Reasons for improper simple hysterectomy in patients with invasive cervical cancer in the northern region of Thailand

Occult invasive cervical cancer after simple hysterectomy: a multi-center retrospective study of 89 cases

Background

Occult invasive cervical cancer (OICC) is sometimes incidentally found in surgical specimens after a simple hysterectomy (SH). This study was aimed at identifying a subset of patients with OICC who have a favorable prognosis. This patient group may not require adjuvant radiotherapy and other procedures.

Methods

The medical records of women in whom OICC was detected after an inadvertent SH were retrospectively reviewed. The relevant data, including clinicopathological characteristics, treatment and clinical outcome were evaluated. The primary and secondary endpoints were overall survival (OS) and relapse-free survival (RFS), respectively.

Results

Eighty-nine patients who met the inclusion criteria were included for analysis, and the risk of OICC was found to be 1.9 %. Finding an invasive cancer in a hysterectomy specimen after a conization procedure that shows positive margins was the most common reason (41.6 %) for the performance of inadvertent SH. In the univariate analysis, a tumor width > 20 mm, deep stromal invasion, and lymph node metastasis (LNM) were adversely associated with relapse (P < 0.001, < 0.001, and = 0.001, respectively) and survival (P = 0.003, 0.004, and 0.027, respectively), although these parameters were not independently associated with patient prognoses in the multivariate analysis. In patients with a tumor width ≤ 20 mm and superficial stromal invasion in the observation subgroup, the 5-year RFS and 5-year OS were both 100 %, whereas they were 57.1 % and 66.7 %, respectively, in patients with a tumor size > 20 mm and deep stromal invasion in the radiotherapy or chemotherapy subgroup (P < 0.001, and = 0.008, respectively).

Conclusions

Simple observation after a lymphadenectomy procedure may be feasible in OICC patients with a tumor width ≤ 20 mm, superficial stromal invasion, a negative section margin in hysterectomy specimens, and no LNM.

Consequences of inadvertent, suboptimal primary surgery in carcinoma of the uterine cervix

OBJECTIVES

Invasive cervical cancer that is discovered only after simple hysterectomy remains a problem. Little is known about the best management of this group since there are no relevant outcome studies. This study aimed to quantify the benefits of guideline-based treatment by comparing outcome data in patients treated by inappropriate simple hysterectomy and adjuvant radiotherapy with data in patients treated with primary radical surgery, radiotherapy, or radiochemotherapy.

METHODS

Records of 288 patients who had undergone radical hysterectomy with pelvic lymphadenectomy or simple hysterectomy were extracted and divided into three groups-radical hysterectomy alone (n = 89), radical hysterectomy and adjuvant radiotherapy (n = 119), and simple hysterectomy with adjuvant radiotherapy (n = 80). Disease-free and overall survival were calculated using Kaplan-Meier analyses.

RESULTS

There was a trend towards better overall survival in the radical hysterectomy group. Disease-free survival was significantly better in patients treated by radical hysterectomy, followed by simple hysterectomy plus radiotherapy, and then radical hysterectomy plus radiotherapy (P(log rank DFS) < 0.002). When the two radical surgery groups were combined and compared with the suboptimally treated group, no significant differences were seen for overall survival.

CONCLUSION

Postoperative radiotherapy is a good treatment for patients with cervical cancer who have undergone suboptimal simple hysterectomy. Appropriate selection criteria for further surgery remain to be defined.