A Clinical Experience of Radical Hysterectomy on 398 Cases of Locally Invasive Cervical Cancer

Kim, Young Nam; Chung, Dae Hoon; Kim, Young Sam; Lee, Kyung Bok; Kim, Ki Tae; Kim, Hyun Chan

Abstract

OBJECTIVE: To survey the clinical features, complications, prognostic factors and Five-year survival rates of 398 patients with invasive cervical cancer(stage Ib-IIb), subjected to radical hysterectomy and bilateral pelvic lymphadenectomy.
METHODS
Medical records and pathologic reports were reviewed retrospectively on 398 cases, diagnosed and operated on during the period of Jan. 1988 - Dec. 1998. Five-year survival rates were estimated by the Kaplan-Meier method, and prognostic factors were assessed using Wilcoxon test.
RESULTS
Of the 398 cases, 285 were in stage Ib(71.6%), 58 in stage IIa(14.5%), and 55 in stage IIb(13.8%). The mean age of patients was 48+/-9.9 years. Neoadjuvant chemotherapy was given to 200 patients(50.2%), Adjuvnat radiotherapy in 160 patients(40.2%) postoperatively. Operative complications occured in 121 patients(30%). Massive blood loss and bladder dysfuction were frequent complications(11.3% and 10.3%, respectively). Others were urinary tract infection(9.3%), wound infection(7.5%), lymphocyst(3.5%) and urinary tract fistula(0.7%), respectively. The Five-year survival rates for stage Ib, IIa, and IIb were 84.2, 82.8%, and 75.8%, respectively. Factors that affect the Five-year survival rates were cell type(small cell Vs other, P=0.0146), tumor size(< or = 3cm Vs >3cm, P=0.0425), depth of invasion( < or = 5gm Vs >5ne, P= 0.0007), response of chemotherapy(poor response Vs other, P= 0.0001), LN metastasis(1 Vs 2 Vs more, P=0.0001).
CONCLUSION
Accumulating the clinical experience, we could improve results, reduce complications and speculated that the survival rates could be improved by neoadjuvant chemotherapy and/or adjuvant postoperative radiotherpy. Prospective randomized trials are needed to evaluate our approach and to be compared with concurrent chemoradiotherapy to definite its precise role in locally advanced cervical cancer.