Radical hysterectomy for recurrent XXXX following radiation therapy.

@entity1 @entity86 @entity5 @entity158
In @entity1 with small central recurrences following radiation therapy for @entity5 the surgeon may have to make a judgment as to when radical hysterectomy is preferable to exenteration. During the years 1968-1984 there were 21 radical hysterectomies performed at Memorial Sloan-Kettering Cancer Center for recurrent @entity5 . The original clinical stage distribution is as follows: IB-4, IIA-4, IIB-11, IIIB-1, IVA-1. The median interval from initial diagnosis to recurrence was 10 months. There were two operative deaths; both were from sepsis. Ten of the 21 @entity1 developed @entity86 , with 9 requiring surgical diversion of the urinary or both urinary and intestinal tracts. Thirteen of 21 @entity1 (62%) have survived with a median follow-up of 73 months. Seven @entity1 @entity158 following radical hysterectomy. All developed recurrence in the central pelvis. Four had sidewall disease as well, but none had distant disease at the time recurrence was diagnosed. Of 11 @entity1 with cervical @entity5 of 2 cm or less in size at the time of radical hysterectomy, none experienced recurrence, while among 10 @entity1 with @entity5 size of greater than 2 cm, 7 had recurrence. All @entity1 whose initial clinical stage was IB or IIA have survived without recurrence. There was only 1 survivor among 5 @entity1 with positive parametrial or vaginal margins. Six of the 13 survivors required urinary diversion, and 2 required colostomy as well. Radical hysterectomy for this indication is a morbid procedure which should be undertaken only by the most experienced of pelvic surgeons and limited to @entity1 of early clinical stage with central recurrences of less than 2 cm in size.
