INTRAOPERATIVE AND PERIOPERATIVE COMPLICATIONS ASSOCIATED WITH TANDEMAND COLPOSTAT APPLICATION FOR CERVIX CANCER

Purpose. The purpose of this study was to chronicle the acute morbidit y associated with the implantation of tandems and colpostats in women with carcinoma of the cervix; to determine factors that predispose to the development of such complications; and to assess whether the use o f ultrasound allowed the apparatus to be safely implanted in women at relatively high risk for perforation of hollow viscous organs. Methods . A database from two Philadelphia institutions was used to assess the aforementioned factors among 143 tandems/colpostats inserted into 100 women with cervix cancer. Twenty patients had insertion under ultraso und guidance because of stenotic cervical os, fibrosis from external-b eam irradiation, indeterminate orientation of endometrial cavity axis, or previous perforation. Univariate and multivariate analyses were pe rformed to identify predictors of intra- and perioperative complicatio ns. Results. Intraoperative complications occurred in 7 of 143 placeme nts (5%). These included uterine perforations (n = 4), vaginal lacerat ions (n = 2), and one instance of bladder perforation. Only older age, whether entered as a continuous or a dichotomous variable, was associ ated statistically with these complications. Perioperative complicatio ns (e.g., fever, bowel obstruction, exacerbation of chronic obstructiv e pulmonary disease, cardiac complication) occurred in 54 of 143 impla nted women. In univariate analysis, older age and underlying chronic o bstructive pulmonary disease (COPD) appeared to be associated with per ioperative complications. A multivariate analysis showed that underlyi ng COPD predisposed to perioperative complications during the first im plant and that age over 60 years independently predicted for complicat ions during any implant. Conclusions. Intraoperative complications are relatively rare events. Ultrasonography seems to allow safe intrauter ine insertion of the tandem despite the selection of difficult cases f or this adjunctive imaging tool. Patient age over 60 years independent ly predicts for perioperative complications. COPD predicts for periope rative complications during the first but not the second implant, impl ying that physicians are able to optimize the medical management of pu lmonary disease to allow a second implant to be performed more safely. (C) 1997 Academic Press.