Consequences of inadvertent, suboptimal primary surgery in carcinoma of the uterine cervix

Objectives. Invasive cervical cancer that is discovered only after simple hysterectomy remains a problem. Little is known about the best management of this group since there are no relevant outcome studies. This study aimed to quantify the benefits of guideline-based treatment by comparing outcome data in patients treated by inappropriate simple hysterectomy and adjuvant radiotherapy with data in patients treated with primary radical surgery, radiotherapy, or radiochemotherapy. Methods. Records of 288 patients who had undergone radical hysterectomy with pelvic lymphadenectomy or simple hysterectomy were extracted and divided into three groups-radical hysterectomy alone (n = 89), radical hysterectomy and adjuvant radiotherapy (n = 119), and simple hysterectomy with adjuvant radiotherapy (n = 80). Disease-free and overall survival were calculated using Kaplan-Meier analyses. Results. There was a trend towards better overall survival in the radical hysterectomy group. Disease-free survival was significantly better in patients treated by radical hysterectomy, followed by simple hysterectomy plus radiotherapy, and then radical hysterectomy plus radiotherapy (P-log rank DFS < 0.002). When the two radical surgery groups were combined and compared with the suboptimally treated group, no significant differences were seen for overall survival. Conclusion. Postoperative radiotherapy is a good treatment for patients with cervical cancer who have undergone suboptimal simple hysterectomy. Appropriate selection criteria for further surgery remain to be defined. (C) 2004 Elsevier Inc. All rights reserved.