Should Radical Hysterectomy Be Aborted on Intraoperative Detection of Nodal Tumor Metastasis in Early Stage Cervical Cancer?

Abstract

In the United States, type 1 to 3 radical hysterectomy (RH) is used for the treatment of early stage (I-IIA) cervical cancer (ESCC). In the event that nodal metastasis is detected intraoperatively, completion of the procedure is controversial. Here, we present a review of the literature regarding clinical management of patients with ESCC with intraoperative diagnosis of nodal metastasis. An electronic search of PubMed and OVID for the English-language literature published between 1980 and 2008 was performed. Studies regarding completion or abandonment of RH on intraoperative detection of nodal metastasis in ESCC were reviewed to evaluate the impact of either approach on overall survival, recurrence rate, and complication rate. This review was unable to document a difference in overall survival greater than 10% between the aborted and completed RH groups, and the difference was not statistically significant. No clear relationship was found between completion of RH and pelvic control or morbidity. Although urinary complications including bladder dysfunction and fistulae were unique to the completed RH group, radiation-related complications such as radiation cystitis, radiation proctitis, and bone necrosis were seen primarily in the aborted RH group. Given the lack of significant difference in survival, further studies are needed to evaluate the impact of completing versus aborting RH on pelvic control and morbidity to reach a definitive conclusion.