title: Surgical treatment of unexpected invasive cervical cancer found at total hysterectomy.
abstract: OBJECTIVE
  To determine the proper management of patients found to have invasive cancer of the cervix on pathologic examination of a uterus removed for benign indications.
  
  
  METHODS
  We report 18 patients undergoing hysterectomy who were found to have cervical cancer with invasion deeper than 3 mm and/or lymph-vascular space involvement. None had gross residual tumor following simple hysterectomy. All patients underwent a second operation. Seventeen women underwent a radical parametrectomy, upper vaginectomy, and pelvic lymphadenectomy; one had pelvic and periaortic lymphadenectomy alone because of bilateral grossly positive obturator nodes.
  
  
  RESULTS
  Median follow-up was 72 months. One of the 15 women without residual disease or nodal involvement at second operation had pelvic recurrence 66 months after therapy. Three patients with disease identified at radical surgery underwent tailored postoperative pelvic radiation, and two of these had pelvic recurrence. The overall actuarial 5-year survival for the 18 patients was 89%. Operative morbidity was comparable to that of patients undergoing primary radical hysterectomy.
  
  
  CONCLUSIONS
  This study confirms that patients with unexpected invasive cervical cancer found at total hysterectomy can undergo radical re-operation with low morbidity and excellent cure rates.
authors.affiliation: Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange.
authors.forename: J A
authors.initials: JA
authors.lastname: Chapman
authors.forename: R S
authors.initials: RS
authors.lastname: Mannel
authors.forename: P J
authors.initials: PJ
authors.lastname: DiSaia
authors.forename: J L
authors.initials: JL
authors.lastname: Walker
authors.forename: M L
authors.initials: ML
authors.lastname: Berman
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012086:Reoperation; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery