RADICAL HYSTERECTOMY AND PELVIC LYMPHADENECTOMY FOR EARLY INVASIVE CANCER OF THE CERVIX - 14-YEAR EXPERIENCE

During a 14-year period, 397 radical hysterectomies and pelvic lymphad enectomies were performed for early invasive carcinoma of the cervix. Twenty-one patients were in stage IA2 with lymphatic/vascular channel permeation (5.2%), 340 in stage IB (85.6%) and 34 in early stage 2A di sease (8.5%). Eighteen patients (4.5%) were pregnant. Adenocarcinoma c omprised 26.9% of cases. The mean operative time was 4.14 h; the intra operative blood loss was less than 1.51 in 77.3% patients. There was n o operative mortality; one patient died 3 weeks after surgery from clo stridium difficile enterocilitis. Eleven patients (2.7%) developed ven ous thrombosis; severe lymphedema occurred in four (1%). The incidence of uretero-vaginal fistula was 0.2% and that of vesico-vaginal fistul a 0.5%. Ovarian metastases were noted in 4.3% of cases with adenocarci noma. Sixty-six patients had positive nodes (16.6%). Five-year surviva l in patients with more than 2 positive nodes was 68%. The use of adju vant chemotherapy in patients with 'high risk' factors resulted in sur vival rates approaching those without risk factors. Neo-adjuvant chemo therapy was used in 10 patients with large bulky tumors; the results w ere favorable. Recurrences occurred in 47 patients (11.8%); 36 patient s have died (9.1%). Age did not appear to influence survival. The over all 5-year survival was 92.2%.