Dangers. The chief risks of the operation are sepsis, cancer-infection, and injury to the ureters.
The ureters have proved a fertile source of trouble because they are deliberately exposed in the course of the operation, and they are sometimes accidentally divided. It is not uncommon to find a ureter completely blocked by cancer, and occasionally the ureter, after being bared by the operator, undergoes necrosis a few days later.
Wertheim points out that in some instances ureteral fistulæ due to necrosis may be induced to close by the application of iodine or sulphate of copper. It is, however, unfortunately true that many patients with ureteral fistulæ after the radical operation have been obliged to undergo nephrectomy (see [p. 112]).
The ‘radical operation’ for cancer of the neck of the uterus is on its trial in Great Britain. The operative mortality is very high, and no reliable returns concerning the remote results are at present available.
Hysterectomy for cancer of the body of the uterus. The most satisfactory method of dealing with cancer arising in the corporeal endometrium consists in performing total abdominal hysterectomy (see [p. 40]), removing not only the uterus and its neck, but both ovaries, Fallopian tubes, mesometria, and any enlarged lymph glands that are detected. In the course of the operation the surgeon should avoid any undue handling of the uterus, and, in withdrawing it from the pelvis, care should be taken not to infect the operation area with any fluid or semi-fluid stuff which is liable to escape from the cervical canal.
Fig. 19. Cancer of the Uterus. Coronal section through a uterus affected with primary cancer of the corporeal endometrium. The mass measured 10 centimetres transversely and 12 centimetres vertically. Removed by abdominal hysterectomy. Two-thirds size.
There is a rare variety of cancer of the corporeal endometrium, namely, that which attacks small atrophic uteri. These small uteri may sometimes be extirpated by the vagina, but often the narrowness of the vagina in aged spinsters compels the surgeon to resort to the abdominal route.
Cancer of the body of the uterus occasionally causes such enlargement of this organ as to render its removal by the vaginal route difficult as well as undesirable. When this form of cancer is complicated with fibroids, as a rule, vaginal hysterectomy is impracticable.
Cancer of the body of the uterus is more frequent in spinsters and barren wives than in multiparæ; for this reason the cancer often assumes the massive form, because the cervical canal being narrow, pathogenic micro-organisms do not obtain such free ingress as in the case of women with a patulous canal. In some instances the cancerous mass will expand the uterine cavity and lead to thinning of the walls as in Fig. 19.