RADICAL HYSTERECTOMY FOR EARLY-STAGE CERVICAL CANCER IN A LOWRESOURCE SETTING: SURGICAL OUTCOMES AND LESSONS FROM A RETROSPECTIVE CROSS-SECTIONAL STUDY.

Abstract

Background: Cervical cancer remains the leading cause of cancer-related deaths among women in low- and middle-income countries, with Sub- Saharan Africa bearing a disproportionate burden. In low-resource settings, cervical cancer often presents at advanced stages due to delayed diagnosis, limiting options for curative surgery.

Objective: This study describes the feasibility and outcomes of radical hysterectomy (RH)-an infrequently performed surgical procedure in our context-for early-stage disease at Lagos State University Teaching Hospital (LASUTH), Nigeria.

Methods: A retrospective review of all radical hysterectomies performed in 2024 at LASUTH included 7 cases (5.3% of 132 cervical cancer evaluations). Radical hysterectomy represented 0.87% of 804 major gynecologic surgeries. Data collected encompassed demographics, operative details, histopathology, and outcomes. Bilateral internal iliac artery ligation was routine. Statistical analysis was descriptive.

Results: The cohort (mean age 48 years, median parity 4) presented after a mean of 28.29 symptom weeks, with 71.4% (5/7) delaying care for more than one month. No patients had prior screening; 28.6% (2/7) wrongly had screening tests requested post-symptom onset. Mean surgery duration was 177.14 minutes and estimated blood loss was 655 mL. Histology showed squamous cell carcinoma (85.7%, 6/7) and adenocarcinoma (14.3%, 1/7). Postoperatively, 28.6% (2/7) had parametrial involvement and 20% (1/5) had nodal metastasis. Adjuvant therapy was initiated in 71.4% (5/7: chemoradiation 42.9%, chemotherapy 28.6%), while 28.6% (2/7) declined due to cost. One post-operative complication of neurogenic bladder (14.3%) was observed, which resolved with conservative management. All patients survived at 12 months.

Conclusion: Despite the small series and short follow-up, our findings suggest that radical hysterectomy is safe and feasible within a tertiary centre in Nigeria. This study also highlights the persisting gaps in cervical cancer screening and timely referral in our setting, which limit the number of women eligible for curative surgery.