A Review of Radical Hysterectomy as Primary Treatment for Early Stage Cervical Cancer at KNH 2013-2018

Abstract

Invasive cervical cancer (ICC) is the leading cause of cancer death among women in Africa and other developing countries of the world. In Kenya, cancer of the cervix is now the leading cause of cancer death and the second most prevalent cancer among females after breast cancer. Primary surgery or primary chemoradiation alone; or in combination with chemotherapy are utilized for definitive management of invasive cervical cancer. Primary surgical treatment is indicated for early-stage cervical cancer stage IA to IIA. Studies in the developed countries have shown that radical hysterectomy for early-stage ICC is relatively safe and is associated with very good outcomes. Overall five-year survival exceeds 90% for squamous and adenocarcinoma histologic types. Survival is however poor for the non-squamous/adenocarcinoma histologic types at 65%. The surgical outcomes and survival of women treated surgically for cervical cancer in our setting is however unknown. In this study, we reviewed the medical records of women who had radical hysterectomy as primary treatment for early-stage cervical cancer at KNH between January 2013 to December 2018; and describe the preoperative assessment, surgical outcomes and survival of the cases. Study Objectives: To determine the preoperative assessment, complications, complementary therapies and survival of women treated primarily by radical hysterectomy for invasive early stage cervical cancer at KNH between 2013-2018. Methodology This was a descriptive retrospective cohort study of women who had radical hysterectomy as primary treatment for early-stage cervical cancer at KNH between January 2013 to December 2018. Data from eligible cases was obtained by a questionnaire guided review of files retrieved from the archives of the health records department, KNH. De-identified data was entered on the data abstraction form, stored in an excel database, cleaned and exported to Stata v13 (Stata Corp, College Station, TC, USA) for analysis. Descriptive statistics on social-demographics, preoperative assessment and surgical outcomes were summarized. Means (SD) for continuous data were determined, while categorical data is described in proportions. Kaplan Meier curves XII were used to evaluate the survival of study participants. A p-value of <0.05 was considered statistically significant along with the associated 95% confidence interval. Study Results A total of 72 files of women who had radical hysterectomy between 2013-2018 were retrieved, 69 were found to be eligible for study. The mean age of study participants was 44.0 years. Forty three percent were HIV positive of whom 92% were on HAART. Histologically, most were of squamous cell carcinoma (63.8%) and were clinically staged as FIGO stage IB1 and IB2 (54 %). Ultrasound (33%) was the commonest preoperative imaging assessment of disease status. Radical hysterectomy was safe, with 59.4% and 88.4% of cases having no acute or chronic complication respectively. Peri-operative mortality rate was 1.4%. Almost half of the women (52.2%) were found to have intermediate and high-risk factors for disease recurrence as per Sedli’s criteria. More than half (55.6%) of these cases did not receive adjuvant complimentary chemoradiation. The mean overall survival after radical hysterectomy as primary treatment for ICC was 82.5 months. The 2-year survival rate was 93.3% while 5-year survival was 86.8%. Conclusions Radical hysterectomy at KNH as primary treatment for early-stage ICC during the period 2013-2018 was safe with comparable and acceptable outcomes. Efforts need to be made to improve rational preoperative imaging as well as uptake of complimentary chemoradiation after surgery when indicated.