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Carcinoma of the cervix is the commonest malignancy occurring in the female genital tract. There is still much controversy whether the patients with Stage I or II carcinoma of the cervix should be treated by irradiation, primary operation, or a combination of both. Nevertheless, the radical hysterectomy represents one of the accepted and essential methods of treatment. The general use of radical operation should be attributed to Wertheim. Unfort- unately, some of the progagonists state that the radical operation is inadequate unless a significant number of fistulas occur. Some others have refuted this concept by reporting excellent results showing a fistula incidence of 5~10% after Wertheim-meigs`hysterectomy. Thus it appears possible, without compromising the operation, not only to reduce the frequency of fistulas but also to reduce the frequency of other complications that are responsible for the morbidity and mortality associated with radical gysterectomy. We used to have this in selected patients with carcinoma of the cervix since 1959. The present report deals especially with the morbidity and complications after 316 consecutive radical gysterectomies with pelvic lymphadenectomy. Several surgeons in our hospital performed these operations during the past 13 years, since the start of the National Medical Center, using ordinary radical hys- terectomy with pelvic lymphadenectomy, and also the so-called mitra operation in 3 cases. The results were as follows: 1. During 13 years, 437 patients were operated upon and 389 of these(89.0%) have been reviewed and analyzed. The remaining 48 patients(11.0%) were not available for review and consequently excluded. 2. The age distri8bution among the 389 patients ranged from 27 to 69 years, with the maximum incidence at 30-39 years(45%), for carcinoma in situ and 40-49 (50.3%) for invasive carcinoma. 3. Regarding the histological type, squamous-cell carcinoma comprised the great majority(94.3%), while adenocarcinoma and adenosquamous carcinoma occurred in 5.2% and 0.5% respectively. 4. All of the Stage 0 patients were treated with simple total hysterectomy, ext- ended total hysterectomy, cold conization of high amputation of the cervix. Twenty-six patients(6.7%) of more advanced carcinoma were referred to radiation therapy after an exploratory laparotomy. Only 316 patients(81$) of Stage I, II and 2 selected cases of Stage III were treated with radical hysterectomy and pelvic lymphadenectomy and the Mitra operation. 5. Hypertensive disease was the commonest additional medical condition in our series. The overall incidence of cervical cancer associated with pregnancy was 2.8% or 1:1655 deliveries. One patient(0.3%) had a carcinoma combined with a uterine prolapse. 6. Distinct relationship was seen between the morbidity and the number of trans- fusions given during operation. 7. Considering the duration of operation and the morbidity, there was also a significant relationship. If the operation required less than 3 hours, 3 to 4 hours, 4 to 5 hours, more than 5 hours, the morbidity rate was 21.6%, 23.9 %, 34.7% and 40.7% respectively. Average duration of operation was about 3 hours and 30 minutes. 8. The most frequent immediate complication was urinary tract infection(37.3%) and more than one third of the causative organisms was E.coli. Two patients(0.6%) died of postoperative bleeding on the day of operation and on the first postoperative day, respectively. Cardiac failure developed in one patient with active pulmonary tuberculosis, with death on the second postoperative day and the another during operation. The overall mortality rate was thus 1.3%.
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