SURGICAL-TREATMENT OF PATIENTS WITH STAGES IB AND IIA CARCINOMA OF THE CERVIX AND PALPABLY POSITIVE PELVIC LYMPH-NODES

Review of the records of all patients undergoing radical hysterectomy for cervical cancer at our institution between 1956 and 1985 revealed 121 patients with stage IB or IIA lesions and metastasis to pelvic lym ph nodes, A uniform part of our surgical practice is to record the fin dings from visual and palpatory examinations of the intra-abdominal an d retroperitoneal structures at the beginning of the operative report. This information was available for 117 of 121 patients, Of these 117 patients, 51 (44%) had pelvic lymph nodes palpably involved with metas tatic malignant disease at the time of exploration, The Kaplan-Meier e stimate of 5-year disease-free survival for this group was 40% (median follow-up of disease-free patients was 20.5 years). Adjuvant pelvic r adiotherapy was received by 29 of the 51 patients. The remaining 22 pa tients received no adjuvant treatment. Information on the sites of rec urrence was available for 30 of 32 patients who had recurrence, The si te of first recurrence included an extrapelvic component in 22 of the 30 (73%), Disease-free survival rates for these patients reflect the a dvanced nature of their tumors. In light of our experience and our cur rent understanding of the relationship between radiotherapy dose, tumo r volume, and efficacy, we regard the assertion that primary radiother apy is preferable to surgery in this population to be counterintuitive , and we await with interest data demonstrating that disease-free surv ival with approaches that involve leaving macroscopic tumor on the pel vic sidewall is superior to that noted above. (C) 1995 Academic Press, Inc.