Resumo
Cervical cancer remains a public health concern in developing countries that lack the wherewithal to cope with the associated challenges. Screening for premalignant cervical lesions and offering definitive care for early disease is the key to preventing the scourge. We conducted an audit of the radical hysterectomies performed on account of early cervical carcinoma at our centre between September 2006 and August 2008, following capacity-building by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years were managed. All had type III radical hysterectomy. Three patients had adjuvant teletherapy (one was stage IIb, diagnosed intra-operatively). There was a linear reduction in the surgical blood loss and duration of surgery. Average blood loss was 1500mls; four had blood transfusions. One case was complicated with rectovaginal fistula (the woman with stage IIb disease) and another had bilateral lymphoedema and left lower limb sensory neuropathy. There was no tumour recurrence on follow-up. Definitive surgery for early cervical cancer is feasible in developing countries despite limited resources. Audit of surgical care of cervical cancer will assist in strengthening the scarce skill. Determination of suitable cases during preoperative evaluation is crucial to the success of the surgery.
Keywords: Radical hysterectomy, cervical cancer, gynaecological oncology
Résumé
Le cancer du cervix demeure un problème de santé publique dans les pays sous développés qui manquent des moyens de supporter les défis associés. Le dépistage des lésions cervicales et l’apport des soins definitifs des cas précoces est la clé pour prévenir la mortalité, était faite entre Septembre 2006 et Aout 2008, après la construction de l’unité de l’opération Stop du cancer du cervix. Dix femmes âgées de 35 à 60 ans étaient ménagées. Tous avaient le type III d’hystérectomie radical. Trois patients avaient une teletherapie adjuvante. Il y avait une réduction linéaire de la perte du sang après chirurgie et durant la chirurgie. La perte de sang moyenne était de 1500mls; quatre avaient eu des transfusions sanguines. Un cas s’était complique avec une fistule recto vaginale et un autre avait un lymphodeme bilatéral et le pied gauche inferieure et la neuropathie sensorielle jambe gauche inferieure. Il y avait aucune récurrence durant la suivie. La chirurgie définitive du cancer cervicale précoce est faisable dans les pays sous développés bien que ayant les ressources limites. Le bilan des soins chirurgicaux du cancer du Cervix assistera a renforcer l’expertise rare. La détermination des cas appropriés Pendant l’évaluation des soins
pré-opérative est importante dans le succès de la chirurgie.
Correspondence: Dr. A. Oladokun, Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria. E-mail: sinaoladokun@yahoo.com
Referências
World Health Organization. Comprehensive cervical cancer control: a guide to essential practice. Geneva, World Health Organization 2006. Available at http://www.rho.org/files/WHO_CC_control_2006.pdf (Accessed April 8, 2010).
RTCOG/JHPIEGO Cervical Cancer Prevention Group. Safety, Acceptability, and Feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand: a demonstration project. Lancet 2003; 361: 814-820.
PATH (Program for Appropriate Technology in Health). PreHYPERLINK “http://www.path.org/files/eol18_1.pdf”vHYPERLINK “http://www.path.org/files/eol18_1.pdf” Preventing cervical cancer in low-resource settings. Outlook 2000; 18(1): 1-8.
Anorlu, R.I., Cervical cancer: the sub-Saharan African perspective. Reprod Health Matters, 2008. 16(32): p. 41-49.
Landoni, F, Maneo, A, Colombo A, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350: 535-540.
Alvarez, RD, Gelder, MS, Gore, H, et al. Radical hysterectomy in the treatment of patients with bulky early stage carcinoma of the cervix uteri. Surg Gynecol Obstet 1993; 176:539-542.
Soutter P. Radical surgery or radiotherapy for stage Ia-IIb cervical cancer. Lancet 1997; 350: 532.
Lee YN, Wang KL, Lin MH, et al. Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer. A clinical review of 954 cases. Gynecol Oncol 1989; 32: 135.
Piver MS, Rutledge F and Smith JP. Five Classes of extended hysterectomy for women with cervical cancer. Obstet Gynaecol 1974; 44(2): 265-272.
Trimbos JB, Hellebrekers BW. Kenter GG, Peters LA and Zwinderman KH. The long learning curve of gynaecological cancer surgery: an argument for centralisation. BJOG. 2000; 107(1): 19.23.
Chong GO, Park NY, Hong DG, Cho YL, Park IS and Lee YS. Learning Curve of Laparoscopic Radical Hysterectomy With Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer: Comparison of the First 50 and Second 50 Cases. Int J Gynecol Cancer 2009; 19(8): 1459-1464.