Radical Hysterectomy: Personal Reflections

INTRODUCTION significant amount of exposure to general surgical techniques both during internship at the University of Pennsylvania Nineteen-hundred ninety-five is an important anniversary Hospital, then in the armed forces, and again during my year. It marks the centennial year since the performance of residency at Penn, where I spent a 4-month rotation on genthe first radical hysterectomy by John Goodrich Clark on eral surgery. In my case, I was very fortunate in that I spent April 26, 1895, at Johns Hopkins Hospital. A second imall of the time during my second year of residency on two portant event in 1895 was the discovery of X rays by Wilgynecologic services where we operated 6 days a week for helm Konrad Roentgen. Three years later Marie Sklodowska the entire year. Curie discovered radium. Thus, the constellation of events Despite the fact that Clark had been Professor of Gynecolnecessary for the successful management of cervical cancer ogy at the University of Pennsylvania from 1899 until his was made available. death in 1927, there never developed a strong tradition or The history of the development of the radical hysterecprogram in the use of radical pelvic surgery for gynecologic tomy is beautifully elucidated by Clark in a chapter from a cancer. After World War II there were a few feeble attempts 1907 textbook edited by Howard A. Kelly entitled ‘‘Gyneat establishing such a program that were soon abandoned cology and Abdominal Surgery.’’ In it, Clark reviewed the for what then was a safer and more effective treatment by historic events leading up to the first abdominal radical hysradiation therapy. terectomy, the technical problems associated with many of In 1954, the late Dr. Michael Newton who was a resident the early cases, and the factors involved in ensuring the with me in Obstetrics and Gynecology and was trained also complete removal of the cancer with maximum safety to the in general surgery was asked to develop a program of radical patient. Various issues were discussed such as pelvic node gynecologic surgery. Unfortunately, after about 6 months in involvement, the need for node removal, and the extent of this position he was offered the post as Chairman of the dissection, and later whether it was reasonable to continue newly developed Department of Obstetrics and Gynecology doing radical hysterectomy in view of the high morbidity at the University of Mississippi and left the University of and mortality observed in some of the early series of cases. In Pennsylvania. In the Spring of 1955 my chief, Dr. Franklin Chapter 16 of Hoskins and Rubin’s recent textbook entitled L. Payne, asked me if I would be willing to undertake the ‘‘Cervical Cancer and Preinvasive Neoplasia,’’ I outlined vacant position. With much trepidation I agreed. Two days the history of the development of radical hysterectomy later, I took the overnight train from Philadelphia to Boston throughout the latter part of the nineteenth century as well to the Pondville State Hospital where I met Dr. Langdon as the early part of the twentieth century. Parsons, whom Dr. Payne had contacted and made arrangements for my arrival. That day was a turning point in my thinking about how radical pelvic surgery should be done. PROLOGUE Dr. Parsons, a superb general and gynecologic surgeon, carI thought it would be helpful to describe the type of experiried out an anterior pelvic exenteration with urinary diverence and training which was available to many of us not sion to an isolated segment of ileum. Just roughly 6 or 7 long after World War II, when upon completion of a year’s hours of observation of this master surgical craftsman taught rotating internship most of us returned to military service me more than I had learned in all the years before. I shall before beginning our residencies in obstetrics and gynecolbe forever grateful to Dr. Parsons for the opportunity he ogy since residency positions were very limited by returning afforded me and for all that I learned on that day. This was essentially my fellowship. veterans who preceded us. This schedule provided me with a