Abstract
The purpose of this study was to find out the clinocopathologic characteristics, post-operative findings andcomplications of patients with early (up to stage IIA) cervical carcinoma who underwent radical hysterectomy.This study concentrates on the evaluation of our early experience in radical hysterectomy for cervicalcancer in Nepal. This was a retrospective analysis of 48 patients who had radical hysterectomy with bilateralpelvic lymphadenectomy for early cervical cancer at the BP Koirala Memorial Cancer Hospital (BPKMCH)from September 1999 through September 2002. Characteristics such as chief complaint, disease stagingand duration, intraoperative and postoperative complications, histopathological findings, need for bloodtransfusion, and duration of hospital stay were considered for analysis. Patients’ age ranged from 28-67years. Age group of 40-49 had highest number of patients (58.3%). Majority (62.5%) were premenopausalwomen who presented with abnormal vaginal bleeding (73%) as the chief complaint. More than half ofthem (56%) had FIGO stage IIA disease. Thirty-three percent had intraoperative and postoperativecomplications such as urinary problems, wound infection and vessel injury/ureteric injury. All neededblood transfusion, 42% needing four pints. The average duration of hospital stay was 11 days. Forty-fourhad squamous cell carcinoma and four had adenocarcinoma. Pelvic lymph node metastasis was found in 10patients. Resected margins were adequate in 42 patients. Majority (62.5%) of the women were premenopausaland 56% of them had stage IIA disease. Although the primary treatment of early-stage cervical carcinomainvolves either surgery or radiation therapy with or without chemotherapy, surgery (radical hysterectomy)was used for lower-stage disease and smaller lesions in fit and young patients in our resource-poor set-up.Fifteen patients needed postoperative radiation. The complication rate seems to be higher in Nepal; however,it will decrease as more experience is gained.Key Words: Cervical cancer, gynecological malignancies, human papillomavirus, radical hysterectomy.
Highlights
Cervical cancer is ranked as the third most common cancer in women worldwide.[1]
Human papillomavirus (HPV) is considered to be the most important factor contributing to the development of cervical cancer.[4]
Many studies convincingly demonstrate that the major risk factor for development of preinvasive or invasive carcinoma of the cervix is HPV infection, which far outweighs other known risk factors such as high parity, increasing number of sexual partners, young age at first intercourse, low Address for correspondence : Dr Ganesh Dangal GPO Box: 12887, Kathmandu, Nepal Email: gareshma@hotmail.com
Summary
Cervical cancer is ranked as the third most common cancer in women worldwide (after lung and breast).[1]. Signs and symptoms of early disease include watery vaginal discharge, intermittent spotting, and postcoital bleeding, the symptoms may go unrecognised by patients. Management of early cervical carcinoma involves surgery or radiation therapy with or without chemotherapy. Surgical treatment is preferred for young women with small tumors because it permits preservation of ovarian function and causes minimal vaginal shortening unlike significant fibrosis and narrowing/shortening of the vagina with the use of radiation. Radical hysterectomy and bilateral pelvic lymphadenectomy has been considered standard surgical treatment.[15]. The aim of this study was to evaluate our experience of surgical therapy for early cervical carcinoma at the BP Koirala Memorial Cancer Hospital, Nepal. Radical hysterectomy with bilateral pelvic lymphadenectomy was performed for all of the patients: fifteen young patients had ovarian conservation. Postoperative followup could not be done, so we lack data on this aspect
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