Objective results of the operative treatment of cervical cancer.

Surgical staging of cervical cancer samples the retroperitoneal lymph nodes and, at some centres, the parametria. While better than subjective clinical staging, its value is limited because the results of a sampling procedure differ widely from those of a systematic lymphadenectomy. Additionally, considering the pathology of parametrial involvement, it seems unlikely that biopsy can find the majority of parametrial cancer deposits. The most precise data on the spread of cervical cancer are produced by radical hysterectomy and systematic lymhadenectomy. The tumour size has proven to be the most important prognostic criterion and therefore the best suited for patient classification. Tumour size can be measured by a number of methods. Between 1971 and 1987, 583 of 867 patients with Stage Ib to IIb cervical cancer underwent surgical treatment. Lymphadenectomy was systematic and hysterectomy included the resection of the entire parametria at the pelvic wall. In a total of 359 serial giant sections were of sufficient quality for evaluation; most were Stage IIb cases. The frequency of positive pelvic lymph nodes was 30.3% among 132 Stage Ib cases and 44.7% among Stage IIb cases. Most tumours occupied over 40% of the cervical volume. Five-year survival by clinical stage failed to show a statistically significant difference between Stages Ib and IIb. Objective classification by tumour size showed the patients with the smallest tumours to have a five-year survival rate of 92.1%. The patients with the largest still-operable tumours occupying 80% to 100% or more of the cervix still had a five-year survival rate of 65%.(ABSTRACT TRUNCATED AT 250 WORDS)