Long term complications after radical hysterectomy with pelvic lymphadenectomy.

OBJECTIVE: To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy. MATERIAL AND METHOD: A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema. RESULTS: Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema. CONCLUSION: Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.

Outcome of recurrent and persistent disease of malignant ovarian germ cell tumor: a retrospective analysis at King Chulalongkorn Memorial Hospital.

Malignant ovarian germ cell tumor has one of the most successful treatment outcomes in gynecological malignancy. More than 80% of the patients can be cured from this rare type of tumor However, patients with recurrent and persistent disease after primary treatment are still the problem of management. The present study has reviewed the treatment outcome of this cancer in King Chulalongkorn Memorial Hospital during the 12 years periodfrom 1993 to 2004. The overall cases of malignant ovarian germ cell tumor were 71 cases, 8 cases had recurrent disease after primary treatment and all cases received platinum-based chemotherapy for the salvage treatment. All patients in this group received long-term survival with median survival time of 87 months. In patients with persistent disease, 10 cases that resisted to first line adjuvant chemotherapy. Cisplatin and Etoposide regimen was applied as second line treatment, but none of these patients received long term response. The survival outcomes in these 2 groups are significantly different. The overall survival from the treatment of malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital was 85.1%. In conclusion, the outcome of treatment in patients with recurrent disease after non-platinum chemotherapy is excellent. Salvage therapy in this group should contain platinum-based regimen. Patients whose disease persisted after platinum-containing regimen had a poor survival outcome.

Malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital.

OBJECTIVES: To determine the frequency, characteristics, treatment and outcome of patients with malignant ovarian germ cell tumor (MOGCT) in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000. STUDY DESIGN: Retrospective descriptive study MATERIAL AND METHOD: All patients with malignant ovarian germ cell tumor in King Chulalongkorn Memorial Hospital during the period January 1992 - December 2000 were analyzed by the characteristics of patients, treatment and outcome. RESULTS: Sixty-six patients with MOGCT were demonstrated in that period with a mean age of 22.6 years old. Most of the patients were nulliparous and premenopausal status. Primary surgery was done in all patients. Forty-two patients (63.6%) received conservative surgery. Eight patients received no adjuvant treatment after surgery due to stage 1A dysgerminoma and immature teratoma stage I grade I. Fifty-six patients received chemotherapy for adjuvant treatment. VAC regimen was given in 27 cases (40.9%) and PVB regimen was given in 25 cases (37.9%). Salvage therapy in the patients with persistent and recurrent disease was treated in 9 patients, who received a platinum-base of regimen. Two-year survival was 88% with the median time to follow up 24 months. Overall five-year survival in the present study was 85%. CONCLUSION: MOGCT in King Chulalongkorn Memorial Hospital had clinical characteristics similar to other studies in malignant ovarian germ cell tumor Treatment by VAC regimen still has benefit in selected group.