[Endometrial cancer. Clinico-surgical classification and treatment results (analysis of 134 patients)]. / Cáncer del endometrio. Clasificación clínico-quirúrgica y resultados del tratamiento (análisis de 134 pacientes).

The prognostic factors of Endometrial cancer at The General Hospital of Mexico, in accordance with the Surgical Pathologic Staging System of the International Federation of Gynecology and Obstetrics (FIGO, are reported here. One hundred and thirty four patients treated with conventional procedures, were evaluated for end results and in 127 cases, it was applied The Surgical-Pathologic Staging System of The International Federation of Gynecology and Obstetrics (FIGO). We had a follow-up without evidence of disease from 24 months to 10 years with a median of 30 months, in 58/105 adenocarcinomas (55.2%); 5/11 Adenoacanthomas (45.4%) and 4/14 Adenosquamous carcinomas, (28.5%). Same evolution was observed in 36/72 patients with age equal or less than 60 years, (50.0%) and 17/43 with age equal or more than 61 years, (39.5%. Using the current FIGO Staging System, the disease-free Survival was 51.9% (66/127 patients). This number includes 39/51, 76.4% for Stage I, (18/21 Ia, 90%; 13/15 Ib, 86.6% and 8/16 Ic, 50% P = 0.003); 17/23 cases: 73.9% for Stage II, (5/6 IIa, 83.3% and 12/17 IIb, 70.5%); 10/37 cases: 27.0% for Stage III, (5/14 IIIa 35.7%; 2/6IIIb, 33.3% and 3/17 IIc, 17.6%) and 1/17: 5.8% for Stage IV. P = 0.001. The current FIGO Staging System is a useful instrument for predicting natural evolution of endometrial carcinomas. In this series the survival was adversely affected by increasing Stage and age. A poor prognosis in pelvic tumors was related by a deep invasion of myometrial and by parametrial invasion.

[Current status of frequency and complications of pelvic exenterations for recurrent cervico-uterine cancer after radiation]. / Estado actual de frecuencia y complicaciones de exenteraciones pélvicas por cáncer cervico-uterino recurrente a radiación.

Frequency and morbimortality in pelvic exenterations for cervical cancer recurrent after radiation therapy at The Oncology Service, Hospital General de México, SSA., are presented here. Between 1990 to 1994, seventy six patients with this diagnosis, were subjected to surgical exploration with the next findings: forty seven cases, (61.5%) had unresectable tumors; 29, (38.1%) were treated by exenterative procedures: Anterior exenterations, 14, (48.2%); Total exenterations, 13 (44.8%) and Posterior exenteration, 2 (6.8%). Tumor beyond pelvis was the common cause of unresectability in 34 cases, (72.2%) and periaortic lymph node metastases were related with this finding in 29 patients, (61.7%). Thirteen patients with pelvic exenterations, (44.8%) developed postoperative complications between 1 day and seven months after surgery. In seven cases, (24.1%) these complications were considered as minor complications and in six (20.6%) as major complications: Dehiscence of ureteral anastomosis, two cases, (-6.8%); ureterovaginal fistula, two (6.8%); small bowel obstruction, one (3.4%) and Chronic renal failure, one (3.4%). There were no postoperative deaths related to radical surgery in this series. It is concluded that the rate of laparotomies for cervical cancer recurrent after radiation therapy, have decreased in our Service, as compared to previous analysis as well as the rate of postoperative deaths from pelvic exenterations.

[Pelvic exenteration for cancer of the uterine cervix (prognostic factors)]. / Exenteraciones pélvicas por ca. cervicouterino (Factores pronósticos).

The prognostic factors in 104 patients subjected to pelvic exenterations for cervical cancer recurrent after radiation therapy, at The Oncology Service Hospital General de Mexico, S.S., who survived the surgical procedures with a follow-up for three years or more, are presented here. Results were with statistical significance in the next cases: Patients with 35 years old or less, had a better prognosis when compared with the others: 15/22, 68.1%, vs. 36/82, 43.9%, P = 0.03; clinical reports of tumour localized in cervix, 17/22, 77.2%, vs. infiltration of lateral wall of the pelvis: 11/39, 28.2%, P = 0.008. Pyelographic findings of hydronephrosis or renal exclusion: 2/13, 15.3% vs. normal reports: 9/13, 69.2%, P = 0.01. Infiltration of urinary bladder and or rectal wall: 15/41, 36.5% vs. absence of these: 36/63, 57.1%, P = 0.03; tumour involving myometrium with or without ovarian metastases: 2/15, 13.0% vs. absence of these reports: 49/89, 55.5%, P = 0.03 and the absence of lymph metastatic nodes: 40/68, 58.8% vs. the presence of 3 or more positive lymph nodes: 4/15, 26.6%, P = 0.01. In this series we didn't find differences with statistical significance when compared, the modalities of schemes of radiotherapy, the variety of exenterative procedures and the period of time less or more than a year, between the radiotherapy and the surgery.

[Radical hysterectomy for cervix uteri cancer. Experience with 217 patients]. / Histerectomía radical por cáncer cervicouterino. Experiencia con 217 pacientes.

This paper reports an analysis of 217 patients with invasive carcinoma of the cervix, treated with radical histerectomy at The Oncology Service, General Hospital of Mexico. The commonest complications of surgical procedure, were related with the urinary tract: atony bladder observed in 27.6% of patients, vesico-vaginal fistulas in 7.8% and uretero-vaginal fistulas, in 5.5%. Lymph node metastases were present in 20/143, (13.9%) patients classified as belonging to stage Ib and 10/51, (19.6%) of stage IIa, p less than 0.05. After a follow-up period of two years, 92/101, (91%) of patients in stage Ib, 24/32, (75%) in stage IIa, p less than 0.05, 69/73 with tumor less than 2 cm and 111/125, (88.8%) without lymph node metastases, were free of disease. A poor prognosis was related with tumor size of 4 cm or more, 12/18, 66%); adenosquamous carcinomas, (7/11, 63.6%); poorly differentrated carcinomas, (13/20, 65.8%) and lymph node metastases, (8/15, 53.3%).

[Malignant neoplasms of the vulva (analysis of 113 patients)]. / Neoplasias malignas de la vulva (análisis de 113 pacientes).

An analysis of 113 patients with malignant tumors of the vulva seen at The Gynecology Service, Oncology Unit, General Hospital of Mexico, is reported. Mean age the group was 65 years, 91.1% had epidermoid carcinomas and 74.3% were in stages III and IV. Seventy six patients of the overall group, (67.2%) received treament, 67 with surgery, (88.1%) and 9, (11.8%) with palliative radiotherapy. Fifty seven of these, (75.0%) had a follow up that was without evidence of disease from 1 to 10 years (mean 3 year) in 27 patients, (47.3%). Survival by clinical stages was: 1/1 for carcinoma in situ, 3/3 for stage I; 8/10, (80.0%) for stage II; 13/30, (48.3%) for stage III and 1/10. (10.0%) for stage IV. When radical procedures were performed, cancer free survival was: 8/14, (57.1%) for radical vulvectomies and inguinal lymph node dissection, 3/7, (42.8%) for radical vulvectomies combined with inguinal and pelvic lymph nodedissection and 1/6, (16.6%) for more radical procedures. Fifty five per cent of the radiated patients finished their treatment without evidence of cancer. The most important prognostic factors in this series were presence or abscence of lymph node metastases, (7/78, 38.8% vs. 10/10, 76.9%; p less than 0.05) and diameter of the primary lesion. Evolutioned without cancer, 9/12, (75.0%) patients with tumors of 5 cm. or less, versus 8/23, (34.7%) of the others, p less than 0.05.