Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: A prospective randomized study

Objective. The objective of this study was to determine the role of the ext ent of the radicality in the treatment of stage IB-IIA cervical carcinoma w ith respect to survival, pattern of relapse, and morbidity, Methods. Two-hundred forty-three patients with cervical carcinoma (FIGO sta ges IB and IIa) were enrolled in a prospective randomized study comparing t wo types of radical hysterectomy (Piver-Rutledge-Smith class II and class I II) between April 1987 and December 1993, and 238 are evaluable. Disease-fr ee survival, overall survival, pattern of recurrences, and morbidity were t he endpoints of this study. Results. Mean operative time was significantly (P = 0.05) shorter in the gr oup of patients undergoing class II hysterectomy (135 min vs 180 min), wher eas mean blood loss (530 mi vs 580 mi) and number of patients requiring tra nsfusions (35% vs 43%) were similar in the two arms of treatment. Complicat ions unrelated to the extent of the surgical dissection and mean postoperat ive stay were similar in the two arms of treatment. Late morbidity was sign ificantly lower in patients in the class II arm (especially urologic morbid ity, 13% vs 28%), Postoperative radiotherapy was administered to 64 patient s (54%) in class II and to 65 patients (55%) in the class III arm. Recurren ce rate (24% class II vs 26% class III) and number of patients dead of dise ase (18% class II vs 20% class III) were not significantly different in the two groups of treatment. Overall 5-year survival was 81 and 77% and diseas e-free survival was 75 and 73%, respectively. Multivariate analysis confirm s that survival does not depend on the type of operation. Conclusions. Class II and class III radical hysterectomies are equally effe ctive in surgical treatment of cervical carcinoma, but the former is associ ated with a lesser degree of late complications. (C) 2001 Academic Press.