A comparison of survival and side effects in two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa.
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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.Cite
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The report presents 850 patients with cervical cancer operated with vaginal method 1957-1973. Vaginal radical hysterectomy and systemic extraperitoneal pelvic lymphadenectomy were done in 590 patients. A 5 year survival rate in Stage I was 90.4%, in Stage II 76.5%, and in Stage III 72.2%. The 10 survival rate for 462 patients were 86.1, 69.9 and 44.4% respectively. No operative mortality has occurred to date. The incidence of lymph node metastasis in stage I was 9.5%, in Stage II 25.9% and in Stage III 34.9%. The 5 year survival rate of the patients without lymph node metastasis was 88.2% and of those with lymph node metastasis 49.5%. Radical vaginal hysterectomy without the removal of regional lymph node were done in 76 patients. The 5 year survival rate was 86.8%. There was one postoperative death in this series. Vaginal hysterectomy were done in 184 patients. The 5 year survival rate was 92.4%.
Lymphadenectomy
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Objective: To assess the outcomes and complications between radical hysterectomy and definitive radiotherapy in patients with cervical cancer stage IB2 and IIA2 Materials and Methods: A retrospective analysis of patients with cervical cancer stage IB2 and IIA2 between January 2000 to June 2007 at Rajavithi Hospital was performed. The primary outcome measured were 3-year overall survival rates, 3-year progression free survival rate and the rate of complication. Patients with previous treatment from other hospitals, concurrent pregnancy and concurrent malignant disease were excluded from this study. Survival rate was analyzed by Kaplan Meier method. Result: Two hundred and nineteen patients with cervical cancer stage IB2 (n=91) and IIA2 (n=128) were enrolled. Ninety-eight patients (45%) underwent primary surgery (radical hysterectomy with/without adjuvant therapy) and121 patients (55%) underwent definitive radiotherapy (Radiation alone or concurrent chemoradiation). The 3-year progression free survival rate was 88.9% in primary surgery group and 90.4% in definitive radiotherapy group (P=0.952). The 3-year overall survival rates were 90.6% and 80.7%, respectively (P=0.057). The recurrence rate was 13.3% and 10.7% (P= 0.402). Major complications are not difference in both groups. Conclusion: Treatment modalities both of primary surgery and definitive radiotherapy are adequate treatment of cervical cancer stage IB2 and IIA2. The major complications and recurrent rate are not different.
Radical surgery
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This study includes 278 cases of stage I and II cervical cancer subjected to radical hysterectomy and lymphadenectomy. The clinical experience of 278 cases is reviewed. Of these cases, 215 were in stage I, and 63 were in stage II. Intraoperative complications occurred at a rate of 9.7% and involved injuries to the great vessels, lower urinary tract, nerves, and rectum. Operative mortality was found to be 0.3%. Postoperative complications were observed in 20.1% of patients. Fistulae were observed in 8 (2.8%) patients. The overall survival rate was 83.8%. The 5-year survival rates for stages IA, IB, IIA, and IIB were 100.0%, 87.9%, 71.0%, and 64.0%, respectively. Pelvic lymph node metastases varied from 0% for stage IA to 40.0% for stage IIB and paraaortic involvement varied from 0% for stage IA to 50.0% for stage IIB. Radical surgery seems to be the treatment of choice for patients with early invasive cervical cancer.
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Surgical oncology
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hysterectomy and pelvic lymphadenectomy. The surgery was performed by a gynecologist at Korea University Hospital and patients were followed up for 5 to 10 years. In a retrospective study of 75 patients with cervical cancer stages I-II, they were treated with radical hysterectomy and/or adjuvant radiotherapy. Results : The age distribution of patients was from 28 to 65 years old. The International Federation of Gynecology and Obstetrics (FIGO) stage distribution of invasive cervical carcinoma was 32%, 46.6%, 14.7%, 6.7% for stages Ia, Ib, IIa, and IIb, respectively. The five-year survival rate based on the age at diagnosis was as follows: 100% for less than 45 years old, 91.3% for more than 45 years old. The overall incidence of lymph node metastasis was 14.6%. The frequency of lymph node metastasis was 0.0% for stage Ia, 14.3% for stage Ib, 27.3% for stage IIa, and 60.0% for stage IIb. The five-year survival rate was as follows: 100% for stage Ia, 97.1% for stage Ib, 90.9% for stage IIa, and 60.0% for stage IIb. The tumor size also was correlated with survival. The five-year survival rate according to the size of tumor was as follows: 100% for less than 1 cm, 97.7% for 1 cm to 3 cm, 83.3% for 3 cm to 5 cm, 75.0% for more than 5 cm. We estimated survival curves according to different prognostic factors. Age (p=0.033), pelvic lymph node metastasis (p<0.001), initial tumor size (p=0.006) and stage (p=0.002) showed significant correlation with survival. Conclusion : Our study showed that age, clinical stage, lymph node involvement and initial tumor size are identified as independent prognostic factors in the patients with cervical carcinoma.
Lymphadenectomy
Adjuvant Therapy
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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.
Univariate analysis
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This study was undertaken to compare the survival rates of stage IB 1 versus stage IB 2 cervical cancer patients and to evaluate the prognostic factors after treatment primarily with radical hysterectomy and pelvic lymphadenectomy (RHPL). Patients with stage IB cervical cancer undergoing primary RHPL at Chiang Mai University Hospital between January 2002 and December 2009 were evaluated for survival and recurrence. Clinicopathological variables were analyzed to identify the prognostic factors affecting the survival of the patients. During the study period, RHPL was performed on 570 stage IB 1 and 110 stage IB 2 cervical cancer patients. With a median follow-up of 48 months, the 5-year disease-free survivals were 98.1% and 82.8% respectively (p<0.001). Multivariate analysis identified four significant prognostic factors affecting survival including sub-staging, non-squamous cell carcinoma histology, lymph node metastasis and the presence of lymph-vascular space invasion. In conclusion, with a primary radical hysterectomy, stage IB 1 cervical cancer patients have a significantly better survival rate than those with stage IB 2. Significant prognostic factors for stage IB cervical cancer include tumor histology, nodal status, and the presence of lymph-vascular space invasion.
Histology
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Objective To assess the prognostic factors of stage Ⅰ、Ⅱ cervical cancer. Methods 124 cases with Ⅰ、Ⅱ cervical cancer who experienced introcavity radiation at A point before operation, radical hysterectomy and pelvic lymphadenectomy and adjuvant radiotherapy for pelvic lymphatic metastasis were analysed retrospectively. Kaplan-Meier, Log-rank and Cox model were aplied to estimate Survival rate, significance probability and multiple factors respectively. Results The overall 3-year survival rate and 5-year survival rate for the 124 patients were 96.7% and 70.2% respectively. Pathologic diagnosis, clinical diagnosis and lymphatic metastasis were three significant factors but others were not. Conclusion Inorder to improve the prognosis of cervical cancer, It is important for the patients at early stage to receive radical hysterectomy and pelvic lyphadenectomy and improved adjuvant radiotherapy for pelvic lymphatic metastasis.
Adjuvant radiotherapy
Lymphadenectomy
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