Changes in the demographics and perioperative care of stage IA(2)/IB1 cervical cancer over the past 16 years

Objectives. The aim of this study was to determine whether there have been any significant changes in the demographics and perioperative care of FIGO stage IA(2)/IB1 cervical cancer over the past 16 years and, if so, to quant ify them. Methods. Since July 1984, all patients with FIGO stage IA(2)/IB1 cervical c ancer undergoing radical surgery by members of our division have been enter ed into a prospective database. Selection for surgery has been unchanged ov er the past 16 years. Since March 1994 and November 1996, one surgeon has p erformed radical vaginal trachelectomy and laparoscopic assisted radical va ginal hysterectomy, respectively. Statistical analysis used Spearman's corr elation analysis, the proportional hazards regression model of Cox, and the Mantel-Hanzel test was performed. Due to the number of statistical analyse s, statistical significance was defined as P < 0.01. Results. Eight hundred sixty-four patients have undergone radical surgery ( 784 radical hysterectomy, 42 radical vaginal trachelectomy, 32 radical vagi nal hysterectomy, 6 radical abdominal trachelectomy) for FIGO stage IA(2)/I B1 carcinoma of the cervix by members of our division since 1984. There hav e been no changes in the median age (40 years), tumor size (2.0 cm), incide nce of capillary lymphatic space involvement (47%), or positive pelvic lymp h nodes (6%) over the past 16 years. The median Quetelet index (24.6), dept h of tumor invasion (squamous cell carcinomas only) (6.0 mm), and proportio n of patients with comorbid conditions (17%) have increased over time (P = 0.001, P = 0.003, and P < 0.001, respectively). Pathologically, there has b een an increase in the proportion of adenocarcinomas (28%) and a decrease i n the proportion of grade 3 tumors (28%) (P < 0.001 and P < 0.001, respecti vely). The median operating time (2.8 h), hospital stay (7.0 days), blood l oss (600 cc), allogeneic blood transfusion (23%), postoperative infections (13%), and noninfectious complications (6%) have all decreased (P < 0.001, P < 0.001, P ( 0.001, P < 0.01), P < 0.001, and P = 0.002, respectively). T here has been no change in the incidence of positive surgical margins (3%), adjuvant radiation (13%), or recurrence-free survival (2 and 5 years, 94 a nd 90%, respectively) after a median follow-up of 45 months. Conclusion. Despite no substantive changes in the selection criteria for su rgery and the small time interval studied (16 years), almost all indices of operative and postoperative morbidity analyzed have decreased significantl y. These changes have occurred without an increase in the use of adjuvant r adiation or decrease in recurrence-free survival. Although little progress has been made in the cure rates associated with surgical management of FIGO stage IA,IIB, cervical cancer during this time interval, it appears that t he morbidity of surgery has decreased. (C) 2001 Academic Press.