Radical hysterectomy in the elderly
Azamsadat MousaviMojgan Karimi‐ZarchiMitra Modares GilaniNadereh BehtashFatemeh GhaemmaghamiMaryam ShamsMaryam Irvanipoor
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Abstract:
The considerable increase in life expectancy on one hand and an increase in cervical cancer among Iranian patients on the other, brings out the importance of investigating whether radical surgery can be performed safely and effectively on patients above 60 years of age.In a study of historical cohort, all 22 patients 60 years and above who have undergone a Wertheim radical hysterectomy for cervical cancer from 1999 to 2005 were compared with 128 matched cases under 60 years of age who had undergone a Wertheim hysterectomy during the same calendar year. All patients were analyzed for preexisting medical comorbidities, length of postoperative stay, morbidity, and postoperative mortality.There was no operative mortality in either group, morbidity (minor, p = 0.91; major, p = 0.89) were statistically not different in the two groups despite the patient's above 60 years having significantly higher comorbidity prior to surgery than the younger cohort (minor, P < 0.05; major, P < 0.05). The mean postoperative hospital stay was significantly longer in the older patients (5 days vs. 3 days, P < 0.001).Wertheim Radical hysterectomy is a safe surgical procedure in the selected population of patients 60 years and over. No differences in operative mortality or morbidity were found when compared to a cohort of patient's aged 60 years or younger.Keywords:
Surgical oncology
Objective . Cervical cancer patients who had an abandoned radical hysterectomy were evaluated for preoperative clinical predictors, complication rates, and outcomes. Study Design . IRB approval was obtained for this retrospective analysis and chart review was performed. Results . From 268 women with early‐stage (IA2 to IIA) cervical cancer, 19 (7%) had an abandoned hysterectomy for finding grossly positive lymph nodes (84%) or pelvic spread of tumor (16%). No clinical characteristics clearly identified women preoperatively at risk of having an abandoned hysterectomy. In the abandoned group, 26% suffered major morbidities, compared to 34% in the completed group (OR 0.69, [CI 0.16–2.57], P = .789). Thirty‐seven percent recurred in the abandoned group, compared to 18% in the completed group ( P = .168). Overall survival in the abandoned group was 73% versus 80% in the completed group ( P = .772). Conclusion . The practice of abandoning a planned radical hysterectomy for unexpected metastatic disease may not worsen the outcome.
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Cervical cancer remains to be the most common gynecologic malignancy among Filipino women despite being a preventable disease. Radical hysterectomy with pelvic lymphadenectomy is considered the standard surgical treatment of choice for patients with cervical cancer confined to the cervix up to the upper vagina. However, recent studies show that a less radical approach can be offered to these patients with comparable outcomes to radical hysterectomy, but with lesser perioperative and post-operative morbidity. The purpose of this study was to compare the outcomes in terms of recurrence and survival among cervical cancer patients who underwent simple hysterectomy and radical hysterectomy seen in a tertiary government hospital. Records of all cervical cancer patients who underwent radical hysterectomy and simple hysterectomy for the past ten years were reviewed. The incidence of cervical cancer patients who underwent simple hysterectomy from 2009–2018 is 0.37 per 100 person years or 0.592:16, lower than 1:16 ratio from 1964–1974, as reported by Manalo and Sotto.1Only 9 out of 42 patients who underwent simple hysterectomy had cervical cancer screening within 1 year prior to surgery. The most common indication for surgery was myoma uteri. Those who underwent radical hysterectomy had better recurrence free survival and overall survival than those who had simple hysterectomy, but among low risk patients, those with 2 cm or less tumor size with no other risk factors, there was no significant difference in survival outcomes between the two groups.
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The study compares survival and complications during two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa. Group A included 128 patients operated during the years 1983-87. In that period 5 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Group B included 135 patients operated during the years 1988-91. In that period 7 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Considering stage 1b separately, the frequency of operation was raised from 52 (123/237) to 87% (128/148). A 5-years crude survival rate of 85% and 88% was observed in the two groups. The mortality rate was zero in both periods and no fistulae occurred. There were no significant increase in morbidity or length of hospitalization. In the elderly patients over sixty years a significant increase in minor postoperative complications and hospitalization more than 2 weeks were seen. The conclusion is that the frequency of radical hysterectomy as treatment of cervical cancer stage Ib can be raised from 52% to 87% without any noticeable influence on survival or complication rate.
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During the last 3 decades, the standard treatment for stage Ia2-Ib1 cervical cancer has been Piver-Rutledge class II or III radical hysterectomy. However, this surgery is associated with a high rate of urologic morbidity.To determine the efficacy of class I radical hysterectomy compared with class III radical hysterectomy in terms of morbidity, overall survival, and patterns of relapse in patients with Ia2-Ib1 cervical cancer undergoing primary surgery.A total of 101 patients with stage Ia2-Ib1 cervical cancer < 2 cm were randomized to class I and class III hysterectomy groups. Clinical, pathologic, and follow-up data were prospectively collected. Univariate analysis was carried out. Of the total patients, 45 were randomized to class I surgery and 56 to class III surgery. No significant differences were observed in terms of pathologic findings or adjuvant treatment (p > 0.05). The morbidity rates were higher after class III surgery.The difference in recurrence rate between the class I and class III groups was not statistically significant (p > 0.05). The 5-year overall survival rate was 93% and 91%, respectively (p > 0.05). There were no significant differences in terms of recurrence rate or overall survival among patients with stage Ia2-Ib1 cervical cancer < 2 cm who underwent class I or radical (class III) hysterectomy. Morbidity was proportional to the extent of radicality.These data confirm the need for reducing surgical radicality in the treatment of patients with early cervical cancer, by tailoring the extent of resection according to the extent of disease.
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