92 - Radical hysterectomy

Summary

Carcinoma of the uterine cervix is the third most common gynecologic malignancy in the United States, with an estimated 12 200 newly diagnosed cases and 4100 deaths in 2003. With the adoption of routine screening programs, the mortality from the condition has steadily decreased since the 1940s in this country, though the disease remains a significant problem in developing countries.

The disease is typically clinically staged, and all stages may be treated with radiotherapy or a combination of radiotherapy and chemotherapy. Traditionally, surgical treatment has been used in early stage disease. Microinvasive disease or stage IA1 can be adequately treated with a vaginal or simple abdominal hysterectomy. Radical hysterectomy, usually referred to as a type III hysterectomy, is a treatment modality utilized to treat early stage invasive carcinoma of the cervix (stages IA2 thru IIA). In addition to the radical hysterectomy, a pelvic and/or para-aortic lymphadenectomy is also performed as a component of this treatment. Wertheim and Meigs described variations of the radical hysterectomy that are most often employed today.

Whether patients are treated with radical hysterectomy and lymphadenectomy versus radiotherapy, treatment outcomes for early stage cervical cancer are similar. Patients undergoing surgery must consider the following operative risks: blood transfusion, perioperative infection, thromboemobolic disorders, postoperative bladder and bowel dysfunction, fistula formation, nerve injury, and lymphedema.

Despite the risks, there are certain potential advantages to radical hysterectomy over primary radiotherapy. For premenopausal women, radical hysterectomy affords the opportunity for ovarian preservation.