Modified type IV-V radical hysterectomy with systematic pelvic and aortic lymphadenectomy in the treatment of patients with stage III cervical carcinoma: Feasibility technique, and clinical results

Pierluigi Benedetti-Panici, Francesco Maneschi, Giuseppe Cutillo, Stefano Greggi, Maria Giovanna Salerno, Mariangela Amoroso, Giovanni Scambia, Salvatore Mancuso

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND. Due to the high prevalence of perioperative major morbidity and the difficulties in achieving surgical disease free margins, surgery has had no role in the treatment of patients with Stage III cervical carcinoma. METHODS. Forty-two women with International Federation of Gynecology and Obstetrics (FIGO) Stage III cervical carcinoma responding to platinum-based neoadjuvant chemotherapy underwent the maximum surgical effort, comprised of a modified type IV-V radical hysterectomy (37 patients) or anterior pelvectomy (5 patients) with systematic pelvic and aortic lymphadenectomy. Feasibility, modifications of surgical technique, and pathologic and clinical data were analyzed. RESULTS. Surgery was feasible in all 42 patients intraoperatively selected. Disease free margins were achieved in all but one patient. The median operating time was 390 minutes, and the median estimated blood loss was 800 mL. In the last series of patients, these figures declined to 320 minutes and 600 mL, respectively. Major morbidity consisted of severe intraoperative hemorrhage in two patients, pulmonary embolism in four, ureteral fistula in three, and laparocele in three. The number of lymph nodes removed ranged from 30 to 117 with a median of 56. The mean lengths of vagina and lateral parametrium resected were 55 and 48 mm, respectively. Despite perioperative chemotherapy, lymph node metastasis was present in 36% of patients, parametrial disease in 38%, and vaginal disease in 45%. After a median follow-up of 53 months, the 5-year overall and disease-free survival rates of radically operated patients were 70% and 58% respectively. CONCLUSIONS. Thanks to improved surgical technique and perioperative care, extended radical surgery appears to be feasible with acceptable morbidity in chemosensitive women with Stage III cervical carcinoma and may constitute a valid alternative to radiotherapy in these patients.

Original languageEnglish
Pages (from-to)2359-2365
Number of pages7
JournalCancer
Volume78
Issue number11
DOIs
Publication statusPublished - Dec 1 1996

Keywords

  • cervical carcinoma
  • neoadjuvant chemotherapy
  • Stage III
  • surgical treatment

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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