Surgical treatment of cancer of the uterine cervix. Results at Provincial Taipei Hospital from 1955 to 1958

Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: a clinical review of 954 cases

Nine hundred fifty-four patients, who received a radical hysterectomy and a bilateral pelvic lymphadenectomy, were included in this study which ran from January 1971 to December 1986. The subjects, by in large, ranged in age from 41 to 60. Of these cases, 62.5% were in clinical stage IB, while 26.2% were in stage IIA. Urinary tract fistula formations occurred in 2.4% of the cases and substantially decreased from 6.1% during 1971-1978 to 0.9% in the subsequent period from 1979 to 1986. The operative mortality rate was 0.4%. The follow-up included 438 cases that came from 1971 to 1981, and each was evaluated over a period of 5 years. Of these cases, 28 patients were lost during the follow-up period and were presumed to have died from cancer. The absolute 5-year survival rates for the patients in stage IB, stage IIA, and IIB were 86.1, 71.7, and 60.1%, respectively. The respective 5-year survival rates for patients with stage IB LN(-) and LN(+), i.e., without or with lymph node metastasis, were 87.7 and 73.1%. The survival rates for patients with stage IIA LN(-) and LN(+) were 79.8 and 40.9%, respectively. In retrospect, the 5-year survival rates seem to be related to age, parametrial involvement, and histological type. This study shows that because of improving surgical techniques and anesthesia, acceptable operative morbidity and mortality, as well as favorable 5-year survival rates, radical surgery seems to be the treatment of choice for patients with early invasive uterine cervical, and especially for younger women.

A review of prognostic factors in early-stage carcinoma of the cervix (FIGO I B and II A) and implications for treatment strategy

Several prognostic factors in stages I B and II A cervical carcinoma have been widely studied to define groups of patients with a poor prognosis. Most of these factors are interrelated. The characteristics which should be regarded as main factors have not yet been defined, because the studies reported were based on mainly retrospective and non-randomized analysis. Reviewing the literature, lymph node metastasis, differentiation grade, tumor size, parametrial extension, lymph-blood vessel invasion and cervical invasion seem to be prognostically important factors, which suggests that the subdivision of patients according to the FIGO classification alone is inaccurate. It seems useful to define subgroups of patients according to tumor characteristics, determined after surgical treatment and accurate histologic examination of the surgical specimen. Patients with one or more of these tumor features need additional treatment to improve survival. The current treatment modalities, such as postoperative radiotherapy, have not been thoroughly evaluated, but doubt exists as to their efficacy. Data in the literature suggest that particularly patients with para-aortic or multiple pelvic lymph node metastasis (greater than 3) have already developed distant metastases at the time of primary treatment and therefore need adjuvant systemic therapy. Patients with tumors larger than 4 cm in diameter, differentiation grade III, lymph-blood vessel invasion or cervical invasion (of more than 70%) seem to have high recurrence rates at both pelvic and distant sites, indicating that there is also a need for better pelvic control.

Carcinoma of the cervix: lymphangiography and computed tomography

Twenty-four patients with carcinoma of the uterine cervix examined by lymphangiography followed by computed tomography (CT) were reviewed to assess the findings and their impact on management. The lymphangiogram was of value in detecting metastases in relatively small nodes, (less than 1.5 cm maximum diameter) and in differentiating metastases from reactive hyperplasia in the larger lymph nodes which were opacified. Although as yet unable to define alterations in the internal architecture of lymph nodes. CT detected masses of lymph nodes totally replaced by neoplasm or those not visualized by lymphangiography. In addition, the local extension of the primary neoplasm and distant metastases, such as to the urinary tract, liver, and skeleton, were readily demonstrated by CT. In advanced or recurrent disease, CT provided new information on 10 of 17 patients but resulted in a change in management for only one.