RADICAL VAGINAL OPERATION (SCHAUTA) FOR CARCINOMA OF THE CERVIX

Abstract

I N THE first decades of this century considerable interest existed in the radical vaginal hysterectomy for cancer of the cervix, especially in the Central European clinics. Schauta’s name is associated with this procedure which was offered as a substitute for Wertheim’s abdominal hysterect0my.l The advantages set forth in favor of the radical vaginal operation were : (a) decreased morbidity, (b) decreased mortality, (c) “cure rates” comparable to or even greater than those obtained with the then more formidable abdominal operation. With the advent of radiation therapy for cancer of the cervix, the operative treatment waned considerably in a number of countries, and was in fact regarded as practically obsolete in most centers in the United States, England, France, Scandinavian and other western European countries, as well as in Latin America. Adler? continued to support the operation, eventually combining it with local insertion of radium capsules; NavratilS in Graz was also a proponent of it for a period since the last World War. Subodh Mitra4 of Calcutta continues to report series of patients subjected to this operation, contending that in his patients and under his working conditions the lowered operative risk and mortality justify the procedure. Bastiaanse5 in Holland is also a proponent of the operation. In Italy, Ingiullae has reported his experience with the Amreich modification of the Schauta procedure. Recent communications in the Austrian literature indicate continued employment of the operation. It is of interest no note that the surgical treatment of cancer of the cervix has been pushed so far into the background in this country that many are not at all acquainted with the operation and most American gynecological texts published in recent years do not even mention the operation. The outstanding disadvantage of the radical vaginal operation for cancer of the cervix is the failure to reach and excise the pelvic lymph nodes and fatty tissues of the obturator and external iliac regions. Some of the hypogastric nodes and surrounding fatty tissues can be reached. Thus it is admittedly an operation of limited extent. On the other hand, it does not subject the patient to the physiologic strain that obtains with radical panhysterectomy and pelvic lymph node excision and therefore should be accompanied by less morbidity and less mortality. In the pursuance of a surgical program for attack upon cancer of the cervix in the Memorial Hospital,7 certain patients were deemed poor operative