Surgical intervention following multimodality therapy for advanced cervical cancer

From 1978 through 1986, 183 women with cervical carcinomas underwent pretreatment extraperitoneal surgical staging followed by definitive radiation therapy. Overall 10-year actuarial relapse-free and survival rates were both 64%. There were a 20.2% overall incidence and 31.6% actuarial incidence of patients with subsequent abdominal surgery. Of the 47 total surgical procedures, most frequent were 15 repairs of radiation-related bowel injury (11 patients), 11 colostomies for tumor-related obstruction or fistula and 10 explorations for possible exenteration. Only one exenteration could be performed. Other operations consisted of 5 hysterectomies, 3 negative explorations for suspected recurrence, 1 cholecystectomy, 1 small bowel obstruction following surgical staging, and 1 sigmoid resection for colon cancer. Seven patients had multiple operations. Logistic analysis revealed cervix size, pelvic node status, periaortic lymph node status, and thin physique to be significant predictors of overall recurrence, while cervix size was the only significant predictor of exploration for exenteration. Tumor-related colostomies and radiation complications tended to occur in lower and higher clinical stages, respectively. There was a trend toward greater survival in patients with surgery for radiation complications.