Surgical management of early stages of cervical cancer: the value of internal iliac artery ligation

Abstract

Assessment and removal of pelvic lymph nodes is an essential component of radical surgery for gynaecological cancer. However, control of pelvic haemorrhage presents a challenge to the gynaecologist. This study was designed to determine the value of routine bilateral internal iliac artery ligation (BIIAL) in the management of patients with early states of cervical cancer treated at the University Teaching Hospital (Benin). The data sheets of 32 patients who had a radical hysterectomy for Stages 1-2a carcinoma of the cervix (cases) and 128 patients (controls) who had had either total abdominal hysterectomy or other gynaecological pelvic surgery for benign conditions, between January 1992-2000, were analysed. Information extracted for analysis included socio-biological data, blood loss, complications at surgery and postoperative events. BIIAL was performed as a routine part of the procedure to control pelvic haemorrhage. The mean age of patients was 43.5 years - 9.4, with a range of 25-65. The mean parity was 6.64 - 2.11, range 2-11; 14/32(43.7%) and 11/32 (34.38%) of the patients had Stages IIA and Ib diseases. The mean pre- and postoperative PCV was 32% and 31%, respectively (cases). There was no significant difference in the pre- and postoperative PCV of the two groups. The estimated blood loss at surgery (cases) had a range of 300-850 mL, with a mean of 465 mL - 150.85. The mean blood loss of the controls (surgery without BIIAL) was 856 mL - 393.3, with a range of 300-2500 mL. The difference was statistically significant P <0.0006, Student's two-tailed type 2, t -test). Eight patients (25.0%) had no blood transfusion, 19/32 and 5/32 patients (59.4% and 15.6%) had 2 and 3 units of blood transfused. No patient who had BIIAL required 4 units of blood transfusion. One patient (3.13%) had a laceration of the internal iliac vein; there was no operative mortality. The average hospital stay was 12 days. Ligature of the internal iliac artery seems to reduce operative blood loss when used as a prophylactic routine procedure at radical hysterectomy. This is of value to the surgeon in the developing world where there are inadequate blood transfusion and chemoradiation services. A randomized controlled trial is suggested.