A retrospective analysis of radical hysterectomies done for cervical cancer: Is there a role for the Pfannenstiel incision?

Objective. The goal of this work was to review patients with early-stage ce rvical cancer undergoing radical hysterectomy, comparing Pfannenstiel and v ertical midline incisions for surgical feasibility, complications, and leng th of stay. Methods. Patients were identified by searching our institutional database. Data were collected from review of each patient's medical record, including demographics, cancer stage, histology, procedural information, length of s tay, and complications. Associations between variables were studied using c hi (2) and two-tailed t tests. Multivariate analysis was performed using lo gistic regression. Results. Between March 1996 and June 2000, 113 patients from the University and Presbyterian Hospitals, Oklahoma City, Oklahoma, underwent radical hys terectomy and pelvic and paraortic lymph node dissection with records avail able for review. Group 1 consisted of 40 patients who had vertical incision s and group 2 consisted of 73 patients who had Pfannenstiel incisions. Ther e was no difference in race, number of previous abdominal surgeries, distri bution of stage, histology, percentage of type III hysterectomies, estimate d blood loss, nodal counts, pathologic margin positivity, and postoperative complications among the two groups. Group 2 were younger (41.6 vs 46.5, P = 0.02) and had a lower average QI than group 1 (24.9 vs 28.9, P = 0.001). Group 2 also had a shorter average hospital stay (4.6 days vs 5.8 days, P = 0.04) and shorter operative time (215 min vs 273 min, P = 0.09). Multivari ate analysis resulted in Pfannenstiel incisions (P 0.002), younger age (P = 0.004), and smaller body mass index (P = 0.01) being significant predictor s of length of stay. Conclusions. Pfannenstiel incisions are feasible without increased morbidit y and equal nodal retrieval as compared with vertical midline incisions in patients with early-stage cervical cancer. Pfannenstiel incisions may offer an advantage besides cosmesis in the form of shorter operating room time a nd earlier discharge from the hospital. (C) 2001 Academic Press.