INITIAL EXPERIENCE OF RADICAL HYSTERECTOMY FOR EARLY CERVICAL CANCER AT A CANCER HOSPITAL IN NEPAL

Abstract

The purpose of this study was to find out the clinocopathologic characteristics, post-operative findings and
complications of patients with early (up to stage IIA) cervical carcinoma who underwent radical hysterectomy.
This study concentrates on the evaluation of our early experience in radical hysterectomy for cervical
cancer in Nepal. This was a retrospective analysis of 48 patients who had radical hysterectomy with bilateral
pelvic lymphadenectomy for early cervical cancer at the BP Koirala Memorial Cancer Hospital (BPKMCH)
from September 1999 through September 2002. Characteristics such as chief complaint, disease staging
and duration, intraoperative and postoperative complications, histopathological findings, need for blood
transfusion, and duration of hospital stay were considered for analysis. Patients’ age ranged from 28-67
years. Age group of 40-49 had highest number of patients (58.3%). Majority (62.5%) were premenopausal
women who presented with abnormal vaginal bleeding (73%) as the chief complaint. More than half of
them (56%) had FIGO stage IIA disease. Thirty-three percent had intraoperative and postoperative
complications such as urinary problems, wound infection and vessel injury/ureteric injury. All needed
blood transfusion, 42% needing four pints. The average duration of hospital stay was 11 days. Forty-four
had squamous cell carcinoma and four had adenocarcinoma. Pelvic lymph node metastasis was found in 10
patients. Resected margins were adequate in 42 patients. Majority (62.5%) of the women were premenopausal
and 56% of them had stage IIA disease. Although the primary treatment of early-stage cervical carcinoma
involves either surgery or radiation therapy with or without chemotherapy, surgery (radical hysterectomy)
was used for lower-stage disease and smaller lesions in fit and young patients in our resource-poor set-up.
Fifteen patients needed postoperative radiation. The complication rate seems to be higher in Nepal; however,
it will decrease as more experience is gained.

Key Words: Cervical cancer, gynecological malignancies, human papillomavirus, radical hysterectomy.