The abandoned radical hysterectomy: a Gynecologic Oncology Group Study

Abstract

Objective: The aim of this study was to evaluate the frequency with which intended radical hysterectomy for cervical cancer is abandoned and the outcomes for those patients.

Methods: A secondary evaluation of a prospective surgical pathological trial was performed. There were 1127 patients with Stage IB carcinoma of the cervix entered on Gynecologic Oncology Group Protocol No. 49. These patients were to undergo radical hysterectomy and pelvic lymphadenectomy with careful analysis of pathologic findings, complications, and outcomes.

Results: Ninety-eight women were found, at operation, to have extrauterine disease and the proposed radical operation was abandoned at the discretion of the operating surgeon. The records of these patients were evaluated. Subgroups of patients with extrapelvic disease (30) and pelvic extension (26), including grossly positive pelvic nodes (12), other pelvic implants (8), and gross serosal extension (2), were identified. Sixty-three (93%) patients subsequently underwent pelvic radiation therapy and one or two intracavitary applications. Para-aortic fields were added for 8 patients who were found to have positive para-aortic nodes. Five patients received radiotherapy and chemotherapy; 4 patients received chemotherapy alone. One patient declined any further therapy. The disease-free survival was shorter for patients whose radical procedure was abandoned than for those patients who underwent radical hysterectomy. Among the abandoned-operation patients, those with extrapelvic disease had the shortest progression-free interval and survival and those with direct pelvic extension the longest.

Conclusions: Retrospective comparisons of radical hysterectomy to radiation therapy are not valid unless the group of patients whose radical operation was abandoned is included. The morbidity of the operation is low even when followed by radiation therapy. However, no recommendations for optimal therapy can be made from this analysis.