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OBJECTIVE: To evaluate the difference between early and delayed removal of indwelling urinary catheter after radical hysterectomy (RH) or radical trachelectomy (RT). METHODS: An ambispective study was conducted in early-stage cervical cancer patients who underwent RH or RT. Delayed indwelling urinary catheter removal occurred on a postoperative day (POD) 7 in the retrospective group (January 2012-November 2013), and early removal occurred on POD 1 in the prospective group (May 2014-June 2017). The postvoid residual (PVR) test was performed after indwelling catheter removal in both groups. RESULTS: Our sample included 47 patients in the delayed group and 48 in the early one. There was no difference in age, body mass index, tumor size, histology, stage, surgical approach, and intraoperative and postoperative complications. Indwelling urinary catheter reinsertion was needed in 16 (34%) patients in the delayed group and 12 (25%) in the early group (P = .37), with no statistical difference between the median PVR volumes -82.5 and 45 mL (P = .06), respectively. Seven (14.9%) patients in the delayed group presented with 30-day urinary tract infection vs two (4.2%) in the early group (P = .09). CONCLUSIONS: Early indwelling urinary catheter removal, in regard to the rate of catheter reinsertion and PVR volume, does not differ from delayed removal.
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Cateteres de Demora , Remoção de Dispositivo , Cateteres Urinários , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologiaRESUMO
BACKGROUND: The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated a higher rate of disease recurrence and worse disease-free survival in patients who underwent minimally invasive radical hysterectomy. OBJECTIVES: To evaluate surgical and oncological outcome of laparoscopic radical hysterectomy performed at Hospital Italiano in Buenos Aires, Argentina. METHODS: This retrospective study included all patients with cervical cancer, 2009 FIGO stage IA1, with lymphovascular invasion to IB1 (<4 cm) who underwent a laparoscopic radical hysterectomy between June 2010 and June 2015. Patients were eligible if they had squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, and no lymph node involvement by imaging. Patients must have undergone a type C1 radical hysterectomy. Only patients who were treated by a laparoscopic approach were included. Patients were excluded if histopathology showed a component of neuroendocrine carcinoma before or after surgery; if they had synchronous primary tumors, history of abdominal or pelvic radiotherapy, or were operated on at an outside institution; and if they had only surgery and no follow-up in our institution. Relapse rate and disease-free survival were evaluated using the Kaplan-Meier method. RESULTS: A total of 108 patients were evaluated. The median age was 41 years (range 27-70). Distribution of histologic sub-types was squamous carcinoma in 77 patients (71%), adenocarcinoma in 27 patients (25%), and adenosquamous carcinoma in four patients (4%). Ninety-nine patients (92%) had stage IB1 tumors and 58 (54%) patients had tumors ≤2 cm. The median surgical time was 240 min (range 190-290), the median estimated blood loss was 140 mL (range 50-500) and the transfusion rate was 3.7%. The median length of hospital stay was 2 days (range 1-11). The median follow-up time was 39 months (range 11-83). The global recurrence rate after laparoscopic radical hysterectomy was 15% (16/108). According to tumor size, the recurrence rate was 12% in patients with tumors ≤2 cm (7/58) and 18% in patients with tumors >2 cm (9/50) (OR=0.76; 95% CI 0.26 to 2.22; p=0.62) The 3- and 5-year relapse rate was 17% (95% CI 11% to 27%). The 3- and 5-year disease-free survival was 81% (95% CI 71% to 88%) and 70% (95% CI 43% to 86%), respectively. Overall survival at 3 years was 87% (95% CI 76% to 93%). CONCLUSION: The recurrence rate after laparoscopic radical hysterectomy was 15%, and in tumors ≤2 cm it was 12%. The 3-year disease-free survival was 81%. Given these results our hospital has changed the approach to open radical hysterectomy.
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Histerectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Argentina/epidemiologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologiaRESUMO
ANTECEDENTES: La histerectomía radical abierta con linfadenectomía pélvica bilateral es el tratamiento estándar para el cáncer de cérvix uterino (CACU) en etapas temprana (1A2-1B1); la histerectomía radical por laparoscopia (HRL) es una opción segura y viable. OBJETIVO: Evaluar la seguridad y la factibilidad de la HRL en un centro hospitalario de atención de cáncer. MÉTODO: Estudio retrospectivo que incluyó 17 pacientes con CACU en etapa temprana intervenidas con HRL entre abril de 2013 y noviembre de 2016 en el Instituto Nacional de Cancerología de México. RESULTADOS: Las 17 pacientes se encontraban en etapa clínica IB1, en 10 (58.8%) fue subtipo epidermoide, en 4 (23.5%) adenocarcinoma y en 3 (17.6%) adenoescamoso. La media de edad fue de 42 ± 8 años. El tamaño del tumor fue de 2.3 ± 0.9 cm, y en el 94.1% los márgenes quirúrgicos estaban libres de enfermedad. El promedio de tiempo operatorio fue de 341 ± 65 minutos, con una pérdida sanguínea de 107 ± 64 ml, no requirieron trasfusión sanguínea y no hubo conversión a cirugía abierta. La media de estancia hospitalaria fue de 2.7 días (rango: 2-7 días). No se presentaron complicaciones intraoperatorias ni posoperatorias. CONCLUSIONES: La HRL es una alternativa segura y confiable para el tratamiento del CACU en etapa temprana. BACKGROUND: Open radical hysterectomy with bilateral pelvic lymphadenectomy is the standard treatment in early stages (1A2-1B1) of uterine cervical cancer (UCC); laparoscopic radical hysterectomy (LRH) is a safe and viable option. OBJECTIVE: To evaluate the safety and feasibility of LRH in a hospital cancer care center. METHOD: Retrospective study that included the first 17 patients with UCC in an early stage operated with LRH in the period from April 2013 to November 2016 at the National Cancer Institute of Mexico. RESULTS: The 17 patients were stage IB1 clinical, of which 10 (58.8%) was epidermoid subtype, 4 (23.5%) adenocarcinoma and 3 (17.6%) adenoescamoso. The mean age was 42 ± 8 years. The tumor size was 2.3 ± 0.9 cm, and in 94.1% the surgical margins were free of disease. The average operative time was 341 ± 65 minutes and blood loss of 107 ± 64 ml, no patient required blood transfusion and there was no case of conversion to open surgery. The average length of hospital stay was 2.7 days (range: 2-7 days). There were no intraoperative or postoperative complications. CONCLUSIONS: LRH is a safe and reliable alternative for the treatment of early stage UCC.
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Histerectomia/métodos , Laparoscopia , Neoplasias do Colo do Útero/cirurgia , Academias e Institutos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Histerectomia/efeitos adversos , México , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologiaRESUMO
STUDY OBJECTIVE: To compare outcomes of radical hysterectomy (RH) across age groups based on surgical approach: minimally invasive surgery (MIS) vs laparotomy (LP). DESIGN: Cross-sectional retrospective review (Canadian Task Force classification II-2). SETTING: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M.D. Anderson Cancer Center. PATIENTS: Patients with early-stage cervical cancer who underwent RH at a tertiary cancer center between 1990 and 2013. INTERVENTIONS: Patients were stratified by age group (<50, 50-59, and ≥60 years) and by surgical approach (minimally invasive surgery [MIS] vs laparotomy [LP]). MEASUREMENTS AND MAIN RESULTS: Patients with early-stage cervical cancer who underwent RH were retrospectively reviewed to obtain demographic data, surgical data, and clinical outcomes. We used the Fisher exact, Wilcoxon rank-sum, and Cochran-Mantel-Haenszel tests to compare categorical and continuous variables stratified by surgical approach and age group. A total of 548 patients were evaluated, including 427 (77.9%) who underwent LP (age <50, 84.3%; 50-59, 11.2%; ≥60, 4.5%) and 121 (22.1%) who underwent MIS (age <50, 71.9%; 50-59, 17.3%; ≥60, 10.8%). In the MIS group, 71 patients (58.7%) underwent laparoscopy and 50 (41.3%) underwent robotic surgery. Patients in the MIS group were significantly older and heavier than those in the LP group. The operative time was significantly longer in the MIS group. There was no between-group difference in intraoperative complications in any of the 3 age groups. LP patients had more infectious complications (respiratory, systemic, and wound) than MIS patients in the <50-year age group (53.3% vs 21.8%). The difference between the LP and MIS groups with respect to the postoperative noninfectious complication rate was greatest in the ≥60-year age group (p = .0324). CONCLUSION: The between-group difference in postoperative noninfectious complication rate in the oldest age group was twice that in either of the other 2 age groups (p = .0324), even though the MIS patients were older, heavier, and had a longer operative time compared with the LP patients.
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Histerectomia , Laparotomia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos , Neoplasias do Colo do Útero/cirurgia , Adulto , Fatores Etários , Estudos Transversais , Feminino , Humanos , Histerectomia/métodos , Laparotomia/métodos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologiaRESUMO
BACKGROUND: Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner. METHODS: A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis. RESULTS: In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy. CONCLUSIONS: This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.
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Adenocarcinoma/cirurgia , Aorta/cirurgia , Carcinoma de Células Escamosas/cirurgia , Histerectomia/mortalidade , Excisão de Linfonodo/mortalidade , Neoplasias Pélvicas/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/patologia , Adulto , Aorta/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Técnicas Imunoenzimáticas , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Pélvicas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/patologiaRESUMO
OBJECTIVE: The goal of our study was to report on the feasibility of outpatient laparoscopic radical hysterectomy in patients with early-stage cervical cancer. METHODS: We included all patients who underwent a laparoscopic radical hysterectomy at the Instituto de Cancerología - Las Americas in Medellin, Colombia, between January 2013 and July 2015. The control group was a similar cohort of patients who were admitted after their surgery. RESULTS: Seventy-six patients were included [outpatient (31) and admitted (45)]. There were no statistically significant differences between groups regarding age, clinical stage, histology, nodal count, need of adjuvant treatment, visual pain scores at discharge or follow up time. All patients underwent a transversus abdominis plane block. The median operative time was 150min (range, 105-240) in the outpatient group vs. 170min (range, 97-300) in the admitted group (p=0.023). The median estimated blood loss was 50ml (range, 20-150) in the outpatient group vs. 120ml (range, 20-1000) in the admitted group (p=0.001). All patients were able to void spontaneously and tolerate a diet before discharge. In patients who were admitted, the median hospital stay was 1day, (range; 1-6), and 39 (87%) were discharged at postoperative day 1. There were 6 postoperative complications, 3 in each group. There were no recurrences in the follow-up period in the outpatient group, and there were 3 (6.6%) recurrences in the admitted group. CONCLUSION: Outpatient laparoscopic radical hysterectomy is feasible and can be performed safely in a developing country in well-selected patients.
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Histerectomia/métodos , Laparoscopia/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Período Perioperatório , Resultado do TratamentoRESUMO
Introducción: el cáncer de cuello uterino continúa siendo un problema de salud en todo el mundo y especialmente en los países subdesarrollados. Objetivo: describir la mortalidad postquirúrgica y sobrevida de las pacientes con diagnóstico de cáncer cervical, con estadio clínico Ia2 y Ib1 que recibieron tratamiento quirúrgico radical. Material y Método: se realizó un estudio descriptivo, retrospectivo de 27 pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología (INOR) de La Habana, durante el período comprendido desde enero del 2002 hasta diciembre de 2007 con este tipo de neoplasia en estadios Ia2 y Ib1, que fueron tratadas quirúrgicamente con histerectomía total abdominal radical con linfadectomia pélvica, (Wertheim-Meigs). Se procedió a la descripción del proceder quirúrgico, determinando el intervalo libre de enfermedad y la supervivencia global a través del método de Kaplan-Meier. Resultados: el 92.6% de las pacientes estudiadas correspondió al estadio Ib1. No hubo mortalidad operatoria. La morbilidad médica estuvo ausente y la quirúrgica involucró a 4 pacientes, en las que la sepsis fue la causa determinante. La enfermedad fue recurrente en 3.7% del total de casos. Se obtuvo un intervalo libre de enfermedad (ILE) global de 96.3% y una sobrevida de 100 % a los 5 años. Conclusiones: la histerectomía radical o ampliada constituyó un método de tratamiento seguro para las pacientes con cáncer de cérvix en este estudio.
Introduction: the cervical cancer is still a health problem in women worldwide, and it remains a one of the leading cause of cancer-related death for. Objective: describe the post-surgical treatment mortality and survival in patients treated with radical hysterectomy, with clinical state Ia2 and Ib1 cancer of the cervix diagnosis. Material and Method: there for a retrospective and descriptive study was conducted, that includes 27 patients with this type of neoplasms, stages Ia2 and Ib1 treated with radical hysterectomy at the Service of Gynecology of the National Institute of Oncology and Radiobiology of La Habana, from 2002 to 2007. The results of the surgical procedure were described, and the disease free interval and the overall survival were determined by the Kaplan-Meier method. Results: 92.6 % of the studied patients corresponded to stage Ib1. There were no operative mortality or medical morbidity and the surgical morbidity affected 4 patients. A predominance of sepsis was observed. The disease recurred in 3.7 % of the total cases. It was obtained a disease free interval global of 96.3 % and a total survival of 100 %. Conclusions: radical hysterectomy is a safe treatment for cervix cancer in our environment.
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BACKGROUND: The aim of the present study was to demonstrate that radical hysterectomy (RH) leads to improved survival outcomes in FIGO stage IB2-IIB cervical cancer when compared with standard brachytherapy (BCT) after identical external beam chemoradiation (EBRT-CT). PATIENTS AND METHODS: EBRT-CT treatment consisted of six courses of cisplatin at 40 mg/m² and gemcitabine at 125 mg/m² per week concurrent with 50.4 Gy of radiation. In the BCT arm, EBRT-CT was followed by BCT to reach a point A dose of 85 Gy, whereas in the experimental arm, a type III RH with bilateral pelvic lymph node dissection and para-aortic lymph node sampling (RH) was carried out within 4-6 weeks after EBRT-CT. RESULTS: Between May 2004 and June 2009, 211 patients were enrolled (BCT, 100 and RH, 111). At a median follow-up time of 36 months (3-80), progression-free survival (PFS) and overall survival (OS) rates were similar in both the arms. PFS rates were 74.8% and 71.7% in the BCT and RH arms [HR 0.6516 (95% confidence interval (CI) 0.3504-1.2116)], P = 0.186. OS rates were 76.3% in the BCT versus 74.5% in the surgical arm [HR 0.6981 (95% CI 0.3106-1.3439)], P = 0.236. No differences were observed in the pattern of local and systemic failures. CONCLUSIONS: This study failed to demonstrate that RH after EBRT-CT is superior to standard BCT.
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Braquiterapia , Cisplatino/uso terapêutico , Desoxicitidina/análogos & derivados , Histerectomia , Neoplasias do Colo do Útero , Adulto , Idoso , Quimiorradioterapia , Desoxicitidina/uso terapêutico , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Radiossensibilizantes/uso terapêutico , Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem , GencitabinaRESUMO
Objetivo: Determinar la factibilidad y seguridad del ganglio centinela (GC) con el uso combinado del mapeo linfático con Tc 99 y la inyección de colorante azul (patent blue) en pacientes con cáncer de cérvix temprano sometidas a histerectomía radical con linfadenectomía pélvica bilateral. Diseño: Estudio prospectivo. Institución: Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú. Participantes: Pacientes con cáncer temprano de cuello uterino. Intervenciones: Entre diciembre de 2003 y diciembre de 2006, 66 pacientes con cáncer temprano de cuello estadios IA2 (n=2), IB1 (n=63) y IIA (n=1) fueron sometidas a detección del ganglio linfático centinela con linfoscintigrafía el día previo a la operación y mapeo linfático intraoperatorio con colorante azul y sonda detectora de radiación gama. El tratamiento quirúrgico se completó con la realización de la histerectomía radical y linfadenectomía pélvica bilateral, por laparotomía. Principales medidas de resultados: Detección de ganglios centinelas. Resultados: En las 66 pacientes estudiadas se detectó 136 ganglios centinelas, con un promedio de 2,06 por paciente. Se utilizó el método combinado (Tc 99 y patent blue). La localización más frecuente fue la región obturatriz con un 69,9% (n=95). Se halló metástasis en los ganglios pélvicos en 11 pacientes, que fueron correctamente localizadas en el ganglio centinela con una sensibilidad de 100%. Cuando el ganglio centinela fue negativo, no se encontró metástasis en los ganglios no centinela (VPN 100%). Conclusiones: La identificación del ganglio centinela con tecnecio-99 combinado con la inyección de colorante azul es factible y mostró un valor predictivo negativo de 100%.
Objective: To determine sentinel node (SN) detection feasibility and safety by using lymphatic mapping with 99m Tc Dextrán and injection of blue dye (patent blue) in patients with early cervical cancer undergoing radical hysterectomy with bilateral pelvic lymphadenectomy. Design: Prospective study. Setting: Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru. Participants: Patients with early cervical cancer. Interventions: Between December 2003 and December 2006, 66 patients with early cervical cancer stages IA2 (n = 2), IB1 (n = 63) and IIA (n = 1) underwent sentinel lymph node detection with lymphoscintigraphy the day before operation and intraoperative lymphatic mapping with blue dye and gamma radiation detection probe. Surgical treatment was completed with radical hysterectomy and bilateral pelvic lymphadenectomy by laparotomy. Main outcome measures: Sentinel node detection. Results: One hundred and thirty-six sentinel nodes were detected in all 66 patients, average 2.06 per patient, by using the combined method 99m Tc dextrán and patent blue. Most common location was the obturator region in 69.9% of cases (n = 95). Pelvic lymph node metastases were found by the sentinel node in 11 patients (sensitivity of 100%). In negative sentinel node cases (55 patients) no metastases were encountered (negative predictive value, NPV = 100%). Conclusions: Sentinel node identification using 99m technetium Dextrán and blue dye injection is feasible and had a negative predictive value of 100%.
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Se revisaron las historias clínicas de 139 pacientes con cáncer de cérvix estadio 18 sometidas a histerectomía radical tipo Wertheim-Meigs, en el Hospital San Vicente de Paúl de Medellín entre 1980 y 1990, con el fin de evaluar los resultados en lo referente a complicaciones derivadas de la cirugía, presencia de lesión cervical residual y recurrencias. La edad promedio de las pacientes fue 39.3 :!: 9.4 años. El tiempo de seguimiento varió entre 0 y 181 meses. El 87.8 por ciento de los tumores fueron epidermoides y el 12.2 por ciento adenocarcinomas. En 101 casos se logró determinar el grado de diferenciación del tumor; fueron bien diferenciados 43 (42.6 por ciento), moderadamente diferenciados 29 (28.7 por ciento) y mal diferenciados 29 (28.7 por ciento). Se encontró compromiso ganglionar pélvico metastásico en 13 pacientes (9.4 por ciento); en 11 de ellas unilateral y en dos bilateral. Quedaron con lesión cervical residual seis pacientes (4.3 por ciento) de las cuales 4 recibieron radioterapia como tratamiento complementario. Las recurrencias se presentaron en 12 de las 100 pacientes seguidas durante un período igualo superior a dos años; siete de ellas aparecieron en los dos primeros años y una se presentó 13 años después de la cirugía. Las recurrencias sucedieron más frecuentemente en las pacientes con tumores mal diferenciados y moderadamente diferenciados. Presentaron complicaciones 43 de las 139 pacientes (30.9 por ciento), entre las cuales predominó la morbilidad infecciosa, expresada en infección urinaria (17 casos), infección de la herida quirúrgica (15 casos) e infección de la cúpula vaginal (14 casos).
A review was made of clinical charts of 139 patients with cancer of the cervix stage IB, treated by Wertheim-Meigs radical hysterectomy, at Hospital San Vicente, Medellín, Colombia, between 1980 and 1990, in order to evaluate results concerning complications derived from surgery, recurrences and residual cervicallesions. Average age was 39.3 ::!: 9.4 years. Follow-up period fluctuated between 0 and 181 months. One hundred and twenty two tumors (87.8%) were epidermoid and 17 (12.2%) adenocarcinomas. The degree of differentiation was determined in 101 cases: 43 (42.6%) were well differentiated, 29 (28.7%) moderately differentiated and 29 (28.7%) poorly differentiated. Metastatic pelvic Iymphnodes involvement was present in 13 patients (9.4%): In 11 of them involvement was unilateral. Residual cervicallesion was left in 6 patients (4.3%) of which 4 received additional treatment with radiotherapy. Recurrences appeared in 12 of the 100 patients followed for 2 or more years; in seven of these the recurrence ocurred in the first two years; there was a recurrence 13 years after surgery. Recurrences happened more often when tumors were poorly or moderately differentiated. Complications, mostly infectious, occurred in 43 patients (30.9%): Urinary tract infections (17 cases), wound infection (15 cases) and infection of the vaginal dome (14 cases) were the most frequently found.