Influence of exploratory celiotomy on the management of carcinoma of the cervix. A preliminary report.

Abstract

The policy of treating patients with Stages IB and IIA carcinoma of the cervix by radical hysterectomy and pelvic lymphadenectomy led to the initiation of laparotomy staging of carcinoma of the cervix in 1970. Two-hundred twenty patients were subjected to surgical staging at which time bilateral aortic lymphadenectomies and biopsies of perirectal and perivesical spaces were done. If these were negative, radical hysterectomy and pelvic lymphadenectomy were performed in patients with surgical Stage IB and IIA. Para-aortic node involvement was seen in 7%, 14%, 18%, and 19% in patients with Stages IB, IIA, IIB, and IIIB, respectively, in the context of the surgical material being heavily weighed in favor of early stage disease. The methods of management in these patients were designed according to the findings at exploratory celiotomy. Twenty-one patients were found to have positive para-aortic nodes and received en bloc pelvis and para-aortic irradiation. Four patients are alive and well at 63,23,20, and 19 months, respectively. One patient is alive with disease at 18 months. Two died from other causes at 34 and three months. There was no difference in the survival of the two groups of patients among 75 with negative para-aortic nodes, who received either pelvic irradiation alone or pelvic and para-aortic irradiation on the basis of possible presence of subclinical disease not dissected at the time of surgery.