Radical hysterectomy with bilateral pelvic node dissection. Our experience at the Philippine General Hospital

From June 1961 to Jan. 1989 (28 & 1/2 years) a total of 627 patients were subjected to radical hysterectomy with bilateral pelvic node dissection (Meigs Operation). The main indication was cancer of the uterine cervix, which comprised 96%. There were 6 surgical deaths, with a mortality rate of 0.9%. The causes of death were hemorrhage, sepsis, atelectasis, and blood transfusion reaction. In the unirradiated group, the most common postoperative complication was infection, which was encountered in 23.8%. The most common site of infection was the urinary tract, 13.6%, followed by the incision (5.5%), and the pelvis (4.7%). One of the most distressing complications of the operation, ureterovaginal fistula, occurred in 7 patients, a rate of 1.3%, which is quite low. All except one were repaired successfully. There were 3 vesicovaginal fistulas (0.5%), and two of these healed spontaneously. In the irradiated group, the complication rate was much higher and more serious. The incidence of serious infection was 48.4%, which was more than double the unirradiated group. In addition, there were six cases of rectovaginal fistula (9.7%), two cases of vesicovaginal fistula, and 1 case of ureterovaginal fistula. The 3 year survival rate for stage I cancer of the cervix was 68.5%, stage IIa, 52.8%, recurrent cervical cancer, 25.8% and for stage II endometrial cancer, 89%.