Lack of effect of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib.

The aim of this retrospective study was to analyze the effects of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib. A total of 295 patients who had undergone surgery from 1987-2002 were included. Forty seven patients underwent conization before definite surgery, and 2 patients were subsequently lost to follow up. Among the remaining 246 patients, 97 received allogenic blood transfusion, 38 received autologous blood transfusion, and 111 received no transfusion. The clinicopathologic finding of these three groups were reviewed and analyzed. There was no significant difference among three groups in age, chief complaints, duration of symptoms, size of lesion, histopathology, grade, margin or parametrium involvement, node status or postoperative adjuvant treatment. The most prominent presenting symptoms were abnormal vaginal discharge, abnormal vaginal bleeding, and postcoital bleeding. Although the 5-year disease-free survival (DFS) (and 95% CI) for autologous blood transfused group was 90.9% (74.4-97.0%), falling to 88.1% (77.8-93.8%) in untransfused blood group and 81.7% (71.3-88.6%) in allogenic transfused blood group, there were no significant differences among three groups (P = 0.699). In multivariate analyses, only age (P = 0.046), size of lesion (P = 0.024) and histology (P = 0.046) were statistically significantly associated with DFS, whereas transfusion status was not. In conclusion, there is no evidence that perioperative blood transfusion affects DFS of patients undergoing radical hysterectomy and pelvic lymphadenectomy. Only age, size of lesion and histology were statistically significantly associated with DFS.

Situation analysis for management of abnormal Pap smears in the lower southern Thailand.

OBJECTIVE: To identify the resources for management of abnormal Pap smears and the treatment facilities in pre-invasive cervical neoplasia in the lower southern Thailand. METHODS: After reviewing the necessary data, an expert meeting was scheduled for questionnaire development. The questionnaires were then sent to the general, regional, and university hospitals in the lower southern Thailand for self-evaluation and on-site visits were made for intensive interviews, exploring the services and treatment facilities for women with abnormal Pap smears. RESULTS: All of the 12 target hospitals provided passive cervical cancer screening although the quality of cytological services was obscure and the process of patient notification for the results of the abnormal Pap smears was not convincing. There was a limitation in the pathological laboratory services. The incidence of the abnormal Pap smears in the one-year period of the study, defined as atypical squamous cells of undetermined significance (ASCUS) or above and high grade squamous intraepithelial lesions (HSIL) or above were 1.24% (95% CI 1.15-1.32) and 0.36% (95% CI 0.30-0.43) respectively. All but one hospital reported having a colposcope, but only one could provide standard colposcopy services. The efficiency of the referral system is questionable. CONCLUSION: The resources for the management of abnormal Pap smears as well as the conventional referral system need to be reorganized. The data from this survey support the concept of a centralized colposcopy service with the University hospital as suitable place for the referral center. Two further 2 hospitals have potential for future development as referral centers.

Clinico-pathological profile of vulva cancer in southern Thailand: analysis of 66 cases.

OBJECTIVE: To evaluate the clinico-pathologic findings and treatment outcome of women with vulva cancer in Southern Thailand. MATERIAL AND METHOD: The authors retrospectively reviewed the medical records of 66 women who had been treated with surgery from June 1984 to October 2003 at the Department of Obstetrics and Gynecology, Prince of Songkla University. RESULTS: The patients' age ranged from 30 to 87 years, mean 58.2 years. Two most common presentations were vulva mass (89.4%) and pruritus (57.6%). Duration of symptoms at presentation ranged form 1 month to 5 years. Most cases were squamous cell carcinoma (82.0%). The distribution by FIGO surgical stage I, II, III and IV was 9.1%, 47.0%, 34.8% and 9.1%, respectively. The most common complication was wound infection (45.5%), followed by wound dehiscence, lymphosis and leg edema (each 15.2%). The 5-year survival (and 95% CI) for stages I, II, III and IV was 100%, 96% (76-99%), 94% (63-99%) and 60 (13-88%), respectively. The 5-year survival for node-positive cases was 82% (54-94%) versus 100% for node-negative cases (p = 0.0003). Stage was a significant predictor of survival (p = 0.0142) and disease-free survival (p = 0.0112). CONCLUSION: Stage and nodal involvement are predictors of survival, and stage is a predictor of disease-free survival.