Radical Hysterectomy

The first hysterectomy performed was in 1895, for a cervical cancer case by Doctor Clark at Johns Hopkins Hospital. The procedure was developed in Wertheim by a Viennese physician in 1898 by removing the pelvic lymph nodes and within the parametrium. In the 1900s there was a study made on all the patients that undertook such an operation and the mortality rate for such a surgical procedure was up to 18% and the morbidity rate even higher, up to 31%.

Doctor Shauta reported that the vaginal hysterectomy had a much lower mortality rate in comparison with the abdominal approach and as time passed by radiation therapy became more and more favored due to these statistics.

The radical hysterectomy was revolutionized in 1944 when doctor Meigs modified the former operation with the removal of all the pelvic nodes, reporting a 75% survival rate in all the patients with stage I diseases and proved an only 1% mortality rate when the procedures where undertaken by a professional gynecologist.

Throughout the years there have been various developments within the procedure from intensive care, anesthesia to antibiotics and blood product transfusion science. The decrease in cases of invasive cervical cancer led to more therapies led with non surgical procedures and modalities.

The radical hysterectomy was at first the primary treatment in cervical cancer cases because of the absence of other treatments. Adenocarcinoma and squamous cell carcinoma are two of the most common types that will arise within the cervix area. A distal third of the uterus will be the uterine cervix, which will project into the vagina and will continue to the lower uterine segment.

Within the portion of the cervix that will be exposed to the vagina, there will be found squamous epithelium that will transition to the columnar epithelium up to the squamocolumnar junction, where there will be the transformational zone. In this vulnerable region of the cervix most columnar cells are into an ongoing metaplastic change and where most of the cervical diseases will occur.

For the patients that will be in stage of internal bleeding, there are almost equal rates of risks within both types of treatment: the radiation therapy and the surgical procedure. The first type of treatment will be consisting in pelvic teletherapy combined with brachytherapy, which was in the past reserved only for the patients that were medically infirm and had contraindications for surgical procedures.

Sadly, there can be adverse effects from the radiation therapy and they can last up to several years after the treatment was applied and completed. They can include fibrosis, vaginal atrophy, stenosis and also agglutination that can have the ability to affect sexual function.

Also bladder dysfunction can appear or severe vomiting and diarrhea as primary side effects after the treatment. However, there are cases in which the surgical option is preferred having as an outcome a 85% rate of survival, the rest of 15% having post-operative problems due to the increased complications that this situation can present.

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