Abstract:

Background: Cervical cancer is the fourth common cancer among women worldwide. In developing countries, it remains a major public health burden with more than 85% of all malignancy cases. In Tanzania, it is the leading malignancy in women with approximate 58% of deaths reported annually. Patients presenting in early stage disease can be treated surgically with radical hysterectomy. In Africa limited studies have reported on the outcomes and complications associated with radical hysterectomy.

Objective: The aim of the study was to determine the outcomes of patients undergoing radical hysterectomy for early stage of cervical cancer at Bugando Medical Centre, Mwanza – Tanzania.

Methodology: This study was a 5-year retrospective and prospective case series involving 62 case files and 16 patients with early stage cervical cancer treated with radical hysterectomy at BMC from January 2014 to May 2019. Case files were obtained at BMC medical records and information were extracted and filled in the data collection tool, and the prospective study involved 16 patient who underwent radical hysterectomy from June 2018 to May 2019, who are still on follow up were recruited in this study. Data were analyzed using STATA version 13 according to the study objectives.

Results: During the study period a total of 85 patients underwent radical hysterectomy, seven patients had missing case files, hence only 78 patients were involved in the analysis. Sixty two case files were retrieved retrospectively and 16 patients as prospectively and followed up for a period of 1 month post surgery. The median age was 47.5 [IQR: 42 – 57] years, with the youngest case aged 26 year. Majority of the patients presented with per vaginal bleeding and had more than five children in their life time, 89.5% and 68.0% respectively. Pelvic lymph nodes, parametrial and resected vaginal margins involvement were detected in 12.8%, 10.3% and 23.1% of the patients respectively. Twenty three patients (29.5%) and thirteen patients (16.7%) had intraoperative and postoperative complications respectively. The most intra-operative complication was hemorrhage 14.1%, ureteric injury 7.7%, with operative mortality of 1.3%. The early and late post-operative complication occurred at 12.8% and 9.0%, fistula and bladder dysfunction occurred more frequent at 6.4% in each group respectively. During the study period, the overall survival (OS) rate, disease free survival (DFS) rate and disease recurrence was found to be 92.8%, 81.2% and 11.6% respectively. On fisher’s exact test, tumour size was statistically found to have an association with decrease in survival outcomes and increase in recurrence rate with P – value of 0.019.

Conclusions: Radical hysterectomy is still the preferred treatment for patient with early cervical cancer, with favorable survival outcomes and acceptable surgical morbidity.