Outcomes of loop electrosurgical excision procedure for cervical neoplasia in human immunodeficiency virus-infected women.

The objective of this study was to evaluate the treatment outcomes and complications in human immunodeficiency virus (HIV)-infected women undergoing loop electrosurgical excision procedure (LEEP) for cervical neoplasia. The medical record of 60 evaluable HIV-infected women who had abnormal Papanicolaou (Pap) smear and underwent LEEP following colposcopy at Chiang Mai University Hospital between May 1998 and June 2004 was reviewed. Thirty-one (51.7%) had associated genital infection at screening. Twenty-five (41.7%) had opportunistic infection, but only 18 (30.0%) were treated with antiretroviral therapy. The most common abnormal Pap smear was high-grade squamous intraepithelial lesion (46.7%), followed by low-grade squamous intraepithelial lesion (40.0%). Forty (66.7%) women had clear surgical margins after LEEP. Only one (1.7%) woman had severe intraoperative hemorrhage. Early and late postoperative hemorrhage were noted in three (5%) women of each period. Localized infection of the cervix was detected in seven (11.7%) women. Two (3.3%) women developed cervical stenosis at 6 months after LEEP. There was no significant difference in overall complications between HIV-infected women and the control group (P= 0.24). Among 60 HIV-infected women, no statistical difference in the rate of margins involvement (P= 1.00) and complications (P= 0.85) could be demonstrated between HIV-infected women who received antiretroviral therapy and those who did not. Disease-free rate at 6 and 12 months were 97.1% and 88%, respectively. These data demonstrated that LEEP appears to be safe and effective in HIV-infected women.

Risk for radical hysterectomy failure.

During the period from July 1983 to December 1996, 685 patients who underwent radical hysterectomy as their primary treatment for cervical cancer and had optimal follow-up for at least three years were analyzed. Fifty seven patients (8.3%) had pelvic nodes metastasis and received postoperative whole pelvic radiation. Tumor recurrence was noted in 97 cases (14.2%). Nodal metastasis is the most significant prognostic factor for tumor recurrence. Patients with nodal metastasis had 42.1 per cent risk of recurrence compared to 11.6 per cent in those without nodal metastasis. Furthermore; risk of recurrence significantly increased if more than 1 node was involved. Other factors associated with a significantly higher risk of recurrence in multivariate analysis were tumor histology and clinical stage. Patients with nonsquamous cell carcinoma and clinical stage IIa had disease recurrence in 24.4 per cent and 30.3 per cent compared to only 11.7 per cent in squamous and 13.3 per cent in stage Ib. Tumor grade is the significant prognostic factor only in adenocarcinoma cell type but not in squamous cell type.

Well-Differentiated villoglandular adenocarcinoma of the uterine cervix: a report of 15 cases including two with lymph node metastasis.

Well-differentiated villoglandular adenocarcinoma is a recently described subtype of cervical adenocarcinoma. The tumor of this type is reported to have distinct clinicopathologic features and excellent prognosis. However, lymph node metastases of this tumor have been described in few reports. Fifteen cases of well-differentiated villoglandular adenocarcinoma treated at Maharaj Nakorn Chiang Mai Hospital were retrospectively reviewed for both clinical and histopathological features. All patients underwent radical hysterectomy with pelvic lymphadenectomy. In the cases with lymph node metastasis, adjuvant radiation therapy was also given. The patients ranged in age from 22 to 53 years (mean, 39.3). Fourteen patients were FIGO stage IB and one was stage IIA. All patients had exophytic friable cervical masses. Tumor size known in 14 cases ranged from 1.5 to 4 cm (mean, 2.3). Eleven tumors (73.3%) were confined to the inner third of the cervical stroma with 9 of these (60%) showing only superficial invasion (depth < or = 3 mm). The tumors invaded deeply to the middle third in 3 cases (20.0%), and to the outer third in one (6.7%). Lymphatic invasion was observed in 3 cases, two of them had pelvic lymph node metastasis. Both patients had tumors involving deeper than the inner third of the cervical wall. The follow-up duration ranged from 21 to 144 months (mean, 67.5). Four of thirteen cases without nodal metastasis were lost to follow-up 36 to 59 months after surgery. All patients showed no evidence of disease at the last visit. Presence of lymphatic invasion and deep stromal involvement appeared to be the risk factors for lymph node metastasis of well-differentiated villoglandular adenocarcinoma.

Comparative study of bulky stage IB and IA cervical cancer patients treated by radical hysterectomy with and without neoadjuvant chemotherapy: long-term follow-up.

One hundred and ninety patients with bulky (> 3 cm) stage IB and IIA cervical cancer who underwent radical hysterectomy between 1991 and 1994 at Maharaj Nakorn Chiang Mai Hospital were reviewed to determine whether neoadjuvant chemotherapy (NAC) with MVAC (Methotrexate, Vinblastine, Adriamycin, Cisplatin) improved survival. There were 42 patients treated with pre-operataive NAC (MVAC 1-3 courses) and 148 patients treated by primary surgery (PS). In the NAC group, the overall response rate from MVAC was 88.1 per cent with 31.0 per cent having complete clinical response and 7.1 per cent with complete pathological response. Pelvic lymph node metastasis was not significantly different between the NAC group (16.7%) and the PS group (18.2%). At a median follow-up of 64.5 months, 19.0 per cent in the NAC group and 18.2 per cent in the PS group had tumor recurrence. The 5-year progression free and overall survival was 80.8 per cent and 92.0 per cent respectively for the NAC group which was not significantly different from 80.2 per cent and 92.9 per cent respectively in the PS group. In conclusion, although NAC can decrease the tumor size and produce a high response rate, it does not improve survival in bulky stage IB and IIA cervical cancer patients.

Reasons for improper simple hysterectomy in patients with invasive cervical cancer in the northern region of Thailand.

OBJECTIVE: To determine the reasons for improper simple hysterectomy in the presence of invasive cervical cancer. METHODS: The medical records of 70 patients who had undergone simple hysterectomy in the presence of invasive cervical cancer and were referred to Chiang Mai University Hospital between January 1991 and December 1998 were reviewed. RESULTS: Approximately half of the patients presented with abnormal vaginal bleeding. Failure to perform a Papanicolaou smear before the operation accounted for 35.4%. Normal pelvic examination in which no gross invasive tumor was observed accounted for 59%. The most common indications for inappropriate operation was cervical dysplasia. The reasons for inappropriate simple hysterectomy included lack of preoperative cervical cytology (22.8%), incomplete evaluation of cervical dysplasia or microinvasion on biopsy (21.4%), false-negative cervical cytology (18.6%), failure to perform an endocervical curettage following conization (8.6%), emergency hysterectomy (8.6%), failure to perform indicated conization (5.6%), errors in colposcopic examination (4.3%), incomplete evaluation of an abnormal cervical cytology (1.4%), failure to perform endocervical currettage following loop conization (1.4%), failure to review slide (1.4%), failure to check the pathology report (1.4%), failure to biopsy a gross cervical lesion, and skipped lesion in upper part of the endocervix (1.4%). One case of invasive disease was missed for unknown reason. CONCLUSION: Most cases of inappropriate hysterectomy resulted from deviation from guideline for cervical cancer detection. Preoperative Papanicolaou smear and strict adherence to the well-established diagnostic protocol for patients with an abnormal smear are advised to prevent such occurrence.