Disease-free interval and recurrence pattern after the Okabayashi variant of Wertheim's radical hysterectomy for stage IB and IIA cervical carcinoma

Abstract

From January 1982 to December 1991 271 patients underwent radical hysterectomy according to the Okabayashi modification for cervical carcinoma stage IB and IIA. Intraoperative complications occurred in 3.3%. The urinary fistula rate was only 2.2%. The 5‐year Disease‐free Interval (DFI) was 90%. In a univariate analysis tumor size 3 cm (n = 99), positive pelvic nodes (n = 53), adenocarcinoma (n = 58) and parametrial involvement (n = 36) were all associated with a significantly decreased DFI. Recurrence occurred in 27 patients (10%) of whom 22 died of disease. In adenocarcinoma, DFI was poor when positive pelvic nodes were present. In squamous cell carcinoma however, DFI was not influenced by pelvic node status. In patients with squamous cell carcinoma the locoregional recurrence rate was 3.4% when pelvic nodes were negative, whereas in those with positive nodes it was 5.8%. These data show that the Okabayashi modification of Wertheim’s radical hysterectomy is a safe procedure resulting in very good locoregional tumor control, especially in patients with squamous cell cancer of the cervix.

Prognostic factors affecting cervical adenocarcinoma: 10 years experience in a single institution

“…Tumor stage has also been defined as a prognostic factor in many studies; better outcomes were reported with early stages [19][20][21]. In our series, the 5-year overall survival varied according to the clinical stages, it was 81 and 66 % in stages I and II and 32 and 12 % in stages III and IV, respectively.…”

“…Samlal et al [20] and Nakanishi et al [16,19] both found that 5-year disease-free interval (94 and 90 %, respectively) and survival were significantly affected by the lymph node status. In their studies, when squamous carcinoma was compared to adenocarcinoma, no difference was found between the two histological types when lymph node metastases were absent.…”

Évaluation anatomique et histologique du ligament utérosacré : conséquences pratiques en chirurgie

“…Plusieurs études ont impliqué la radicalité de l'exérèse du LUS dans la survenue de complications postopératoires urinaire et rectale dans le cadre de l'hystérectomie extrafasciale étendue pour cancer [5][6][7][8][9][10][11]. Les étapes chirurgicales à haut risque de lésion nerveuse sont la résection du LUS, des ligaments vésico-utérins (piliers de la vessie) et du paracervix (ligament cardinal, de Mackenrodt) [2][3][4].…”

“…Il en est ainsi lors d'une colpohystérectomie totale élargie distale avec curage interiliaque, le traitement de référence pour les cancers du col utérin débutants stade FIGO IA2 à IIA, responsable d'une morbidité fonctionnelle importante à long terme [5][6][7][8][9]. Il s'agit le plus souvent de patientes jeunes âgées entre 30 et 50 ans.…”

“…Il s'agit le plus souvent de patientes jeunes âgées entre 30 et 50 ans. Les complications représentées surtout par des dysfonctions vésicales, sexuelles et anorectales, seraient les conséquen-ces de lésions accidentelles du système nerveux autonome pelvien lors de l'exérèse élargie du LUS [5][6][7][8][9][10][11]. Le même problème se pose dans le traitement coelioscopique de l'endométriose profonde [12] où l'identification et la conservation des nerfs du système autonome pelvien sont souvent occultées (coagulation à l'aveugle et résection des « ligaments » utérosacraux).…”