Management of Invasive Carcinoma of Cervix after Simple Hysterectomy at NICRH

Abstract

Invasive cervical cancer are sometimes inappropriately managed by simple Hysterectomy and referred afterwards at NICR&H for further management. It has been proven as an inadequate treatment resulting in a reduced survival rate. Objective: The aim of this study was to find out the reason for such inappropriate surgery, further management options, prognosis and survival. Methods: Sixty one cases of invasive cervical cancer referred after simple hysterectomy were studied regarding indications for hysterectomy and histopathology. Disease status at the time of referral was noted and accordingly categorized into two group depending  on the presence of residual growth at the vault .All of them got adjuvant concurrent chemo-radiation.. Result : Sixty one cases of cancer cervix patients were followed up for 6 month to 60 month after completion of radiotherapy. Median period of follow-up was 14 months. 65% had abnormal per-vaginal bleeding preoperatively. At the time of referral 23% (14) had residual growth at the vault. After completion of concurrent chemoradiation 75% (47) patients became disease free. Metastasis occur in two cases. Overall survival rate was 90.2% Median survival was 56 month. Among the prognostic factors type of histopathology (p?.01) and presence of gross cancer tissue at the vault after surgery (p?.001)was found to influence the treatment outcome.Conclusion: Inadvertant simple hysterectomy in cervical carcinoma increases morbidity and decreases survival and should be condemned.