Use Of Radical Surgery Research Articles

Approach to Radical Hysterectomy for Cervical Cancer in Pregnancy: Surgical Pathway and Ethical Considerations.

Cervical cancer is currently the fourth most common cancer in women and in the poorest countries this neoplasia still represents a widespread and potentially lethal disease. We present a rare case of cervical cancer in pregnancy, analyzing the historical changes behind the procedure of radical hysterectomy for cervical cancer and discussing variations in surgical techniques and anatomical definitions that have since been proposed. We present the case of a 33-year-old patient who attended with vaginal bleeding in the second trimester of pregnancy. Examination revealed an abnormal looking cervix, with investigations concluding stage IIb squamous cell carcinoma. Following extensive discussion regarding management options, the patient went on to have a peripartum foetocidal type III nerve sparing radical Wertheim hysterectomy at 18 weeks gestation with conservation and transposition of the ovaries above the level of the pelvic brim. The patient recovered well without significant morbidity and received further input from fertility and psychological medical teams in addition to adjuvant treatment within the department of clinical oncology. This case represents several elements of great interest and learning. Notably, we highlight this both due to the surgical challenges that a gravid uterus presents in the execution of a radical hysterectomy; and regarding the compassionate care demonstrated by the team - not only in supporting the patient and her partner in a period of profound turmoil in terms of the management of their cancer diagnosis and unborn child, but also regarding the uncertainty in consideration of the oncological and fertility related outcomes. This manuscript adds to the growing literature on the appropriate use of radical surgery for cervical cancer, more specifically during pregnancy and in consideration of such ethical dilemma, where management guidelines do not exist to aid clinicians further in their provision of treatment.

Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study.

Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

Pathfinders in oncology from the beginning of modern surgery of intracranial tumors to the introduction of the Pap smear.

During the period from 1922 to 1942, several carcinogens were identified in coal tar, industrial oils, and petroleum, and radium was added to x-ray as a potential carcinogen. It was proven that some viruses are capable of causing cancer, and the dependency of prostatic and mammary hyperplasia and carcinoma on naturally occurring hormones was established. Colon cancer was linked to hereditary and nonhereditary polyposis. A permanent place for diagnostic radiology was defined and radiation therapy advanced to preoperative and postoperative modalities using x-ray and radium. The trend toward the use of radical surgery for primary and metastatic cancers continued. Although several new radical surgical procedures were developed and advanced as far as the technical skills of surgeons and the anatomic setting permitted, several innovative, less radical procedures were introduced. In chemotherapy, the basic principle of the treatment of advanced cancers with hormones was inaugurated. Pathologists synthesized what was known in tumor pathology, named new microscopic entities, recognized carcinoma in situ, developed histologic grading and pathologic staging of cancers, and introduced aspiration cytology and exfoliative cytology as new fields in oncology. It is interesting that despite profound global economic, social, and political upheaval and wars and preparation for wars, writers and producers of musicals and movies presented more memorable works than ever before. In the fields of science and technology, particularly nuclear physics and chemistry, profound discoveries were made that became a permanent part of human life. The progress made in oncology between 1922 and 1942 came about through the dedicated work of many individuals. However, there were 7 pathfinders (3 surgeons, 2 pathologists, 1 physician-chemist, and 1 physician-cytologist) who, despite their widely diverse backgrounds, personalities, and interest, made outstanding contributions to oncology to the magnitude that they deserve a permanent place in the history of medicine and oncology.

Induction or adjuvant chemotherapy for radical multimodality therapy

The use of radical surgery, with either extrapleural pneumonectomy (EPP) or extended pleurectomy decortication (EPD), as part of multimodality treatment in malignant pleural mesothelioma (MPM) has been shown to prolong survival outcomes. The platinum/pemetrexed doublet is used as standard first line chemotherapy as it is the only treatment proven in a randomized trial setting to give a survival advantage. It is unclear as to the optimal timing of chemotherapy, either in the neoadjuvant or immediate adjuvant setting. Some oncologists also favour reserving this standard therapy for the time at which the disease progresses following debulking surgery. Recently published guidelines from the American Society of Clinical Oncology (ASCO) recommend the use of chemotherapy as part of multimodality treatment, but do not stipulate at which point in the treatment regime this should be given. Further research is required to determine the optimal timing of chemotherapy in the context of the multimodality treatment of MPM.

Survival trends in patients with tracheal carcinoma from 1973 to 2011

PurposeThe prognosis for primary tracheal cancer is dismal. We investigated whether there has been improvement in survival in tracheal cancer patients and how treatment modality affected overall and cancer-specific survival. Materials and methodsUsing the Surveillance, Epidemiology, and End Results database, 1144 patients with tracheal cancer were identified between 1973 and 2011. Patients were stratified by age group, gender, race, tumor histology, and treatment modality. Radical surgery and survival rates based upon these stratifications were determined. Longitudinal analyses of survival and the percentage of patients undergoing surgery and radiation were conducted. ResultsIn the final cohort, 327 tracheal cancer patients (34%) underwent radical surgery. Patients of younger age, female gender, and who presented with non-squamous cell tumors were statistically more likely to undergo surgery. Over time, utilization of radiation has declined while use of radical surgery has increased. Concomitantly, 5-year survival has increased from approximately 25% in 1973 to 30% by 2006. Those who did not have surgery were 2.50 times more likely to die of tracheal cancer (95% Confidence Interval 2.00–3.11, p<0.001) than those who did have surgery. Additionally, patients who underwent radical surgery alone (without adjuvant radiation therapy) were 50% or 19% less likely to die of tracheal cancer than those who underwent no treatment or combination therapy, respectively (both p<0.001). ConclusionsSurvival in patients with tracheal cancer is improving over time. The utilization of radical surgery is increasing and confers the highest survival advantage to patients who are candidates.

Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology: 10-y review of the literature

BackgroundBiliary strictures present a unique diagnostic challenge to clinicians as they can be caused by both benign and malignant conditions. With the high mortalities associated with hepatopancreaticobiliary malignancies, accurate and rapid tissue diagnosis is imperative and typically done before initiation of treatment. However, the exact sensitivity of standard cytology from endoscopic retrograde cholangiopancreatography (ERCP) to diagnose malignancy remains unclear because of wide distribution of reported values in the literature. Furthermore, the use of radical surgery to obtain tissue when cytology is indeterminate has led to questions about the role of ERCP in patients with biliary strictures. MethodsA PubMed search was conducted using the terms ERCP, cytology, and brushings. Articles reviewed were published between 2002 and 2012, had patient population with biliary stricture, and had ERCP brushing results and final pathology available for review. The cytology and pathology data were abstracted from each study, and the combined overall sensitivity was calculated. ResultsSixteen studies were identified, with sensitivities ranging from 6%–64% and 99% confidence intervals (CIs) ranging from ±6% to ±32%. A combined total of 1556 patients were included, with positive ERCP cytology results in 358 cases. On final pathology, however, 861 patients were positive for malignancy. When the data were combined, we found an overall sensitivity of 41.6% ± 3.2% (99% CI) with a negative predictive value of 58.0% ± 3.2% (99% CI). ConclusionsERCP brushings suffer from low sensitivity and negative predictive value. This study questions the utility of ERCP to change the surgical management of these diseases in patients with radiographic evidence of a neoplasm or high suspicion of a malignancy.

Persistent Overuse of Radical Nephrectomy in the Elderly

To analyze the use of radical nephrectomy (RN) and partial nephrectomy during a 10-year period in patients aged≥75 years compared with their younger counterparts. Using the Surveillance, Epidemiology, and End Results registry, we identified 18 045 cases of localized renal cell carcinoma of ≤4 cm diagnosed from 1998 to 2007. The baseline differences in demographic and tumor characteristics were compared between the 2 age cohorts (<75 vs ≥75 years), and the rates of RN were determined, stratified by tumor size. A multivariate logistic regression analysis was conducted to predict the odds of undergoing radical nephrectomy for clinical Stage T1a disease. Overall, 2733 patients (15%) were aged≥75 years. The use of radical nephrectomy for clinical Stage T1a renal cell carcinoma decreased during the study period for all patients (79% in 1998 to 49% in 2007). Overall, 66% of patients aged≥75 years underwent RN for their disease compared with 59% of patients aged<75 years (P<.001). For patients with tumors of ≤2 cm, 51% of those aged≥75 years underwent RN compared with 41% of the younger cohort. In a multivariate logistic regression model, age≥75 years independently predicted the use of radical nephrectomy (odds ratio 1.18, 95% confidence interval 1.08-1.29). A 1-year increase in age was associated with a 1% increase in the risk of undergoing RN (odds ratio 1.01, 95% confidence interval 1.01-1.01). Elderly patients with clinically localized small renal masses are treated with RN more frequently than younger patients. Additional studies should address the medical implications of the increased use of radical surgery within the geriatric population.

Radical surgery of lungcancer with chest wall invasion and reliable methods of chest wall reconstruction

：Objective To study theefficacy of radical surgery for the invasion of chest wall by lung cancers and thedifferent methods of chest wall reconstruction. Methods A retrospective analysis ofclinical data was conducted in 27 cases of lung cancer with chest wall invasion in thishospital. 24 cases received lobectomy, 3 cases received pneumonectomy, and all casesreceived wall reconstruction. The size of chest wall defect after resection ranged from6.5 cm × 5.4 cm × 5.0 cm to 15.5 cm × 12.5 cm ×10.0 cm. The number of rib resectionfor each patient ranged from 1 to 4. The reconstructive methods were as follows: usingpolyester fabric to reconstruct costal pleura, using plexiglass, stainless steel wire andgrid-like titanium plate to reconstruct bone defect, and using nearby muscle flap andpedunculated muscle flap to reconstruct muscle defect. Results Pathologic diagnosis wasnon-small cell lung cancer,including 22 cases of squamous cell carcinomas and 5adenocarcinomas. There were pulmonary infections in 6 cases, chest hemorrhage in 1 caseand chest purulence in 1 case. One-year survival was 77. 9 %,3-yearsurvival was 58.3 %,and 5-year survival was 29. 1 %. Conclusion The lung cancer with chest wall invasion isadvisable to make active use of radical surgery. The different methods and repairmaterials are chosen to reconstruct the chest wall defect, supplemented by comprehensivetreatments.

Trends in the use of radiotherapy and radical surgery for patients with bladder urothelial cell carcinoma in East Anglia, 1995–2006

• To examine the use of radiotherapy and radical surgery for bladder urothelial cell carcinoma (UCC) before, during and after national initiatives for reorganization of uro-oncology services. • Population-based data (1995-2006) from a cancer registry with stable coding practices were analysed. • Bladder UCC was defined using relevant International Classification of Disease site and morphology codes. • Time trends in the use of radiotherapy and radical surgery, and other predictors of their use were examined. • Of 4639 bladder UCC patients aged ≥40 years (76% men), stage information was available for 4303 (93%). • Morphology and stage case mix remained stable during the study period. • Radiotherapy use decreased significantly (from 31% in 1995-1998 to 22% in 2003-2006, P < 0.001) among patients of any stage, whilst radical surgery use increased significantly (from 8 to 13%, P < 0.001), particularly among stage II-IV patients. • The proportion of patients treated by both radiotherapy and surgery also decreased notably (from 4.0 to 1.1%). • Women were significantly more likely to present in stages II-IV [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.06-1.40, P = 0.005], and less likely to be treated with radiotherapy (OR = 0.84, 95% CI: 0.72-0.99, P = 0.036). • Use of radical surgery in UCC invading bladder muscle increased and use of radiotherapy decreased during the study period, most probably reflecting the increasing availability of specialist surgical management. Sociodemographic variation in treatment was limited to lower use of radiotherapy in women. • Further research should encompass treatment timeliness and other aspects of care quality, as well as exploring potential differences in endoscopic treatments for disease not invading bladder muscle.

Population based time trends and socioeconomic variation in use of radiotherapy and radical surgery for prostate cancer in a UK region: continuous survey

Objective To examine variation in the management of prostate cancer in patients with different socioeconomic status.Design Survey using UK regional cancer registry data.Setting Regional population based cancer registry.Participants 35 171...

Quality of life after total or partial gastrectomy for primary gastric lymphoma

Up to 90% of patients with localized non-Hodgkin's lymphomas (NHL) in the gastrointestinal tract (GI) are cured and decreased use of radical surgery is favoured. Although quality of life (QOL) may impact treatment choice, little is known about QOL in gastric NHL survivors. The self-reported QOL (EORTC QLQ-C30 and a gastric module) and objective findings from upper GI endoscopy were evaluated in patients in complete remission after treatment for primary gastric NHL at the Norwegian Radium Hospital (NRH). Thirty-six (90%) patients completed the questionnaires, 33 (83%) met for endoscopy. Ten patients were treated with total gastrectomy, 17 with partial gastrectomy, while nine patients did not undergo surgery. Gastroscopy was normal in 55% of the non-gastrectomised patients, oesophagoscopy in 69%. Four patients had Barrett's metaplasia. QOL was not different from population values. Patients treated with total gastrectomy reported poorer emotional function, more diarrhoea and more food-related problems (p ≤ 0.05) compared with the others. Based on the higher level of digestive and food related problems after total gastrectomy, stomach-preserving surgery should be preferred whenever possible.

Cystectomy – Technical Considerations in Male and Female Patients

Simple and radical cystectomy for the treatment of benign and malignant bladder disease goes back to the late 19th century. The technique has changed over the last century due to increasing surgical experience, improvements in medical technology and pharmacology, an evolving technique of urinary diversion and an increase in patients demand for post-operative quality of life. Approximately two decades ago the orthotopic bladder substitution became popular in male patients, whereas in female patients the use of an orthotopic neobladder to a remnant portion of the female urethra started only a decade ago and still does not include the majority of female patients undergoing cystectomy. The major goal of cystectomy for malignant disease in the pelvis is the oncological outcome. Without compromising tumour resection, however, functional results, i.e. continence, volitional voiding, potency and sexual intercourse play an increasingly important role for this type of surgery. This is especially important for a bladder confined disease which has a better long-term tumour outcome, but on the other hand the use of radical surgery for these stages is still debated in favour of more conservative bladder sparing forms of treatment with less favourable outcome. The technique of radical cystectomy and lymphadenectomy both in male and female patients with regards to preservation of the urethra is outlined. In addition technique of sparing autonomic nerves both to the membranous urethra and the penis or the external and internal female genitalia is described. Surgical variations based on recent anatomic and clinical findings are presented and discussed with regards to the best functional outcome in male and female patients.

Major hepatectomy for isolated metastases from gastric adenocarcinoma

Liver metastases from gastric adenocarcinoma denote a poor prognosis. Most gastric metastases will be diffuse, and for these chemotherapy remains the only useful treatment modality. The treatment of isolated liver metastases is still unclear. The Japanese literature has reported good results with surgical resection, but Western series were unable to achieve the same results. We report our results with resection of liver metastases from gastric cancer in nine patients. A retrospective analysis was undertaken to determine the results of the surgical treatment of hepatic metastases from gastric carcinoma over the last five decades. Only nine patients underwent such treatment. Variables analysed were age, gender, the primary tumour, the type of liver operation performed, the time of occurrence of liver metastasis, the morbidity and mortality and the overall survival. Follow-up was complete. There were eight patients with gastric carcinoma staged as T3 and one as T4 (UICC-97). All patients had positive lymph nodes. The hepatic procedure performed was a hemihepatectomy in eight patients and a left lateral segmentectomy in one patient. Right hepatectomy was performed in six cases. There were four patients with synchronous liver metastasis: three involved the right liver and the other involved segments II/III. All were treated by one-step surgery. The five metachronous metastases involved the right liver in three patients (accounting for half of the right hepatectomies), while the other two underwent left hepatectomies. There was a high postoperative mortality rate (33%, 3/9), two of the deaths occurring in the first decade of the study (1956, 1966) secondary to hepatic insufficiency and one from sepsis. One patient died suddenly without recurrence after 3 months. The other five died with evidence of disease at between 2 and 11 months. Despite some anecdotal reports of treatment with chemotherapy, either systemic or intrahepatic, the more consistent results for the treatment of patients with hepatic metastases from gastric adenocarcinoma come from the Japanese literature with the use of radical surgery. Unfortunately, Western series, including our own, do not achieve the same results. At the present time, in view of these results, we are performing less aggressive treatment such as radio-frequency ablation.

Cancer of the ovary

Ovarian carcinoma is one of the most lethal cancers in the Western world. It often presents at an advanced stage and the role of screening is not yet clear. In this article, we review the risk factors predisposing to ovarian carcinoma, the presentation, diagnosis and treatment of this disease. Radical surgery combined with platinum-based chemotherapy is the mainstay of treatment. Despite developments in chemotherapy, including the use of taxanes, and increasing use of radical surgery, there have been only modest improvements in long-term survival. Further research is necessary to establish the most effective combination of chemotherapy and the role of radical surgery.

Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease.

The optimal use of radical surgery to palliate primary rectal cancers presenting with synchronous distant metastases is poorly defined. We have reviewed stage IV rectal cancer patients to evaluate the effectiveness of radical surgery without radiation as local therapy. Eighty stage IV patients with resectable primary rectal tumors treated with radical rectal surgery without radiotherapy were identified. Sixty-one (76%) patients received chemotherapy; response information was available for 34 patients. Radical resection was accomplished by low anterior resection (n = 65), abdominoperineal resection (n = 11), and Hartmann's resection (n = 4). Surgical complications were seen in 12 patients (15%), with 1 death and 4 reoperations. The local recurrence rate was 6% (n = 5), with a median time to local recurrence of 14 months. Only one patient received pelvic radiotherapy as salvage treatment. One patient required subsequent diverting colostomy. Median survival was 25 months. On multivariate analysis, the extent of metastasis and response to chemotherapy were determinants of prolonged survival. For patients who present with distant metastases and resectable primary rectal cancers, radical surgery without radiotherapy can provide durable local control with acceptable morbidity. The extent of metastatic disease and the response to chemotherapy are the major determinants of survival. Effective systemic chemotherapy should be given high priority in the treatment of stage IV rectal cancer.

Up-to-Date Management of Carcinoma of the Penis

Squamous cell carcinoma is the most common tumour of the penis. It is a rare disease in Western countries, and it is often associated with phimosis, poor hygiene or human papilloma virus infection. It could be prevented or diagnosed early in most cases, but, due to cultural and educational reasons, it is often diagnosed late. Nodal metastases are relatively common, but distant dissemination is very rare. Radical surgery gives the best control of the primary tumour, but it is mutilating. Laser surgery for limited superficial lesions and sophisticated radiotherapy for relatively small infiltrating tumours have been successfully employed, alone or in combination with chemotherapy. The use of radical surgery can therefore be restricted to cases which are unsuitable for conservative treatment or to relapses. Survival mainly depends on nodal metastases, but management of regional lymph nodes is controversial. Radical inguinal or ileoinguinal lymphadenectomy can cure approximately 40-50% of patients with positive nodes, but nearly half of the patients with clinically enlarged nodes actually have no metastases. Invalidating oedema is a frequent complication of inguinal lymphadenectomy. The point is to restrict the operation to patients with positive nodes. Expectant policy can be dangerous because results of delayed lymphadenectomy are usually poor. Fine needle aspiration biopsy and imaging may be of help in diagnosing nodal metastases. Modified surgical procedures have been advocated in order to obtain a pathological staging of the inguinal nodes avoiding invalidating sequelae, but results are controversial. Depth of invasion, tumour grade and growth pattern are of help in identifying patients at a very high risk of harbouring nodal metastases. Squamous cell carcinoma of the penis is relatively responsive to chemotherapy. Limited experiences suggest that adjuvant chemotherapy can improve the long-term survival of patients with radically resected positive nodes, and primary chemotherapy can make resectable approximately 50% of cases with fixed inguinal metastases. However, chemotherapy alone is not curative for metastatic disease.

Surgery for gastric cancer.

Radical dissection for gastric cancer is not widely practiced in the West. This paper reviews the evidence in support of lymphadenectomy and the techniques of radical resection as practiced by Japanese surgeons. We believe the published results support increased use of radical surgery in the treatment of gastric cancer and would recommend further adoption of this technique as there is minimal associated morbidity.

Surgery for gynecologic malignancies.

The surgical management of invasive and preinvasive gynecologic malignancies continues to evolve at a brisk pace. Several good techniques are available for the treatment of preinvasive cervical disease, including cryotherapy, loop electrocautery excision, laser therapy, and standard knife conization. The use of radical surgery for early invasive cervical cancer has been extended to older women, and complications have been minimized. There has been a significant trend toward more conservative surgery in the management of invasive vulvar cancer. The new surgical staging system for endometrial cancer has generated much controversy. The importance of thorough surgical staging for ovarian cancer is clear, and our understanding of the role of cytoreduction has increased. The role of new techniques, including operative laparoscopy, is being defined in the management of gynecologic cancers.

Practice of breast self examination: disease extent at diagnosis and patterns of surgical care. A report from an Italian study. GIVIO (Interdisciplinary Group for Cancer Care Evaluation).

The aim was to determine whether breast self examination leads to earlier diagnosis and whether this translates into a larger utilisation of conservative surgical procedures. The study was a survey of a cohort of breast cancer patients diagnosed over the period September 1986-July 1988. Participants were 1315 women enrolled in a clinical trial testing the effectiveness of two follow up regimens by 30 general hospitals throughout Italy. Overall, 511 patients (39%) reported some breast self examination practice, but only 109 (8%) did this regularly and in a way deemed correct by their physicians. Breast self examination practice was positively associated with patients' education and past history of benign breast disease and negatively with age. Self examiners were found to have a significantly greater chance of being diagnosed with a primary tumour coded as pT1 according to the 1982 TNM classification (odds ratio = 1.42, 95% CI = 1.13-1.79). This protective effect was mostly evident in the subgroup of optimal performers (odds ratio = 1.54, CI = 1.01-2.34). Nearly half the patients (319/655) eligible for conservative surgery still had an unnecessary radical procedure. Premorbid breast self examination seems to have a modest effect on the extent of disease at diagnosis. The still widespread use of radical surgery suggests that a careful reanalysis of priorities among possible public interventions is needed before launching massive educational campaigns targeted exclusively at consumers.

Hysterectomy with extended surgical staging and radiotherapy versus hysterectomy alone and radiotherapy in Stage I endometrial cancer: A comparison of complication rates

Extended surgical staging (ESS) has been added to total hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) in patients with clinical Stage I endometrial cancer in order to better define patterns of metastatic spread and the response to treatment. Adjuvant radiotherapy has a demonstrated efficacy in decreasing central recurrence in Stage I disease. The combined use of radical surgery and pelvic radiotherapy for cervical cancer patients results in an increased incidence of complications. This study compares major complication rates in Stage I endometrial cancer patients who underwent either TAHBSO with ESS or TAHBSO alone followed by adjuvant external beam radiotherapy (RT). Records of 52 patients with clinical stage I endometrial cancer were reviewed. Thirty-two patients underwent TAHBSO plus ESS and 20 patients had TAHBSO alone. All patients received postoperative, whole pelvis external radiotherapy. Four patients suffered complications potentially related to treatment which required rehospitalization, and all 4 were in the group which had undergone ESS. A comparison of complication rates between the ESS + RT group ( 4 37 or 10.8%) and TAHBSO + RT group (0/20) suggested a trend toward significance ( P < 0.10). Treatment protocols using extended surgical staging prior to adjuvant radiotherapy in Stage I endometrial cancer should examine complications potentially related to this combination, to further define treatment risks and benefits.