Results of hysterectomy for persistent cervical cancer after complete radiotherapy in Srinagarind Hospital
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Objectives: To analyze the survival outcomes and to determine the surgical complication of patients with persistent cervical cancer who had undergone hysterectomy after completion of radiotherapy at Srinagarind Hospital, Khon Kaen University, Thailand between January 1996 and December 2010. Methods: The medical records of patients who met the study criteria were reviewed. The inclusion criteria are all patients who have residual cervical cancer after complete radiation therapy and biopsy proven. Extracted data included patient’s age, stage, histological subtype, type of radiotherapy received, type of hysterectomy procedure, pathological results, surgical complications, and survival. Results: Forty-three women suitable for study inclusion were identified. The majority of women (53.5%) were in stage IIB. Thirteen (30.2%) women received concurrent chemoradiation while the remaining 30 (69.8%) underwent radiotherapy alone. Thirty-four (79.1%) women underwent extrafascial hysterectomy (EH) while the remaining 9 (20.9%) underwent radical hysterectomy (RH). Median operative time and median amount of estimated blood loss were higher among women undergoing RH compared to those who underwent EH. Overall, grade III-IV complications were noted in 34.9% of patients. The rate of grade III-IV complications was higher among women undergoing RH compared to those in EH group (44.4% vs. 32.4%, respectively). The 5-year survival rate of all women was 54.6%. Median overall survival of all patients was 6.25 years. Median overall survival of women undergoing RH was comparable to those who underwent EH (6.25 years vs. 6.84 years, respectively). Conclusion: Hysterectomy in women who were initially treated with curative intent radiotherapy but subsequently found to have residual tumor may improve survival outcomes, allowing a 5-year survival rate of approximately 55%. The incidence of severe complication was considerably high particularly among those women who had undergone radical hysterectomy.
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