THE FATE OF THE RETAINED OVARIES FOLLOWING RADICAL HYSTERECTOMY

The authors studied the function of the preserved ovaries following ra dical hysterectomy in 65 patients with early stage cervical carcinoma. The ovaries were not displaced and fixed out of the pelvis. Squamous cell carcinoma was diagnosed in 91 cases and adenocarcinoma in 19 case s. Histologic studies of the 110 ovaries removed from 45 patients reve aled no metastatic disease. None of the 65 women suffered from recurre nt disease. Ovarian function was evaluated by: 1) the presence or abse nce of postmenopausal symptoms; 2) basal body temperature charts; 3) b lood tests for FSH, LH, progesterone, and prolactin; and 4) evaluation of the cervical and vaginal epithelium (vaginal smears). The diagnosi s of ovarian failure was based on high levels of FSH (>30 U/L) on at l east three occasions. Basal body temperature studied in 90 cycles of 2 5 patients revealed various curves indicating occasional anovulatory c ycles and luteal-phase deficiency which were confirmed by low serum le vels of progesterone. Serum prolactin levels were within the normal ra nge in all cases. Ovarian failure was diagnosed in two instances. Both occurred within three years of radical hysterectomy. Three of the six patients experienced unilateral ovarian cyst formation following surg ery, the other three had subsequent unilateral salpingo-oophorectomy a t 6, 11 and 24 months after radical hysterectomy. Conclusions: Preserv ation of the ovaries at the time of radical hysterectomy and lymphaden ectomy does not seem to compromise patient care. Impaired function or failure of the retained ovaries, however, is not uncommon; close post- treatment surveillance is therefore important in terms not only of rec urrent disease but of function of the ovaries as well.