Surgical Outcomes in Early-Stage Cervical Cancer Following Radical Hysterectomy in a Resource-Limited Setting: The Experience of the National Cancer Institute (Apeksha Hospital, Maharagama), Sri Lanka.

Abstract

Introduction Cervical carcinoma is the commonest gynecological malignancy in Sri Lanka, and this incidence is rising. Radical hysterectomy is the preferred treatment for stages IB1, IB2, and selected cases of stages IIA1. Although surgery is feasible unless the parametrium is involved, careful patient selection is crucial in order to prevent the patient from receiving a dual mode of radical treatment (surgery and radiotherapy). Pre-operative imaging with MRI and PET-CT can accurately determine the tumor size and the lymph node metastasis. In a resource-limited setting, management is challenging as access to MRI and PET-CT is limited. This study was carried out to evaluate the surgical outcomes, five-year survival, and disease-free survival following radical hysterectomies at the National Cancer Institute, Sri Lanka, which performs the largest number of radical hysterectomies annually in the country. Methods Seventy-four patients who underwent radical hysterectomy, along with pelvic lymphadenectomy, between July 2015 to January 2017 at the National Cancer Institute, Sri Lanka (Apeksha Hospital Maharagama), were reviewed retrospectively, analyzing their clinical data and histopathological findings. Univariate analysis was performed to identify associated factors and mean survival. The Kaplan-Meier method was used for survival analysis. Results With a median follow-up of 63.5 months, five-year disease-free survival was 94.5%, and the five-year overall survival was 95.9%. There is a statistically significant association between mean survival and the cell type, presence of LVSI, and residual tumor on the hysterectomy specimen. Only four patients developed recurrences and four patients died during the follow-up. Eighteen (24.3%) patients needed blood transfusion postoperatively and no cases of bladder or bowel dysfunction in the one year post-operatively.Thirty patients (40.5%) required postoperative adjuvant treatment. Conclusions This analysis shows excellent surgical and oncological outcomes following radical hysterectomy as a primary treatment and comparable five-year disease-free survival with available global figures, despite the multiple scarcity of resources. Further studies are needed to assess the national-level status, and limited access to imaging during surgical planning poses a risk for patients receiving dual modes of radical treatment.