Complicaciones asociadas a histerectomía radical con linfadenectomía pélvica en mujeres con cáncer de cérvix en el Instituto de Cancerología - Clínica Las Américas, Medellín, Colombia: Estudio de cohorte

摘要

Objective: To describe intra-operative and immediate post-operative complications of total radical abdominal hysterectomy with pelvic lymph node dissection, and the pathology results in patients with early-stage cervical cancer at the Instituto de Cancerología - Clínica de Las Américas, over a 8-year period. Materials and methods: Descriptive historical cohort of women with a diagnosis of histologically confirmed cervical cancer, who were diagnosed as stages IA2 to IIA1 according to the FIGO classification at the time of surgery, undergoing type II or III radical hysterectomy between August 2003 and July 2011 at the Instituto de Cancerología - Clínica Las Américas, a private high-complexity referral center in Medellin, Colombia, that provides care to patients of the contributive and subsidized health insurance regimes. A consecutive sample was used. Assessment variables included body mass index, duration of surgery, hospital stay, intraoperative bleeding, clinical stage, histology, stromal infiltration, lymphovascular involvement, parametrial involvement, margins, node count and lymph node involvement, blood transfusion, intra-operative complications, post-operative complications, adjuvant therapy. Information was summarized on the basis of central trend and scatter measurements for continuous variables, and proportions for categorical or ordinal variables. Results: Overall, 199 patients were included with a median age of 46 years (28-75). Of them, 183 (92%) were diagnosed as stage IB1. The most frequent histological diagnosis was squamous cell carcinoma in 125 cases (62.8%), while adenocarcinoma occurred in 66 cases (33.1%). The mean duration of the surgical procedure was 188 min (90-315); average estimated blood loss was 316 cc (30-2000), and 19 patients (9.5%) required a blood transfusion; in average, 22 lymph nodes (9-61) were removed; median hospital stay was 2.44 days (1-31). The rate of intra-operative complications was 9%, all of them associated with vascular lesions and intraoperative bleeding. There were 73 post-operative complications (36.7%), the most frequent of which was urinary fistula (6.5%). Overall, 97 patients (48.7%) required adjuvant therapy. Conclusions: Abdominal radical hysterectomy performed in the study population is a safe, feasible and reproducible, with a frequency of operative and posoperative complications as is expected for that surgery.