C. Kietpeerakool

Twelve years experience with radical hysterectomy and pelvic lymphadenectomy in early stage cervical cancer

The objective of this study was to evaluate the outcome, prognostic factors and complications of early stage cervical cancer patients treated with radical hysterectomy and pelvic lymphadenectomy (RHPL). The medical records of cervical cancer patients undergoing RHPL at Chiang Mai University Hospital over 12 years, between January 1995 and December 2006 were reviewed. There were 1,253 patients in the study period. The mean age was 44 years of age. Of these, 26.9% had prior diagnostic conisation. The maximum tumour size was 8 cm. The most common histology was squamous cell carcinoma (67%) followed by adenocarcinoma (23%). The distribution of FIGO staging was: stage IA 8.7%; stage IB 15.8%; stage IB1 61%; stage IB2 6.2%; and stage IIA 8.5%. Pelvic nodes, parametrial and vaginal margin involvement were detected in 15.9%, 10.7% and 3.8% of the patients, respectively. A total of 66.5% of patients underwent RHPL without adjuvant treatment; 12.1% received neoadjuvant chemotherapy. The estimated 10-year recurrence-free survival rate was 90%. Stage IB2/IIA, non-squamous cell carcinoma, nodal involvement and positive vaginal margins were independent, significant, poor prognostic factors. The most common long-term complication was lymphoedema. It was concluded that early stage cervical cancer patients treated with RHPL have long-term favourable outcome with minimal morbidity. Stage IB2 and IIA, non-squamous cell carcinoma, nodal and vaginal involvement were independent adverse prognostic factors.

An audit of standards of the 'see and treat' approach in women with a high-grade squamous intraepithelial lesion on Pap smears.

Summary This study was undertaken to audit the performances of the ‘see and treat’ approach in women with a high-grade squamous intraepithelial lesion (HSIL) cytology at Chiang Mai University Hospital using selective criteria from the National Health Service Cervical Screening Programme (NHSCSP) 2004 guidelines. Women with a HSIL smear, who had undergone colposcopy and immediate loop electrosurgical excision procedure (LEEP) during June 2006 and September 2008, were reviewed. The standard measurement was determined by the following criteria: (1) the proportion of women treated at the first visit who have evidence of cervical intraepithelial neoplasia (CIN) on histology to be >90%; (2) the primary haemorrhage must be <5%; (3) the proportion of patients admitted as inpatients owing to treatment complication to be <2%. Of 247 women in this study, the histopathological results were as follows: CIN II–III, 188 (76.1%); cancer, 31 (12.6%); adenocarcinoma in situ, 5 (2.0%); CIN I, 5 (2.0%); and no CIN, 18 (7.3%). The prevalence of CIN I or higher was 92.7%. Primary haemorrhage was observed in 13 (5.3%) women. Four (1.6%) women were admitted as inpatients because of LEEP-related complications. In conclusion, the ‘see and treat’ approach in our institute has acceptable overtreatment and complication rates.

Clinicopathologic Predictors of Incomplete Excision After Loop Electrosurgical Excision for Cervical Preneoplasia

The aim of this study was to identify the factors affecting incomplete excision after the loop electrosurgical excision procedure (LEEP) for evaluation and treatment of cervical neoplasia. Patients with abnormal cervical cytology who underwent colposcopy and LEEP at Chiang Mai University Hospital between October 2004 and July 2005, were retrospectively evaluated. During the study period, 201 patients were eligible for analysis. All cone margin involvement was observed in 44% of the patients (95% CI, 37.3-51.4). Multivariate analysis revealed that invasive cancer on cytology (adjusted odds ratio [aOR] =3.05, 95% confidence interval [CI] =1.03 to 9.00; P=0.02), invasive cancer on LEEP histopathology (aOR=9.73, 95%CI =3.95 to 23.9; P<0.001), and a cone length of less than 10 mm (aOR =1.95, 95%CI =1.04 to 3.66; P =0.03) were significant predictors for any cone margin involvement. For endocervical margin involvement, postmenopausal status and a cone length of less than 10 mm were significant predictors of incomplete excision. In contrast to endocervical margin involvement, postmenopausal status was significantly associated with a decreased risk of ectocervical margin involvement. Invasive cancer on histopathology was a significant predictor of both ecto- and endocervical margin involvement. In conclusion, invasive cancer either on cytology or LEEP specimens and a cone length of less than 10 mm are significant predictors of incomplete excision.