The fate of the retained ovaries following radical hysterectomy.

UNLABELLED: The authors studied the function of the preserved ovaries following radical hysterectomy in 65 patients with early stage cervical carcinoma. The ovaries were not displaced and fixed out of the pelvis. Squamous cell carcinoma was diagnosed in 91 cases and adenocarcinoma in 19 cases. Histologic studies of the 110 ovaries removed from 45 patients revealed no metastatic disease. None of the 65 women suffered from recurrent disease. Ovarian function was evaluated by: 1) the presence or absence of postmenopausal symptoms; 2) basal body temperature charts; 3) blood tests for FSH, LH, progesterone, and prolactin; and 4) evaluation of the cervical and vaginal epithelium (vaginal smears). The diagnosis of ovarian failure was based on high levels of FSH (> 30 U/L) on at least three occasions. Basal body temperature studied in 90 cycles of 25 patients revealed various curves indicating occasional anovulatory cycles and luteal-phase deficiency which were confirmed by low serum levels of progesterone. Serum prolactin levels were within the normal range in all cases. Ovarian failure was diagnosed in two instances. Both occurred within three years of radical hysterectomy. Three of the six patients experienced unilateral ovarian cyst formation following surgery, the other three had subsequent unilateral salpingo-oophorectomy at 6, 11, and 24 months after radical hysterectomy.

CONCLUSIONS: Preservation of the ovaries at the time of radical hysterectomy and lymphadenectomy does not seem to compromise patient care. Impaired function or failure of the retained ovaries, however, is not uncommon; close post-treatment surveillance is therefore important in terms not only of recurrent disease but of function of the ovaries as well.