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Surgery for cervical cancer is limited to small sized tumours of the cervix. Alternatively
chemo-radiotherapy is as effective as surgery but is associated with a different morbidity
profile.
Before the operation imaging (X-ray and CT scan) and blood tests are routine measures
and give useful information prior to surgery. Usually no bowel prep is required.
Please fast at least 6 hours prior to surgery. Please stop smoking before the operation
as it makes your postoperative management much easier.
The procedure requires general anaesthesia. I encourage patients to have an epidural
catheter inserted because it allows for appropriate pain control after the operation.
The procedure is usually carried out by a midline incision and takes 2 to 3 hours.
It entails removal of the cervix and the uterus (ovaries can be preserved in the
vast majority of patients), the tissue beside the cervix (parametria) and the pelvic
lymph nodes. Patients with very early cervical cancer with hardly any invasion of
the cancer into the cervical tissue will not require a lymph node dissection because
the chance of lymph node involvement is extremely low.
There is a chance that I will abandon the procedure if there is evidence of cancer
spread to lymph nodes or to other organs in the abdomen. Then radiotherapy is the
treatment of choice, still aiming for cure.
When you wake up from anaesthesia there will be some lines running in and out of
you. A drip will give you the necessary fluids, a catheter will drain the urine
from your bladder and the epidural catheter will allow for adequate pain control.
An oxygen mask will supply oxygen to the respiratory system. A drain may collect
body fluid from the inside of the abdomen. These lines will be removed once I am
happy that your body functions return to normal, which is usually after 24 to 48
hours. The catheter in the bladder will remain for at least 3-4 days because of
the high chance of bladder dysfunction.
The final histopathological report may take up to one week. It forms the basis for
the decision if any further treatment is required. In up to 15% of the patients
postopoerative radiotherapy is recommended.
Surgery always carries risks. Before surgery, we do everything to minimise these
risks. I give antibiotics before the skin incision in order to avoid skin and other
infections. Commencing prior to surgery I give Heparin or calf compression stockings
, which prevent the formation of blood clots in the legs. At surgery sterile handling
of instruments further reduces the risk of infectious complications. However, there
are some immanent risks of surgery for cervical cancer, you should know about:
Medical and anaesthetic risks associated with general anaesthetic, with epidural analgesia or with postoperative pain control do exist. In patients with pre-existing medical conditions these risks are obviously higher.
There is a risk of injury to pelvic organs, such as the bowel, the bladder, the ureters, blood vessels and nerves. These injuries usually get repaired during surgery. However, in a small proportion of patients these injuries are not recognised during surgery or injuries may even develop after surgery. Then another operation is required to repair those defects. Injury to big blood vessels may result in need of blood transfusion. Injury of nerves is common in patients who require removal of lymph nodes in the pelvis. Many patients will experience some numbness of the skin around the upper thigh.
Bladder dysfunction: Due to the dissection of the tissue around the bladder and the ureter the bladder sensation is disturbed. As a consequence most patients experience difficulties emptying their urinary bladder. Therefore a urinary catheter will stay in the bladder for up to 5 days. If the bladder dysfunction is still present after a week, the patient will be trained to perform self-catheterisation of the bladder. Bladder dysfunction beyond 4 weeks is extremely rare.
Lymph oedema: Lymphatic fluid usually drains from the legs via the lymph glands in the pelvis and the aorta back into the blood circulation. When lymph glands have to be removed, some fluid may accumulate in the legs (lymph oedema). The risk of lymph oedema is around 20% in patients who had to have a lymph node dissection.
If the ovaries were preserved, there is a risk in the range of 10 to 20% to develop ovarian cysts, which subsequently may require surgery.
Other possible complications include ...
Infections to the bladder, the abdominal wound, the lungs with resulting temperatures and septicaemia
Thromboembolic complications (formation of blood clots)
Numbness and swelling to the skin around the incision
Psychosexual changes
You need to stay in hospital for around one week. I recommend to give yourself a
break for the next few weeks. Especially I recommend to avoid intercourse, vaginal
tampons and full baths for the next 6 weeks.
Please notify me immediately if your condition becomes worse after you have been
discharged from hospital.
After surgery, you should be seen regularly for follow-up for at least 5 years. These
examinations will include PAP smears, pelvic examinations and sometimes imaging
methods.
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