients (28%) had some kind of complication associated wit h the surgical procedure. Surgical complications were more frequent am ong women over 50 years of age. Bladder dysfunction (11%) and obstruct ion of the ureter (8%) were recorded most frequently. In 19 cases (5.2 %), urinary tract or intestinal fistulas were diagnosed during the per iod of follow-up. With increasing experience of the surgeons and fewer stage II tumors, the frequency of fistulas associated with the surgic al procedure decreased to 2.4% during the latter part (1975-90) of the period. Adjunctive postoperative radiotherapy increased the risk of l ate complications. In 8 cases (6.4%), serious complications associated with the combination of surgery and radiotherapy were reported.