Chapter 100 - Radical hysterectomy

Summary

Carcinoma of the uterine cervix is the second most common gynecologic malignancy worldwide and the third most common cause of cancer deaths in women all over the world. In 2010, an estimated 12,200 women in the USA were diagnosed with cervical cancer, and 4,210 women died from the disease.

Attempts to treat cervical cancer in the early nineteenth century were deemed largely unsuccessful due to the frequent occurrence of recurrent disease in the vaginal cuff. Surgeons such as Wertheim and Clark postulated that this was likely due to inadequate margin of excision. At the turn of the nineteenth century, these surgeons developed an operation that involved removal of the uterus, along with a wide resection of tissues around the involved cervical tumor.

The primary goal of radical hysterectomy is removal of the cervical tumor with a sufficient surgical margin. This entails removal of the uterus, cervix, superior vaginal margin, and parametrial tissue. Removal of the latter involves extensive dissection of the bladder, ureters, rectum, and lateral pelvic sidewalls.

Cervical cancer is staged clinically. All stages may be treated with a combination of radiotherapy and chemotherapy; however, early-stage cervical cancer may be treated with a radical hysterectomy. While microinvasive disease or stage IA1 can be adequately treated with a vaginal or simple abdominal hysterectomy, radical hysterectomy along with pelvic lymphadenectomy is utilized to treat stages IA2 through IIA. The overall survival of early-stage cervical cancer is similar between radical hysterectomy and radiotherapy. Therefore, patients who are poor surgical candidates due to severe medical illness or morbid obesity are probably best treated with primary radiotherapy.