Cervixcarcinoom stadium I en IIa; resultaten van abdominovaginale radicale uterusextirpatie met lymfklierdissectie en analyse van prognostische factoren

- Between 1967 and 1981 213 patients with carcinoma of the uterine cervix stage I and IIa underwent an abdominovaginal radical hysterectomy with transperitoneal lymphadenectomy, the so-called AVRUEL procedure. Five- and ten-year survival rates were 87.5 and 85, respectively. Recurrences were seen in 29 patients (13.6). 39 patients (18,3) had lymph node metastases. The five-year survival rate decreased from 94 to 65 when lymph nodes were positive. Long-term voiding problems occurred in 40.8 of the patients. In at least 23 of the women intercourse was impeded because of shortening of the vagina.

The results obtained with this operation are comparable with other methods reported in the literature. Better survival rates, however, are not seen after this more difficult and timeconsuming procedure. Our conclusion is that there are no reasons to change from the Wertheim operation to this combined approach. Histologic material from all patients was reviewed in order to analyse the prognostically important morphologic properties. The analysis was performed by means of the Cox's regression analysis. Vasoinvasion (p=0.0008) and lymph node metastases (p=0.0001) appeared to be the only prognostic factors significantly related to survival rate. Stage, cell type, differentiation and invasion depth were of no prognostic importance.