[Surgical therapy of stage Ib cervix cancer]

The following question was to be resolved: In view of the usually only minimal involvement (7.9%) of the parametria in stage Ib cervical cancer (CC Ib), is their complete removal necessary in such cases? Experience has shown that exposure can lead to subsequent impairment of the ureter, the bladder, and the rectum. Consequently, between 1971 and 1979, CC Ib was treated surgically in an alternating pattern: either after Wertheim-Meigs (WM) (108 cases in all), or after Galvin-TeLinde (GT), that is to say, with retention of the parametria to a large extent (102 cases in all). Results of histological study of the surgical specimens revealed approximately the same material in the two groups. Postoperative irradiation was performed in approximately 50% of the patients in both groups. In both groups, the frequency of metastases and recurrence was around 20%. In 1983, the evaluation of all the cases revealed a survival rate of 72.3% in the WM group, and of 78.5% in the GT group. The frequency of fistula and complaints in the GT group was only about one third of the found in the WM group. From their investigations, the authors conclude that the parametria do not have to be removed completely in cases of CC Ib, since late results are just as good with this limited operation as with Wertheim-Meigs' radical operation, yet with fewer complications. The removal of the affected uterus together with the pelvic lymph nodes and the extirpation of a vaginal cuff should be obligatory.