22. Incidental cervical carcinoma after simple hysterectomy – Cervical Carcinoma

P. Hillemanns, A. Mustea, F.A. Stübs, M.C. Koch, D. Denschlag

Only a few published studies on this topic were available for the guideline group. They are all retrospective, and show that starting from stage IA2 additional therapy is required after incidental findings of cervical carcinoma in a simple hysterectomy [320], [824], [825], [826]. Avoidance of further treatment is associated with unacceptably high recurrence rates. In a study including 147 patients (with stages IA1 to IIA), the recurrence rate with a median follow-up period of 116 months was 34.6% in a group who received only observation, in comparison with 6.8% in the R(CH)T group and 0% in the group who underwent radical parametrectomy [825]. In another study including 90 patients (with stages Ib to IIb), the 5-year survival rate after secondary radiotherapy was 85.5% and the 10-year survival rate was 74.1% [824]. A more recent analysis of 15 studies including 238 women showed an increased rate of surgical complications with secondary parametrectomy, cranial colpectomy with pelvic lymphadenectomy [827]. However, no specific preoperative factors were identified to predict the survival rate, need for adjuvant treatments, or parametrial involvement. The studies thus do not allow any definite conclusions to be drawn regarding which form of treatment is preferable — RT, R(CH)T, or repeat surgery in the form of radical parametrectomy on analogy with radical hysterectomy (Piver II/III). Instead, several aspects suggest that the treatment options are equivalent in relation to the overall survival. However, if RT/R(CH)T can be avoided on the basis of risk factors, surgery has advantages — particularly in younger women — due to its lower long-term morbidity.