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Aiko K, Kanno K, Yanai S, Sawada M, Sakate S, Andou M. Robot-Assisted versus Laparoscopic Surgery for Pelvic Lymph Node Dissection in Patients with Gynecologic Malignancies. Gynecol Minim Invasive Ther 2024; 13:37-42. [PMID: 38487615 PMCID: PMC10936717 DOI: 10.4103/gmit.gmit_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 03/17/2024] Open
Abstract
Objectives The objective of this study was to compare the surgical outcomes for pelvic lymph node dissection (PLND) performed through conventional laparoscopic surgery (CLS) versus robot-assisted surgery (RAS) in patients with gynecologic malignancies. Materials and Methods Perioperative data, including operative time, estimated blood loss, and complications, were retrospectively analyzed in 731 patients with gynecologic malignancies who underwent transperitoneal PLND, including 460 and 271 in the CLS and RAS groups, respectively. Data were statistically analyzed using the Chi-square test or Student's t-test as appropriate. P < 0.05 was considered statistically significant. Results The mean age was 50 ± 14 years and 53 ± 13 years in the RAS and CLS groups (P < 0.01), respectively. The mean body mass index was 23.4 ± 4.8 kg/m2 and 22.4 ± 3.6 kg/m2 in the RAS group and CLS groups (P < 0.01), respectively. The operative time, blood loss, and number of resected lymph nodes were 52 ± 15 min, 110 ± 88 mL, and 45 ± 17, respectively, in the RAS group and 46 ± 15 min, 89 ± 78 mL, and 38 ± 16, respectively, in the CLS group (all P < 0.01). The rate of Clavien-Dindo Grade ≥ III complications was 6.3% and 8.7% in the RAS and CLS groups, respectively (P = 0.17). Conclusion Shorter operative time and lower blood loss are achieved when PLND for gynecologic malignancies is performed through CLS rather than RAS. However, RAS results in the resection of a greater number of pelvic lymph nodes.
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Affiliation(s)
- Kiyoshi Aiko
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Kiyoshi Kanno
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Mari Sawada
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Shintaro Sakate
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Masaaki Andou
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
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2
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Puga O, Retamales J, Saez N, Urzúa M, Saavedra M, Pérez MV, Acuña D, García K. The role of pre-treatment paraaortic surgical staging for cervical cancer in the EMBRACE criteria. Ecancermedicalscience 2022; 16:1463. [PMID: 36819821 PMCID: PMC9934876 DOI: 10.3332/ecancer.2022.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background The State-of-the-Art Treatment for Locally Advanced Cervical Cancer (LACC) is Definite Radio-Chemotherapy based on the Image-guided intensity modulated External beam radiochemotherapy and MRI-based adaptive BRAchytherapy (EMBRACE) trial, according to the FIGO staging. This staging is based on clinical examination and imaging studies; however, there are limitations of imaging techniques which may result in adverse events or death due to insufficient or overtreatment. The aim of the study was to evaluate the feasibility and outcomes of surgical staging in LACC prior to radiotherapy (RT) to personalise target volumes for radiotherapy. Methods From 2008 to 2018, 138 patients with FIGO 2018 stages IB3-IIIC2 cervical cancer underwent a pretherapeutic laparoscopic staging procedure. The pathological diagnosis was compared with the results of preoperative CT scan. Patients were treated with chemoradiotherapy tailored according to the staging results. Results The mean patient age was 43 years, the mean body mass index was 27 kg/m2; most lesions were squamous cervical cancer (92%). Staging CT scan had a 77% concordance with the histological findings. Sensitivity was 29%, specificity 85%, positive predictive value 21% and negative predictive value 89%. Surgical staging led to change of stage in 24% of cases. Para -aortic dissection led to change the initially planned radiotherapy fields in 47% of the cases. Major complications included involuntary section of the inferior mesenteric artery (IMA) without clinical repercussion, an infected retroperitoneal haematoma and a symptomatic lymphocele requiring laparoscopic drainage. Conclusion Laparoscopic staging before primary chemoradiation in patients with LACC was feasible, safe and reproducible, allowing reduction of the radiotherapy treatment volumes of patients.
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Affiliation(s)
- Oscar Puga
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Javier Retamales
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Chilean Cooperative Group for Oncologic Research, Av Jose Manuel Infante 125 Of. 11 - 7500650, Santiago, Chile
| | - Nicolás Saez
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Miguel Urzúa
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Miguel Saavedra
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - María Victoria Pérez
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
| | - Dania Acuña
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile
| | - Karen García
- Unidad Oncología Ginecológica, Complejo Asistencial Sótero del Río, Av Concha y Toro 3459 - 8207257, Santiago, Chile,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Lira 40 - 8330023, Santiago, Chile
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3
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Donna MCD, Sozzi G, Cucinella G, Giallombardo V, Gallotta V, Uccella S, Garzon S, Scambia G, Laganà AS, Chiantera V. Laparoscopic ultra-radical lymph node debulking using Yasargil clamps for gynecological malignancies: results from a large, multicenter, retrospective analysis. J Minim Invasive Gynecol 2022; 29:1083-1091. [DOI: 10.1016/j.jmig.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
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4
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Tshabalala ZN, Human-Baron R, van der Walt S, Louw EM, van Schoor AN. The anatomy of the obturator nerve and its branches in a South African cadaver sample. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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5
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Capozzi VA, Sozzi G, Monfardini L, Di Donna MC, Giallombardo V, Lo Balbo G, Butera D, Berretta R, Chiantera V. Transperitoneal versus extraperitoneal laparoscopic aortic lymph nodal staging for locally advanced cervical cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:2256-2264. [PMID: 33972143 DOI: 10.1016/j.ejso.2021.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Cervical cancer is the fourth most common neoplasm in women. In locally advanced cervical cancers, the international guidelines recommend nodal aortic assessment. Two techniques have been described to perform laparoscopic aortic lymphadenectomy: transperitoneal laparoscopic lymphadenectomy (TLL) and extraperitoneal laparoscopic lymphadenectomy (ELL). This meta-analysis aims to compare the surgical outcomes of TLL and ELL for staging purposes. The systematic review was carried out in agreement with the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). Two hundred and twenty studies were analyzed, and 19 studies were included in the review (7 for TLL and 12 for ELL group). 1112 patients were included in the analysis: 390 patients were included in group 1 and 722 patients in group 2.38 patients (9.7%) in the TLL group and 69 (9.5%) patients in the ELL group developed major complications. The analysis of all complications (intraoperative and postoperative) rate through pooled analysis did not show a significant difference between the two groups (p = 0.979), although a significantly higher intraoperative complication rate (p = 0.018) occurred in the TLL group compared to ELL. No significant differences were found between groups for BMI (p = 0.659), estimated blood loss (p = 0.889), length of stay (p = 0.932), intraoperative time (p = 0.932), conversion to laparotomy rate (p = 0.404), number of lymph node excised (p = 0.461) and postoperative complication (p = 0.291). TLL approach shows a higher rate of intraoperative complications, while no significant difference was found between the two techniques when postoperative complications were analyzed.
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Affiliation(s)
| | - Giulio Sozzi
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | - Vincenzo Giallombardo
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppina Lo Balbo
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Diana Butera
- Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
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6
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Zimmermann JSM, Radosa JC, Radosa MP, Sklavounos P, Schweitzer PA, Solomayer EF. Survey of current practices and opinions of German Society of Gynecologic Endoscopy members regarding the treatment of ovarian neoplasia by robotic surgery. Arch Gynecol Obstet 2020; 303:1305-1313. [PMID: 33201376 PMCID: PMC8286217 DOI: 10.1007/s00404-020-05876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE As data on this topic are sparse and contradictory, we aimed to ascertain the opinions of the members of the German Society of Gynecologic Endoscopy (AGE) regarding the use of robotic surgery in the treatment of ovarian malignancies. METHODS In 2015, an anonymous questionnaire was sent to AGE members to assess their views on the treatment of ovarian malignancies by robotic surgery according to T stage and the current treatment practices in their facilities. RESULTS Of the 228 respondents, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [n = 218 (96%)] respondents reported treating < 10% of their patients using robotic surgery. Respondents felt that T1 and borderline ovarian tumors, but not T2 (51%) or T3/4 (76%) tumors, should and could be treated by robot surgery. 162 (71%) respondents considered the currently available data on this subject to be insufficient, and 42% indicated their willingness to participate in clinical studies on the applicability of robotic surgery to the treatment of T1/2 ovarian tumors. CONCLUSION The majority of AGE members surveyed considered robotic surgery to be an option for the treatment of T1 ovarian malignancies and borderline ovarian tumors. However, prospective randomized studies are needed to determine the relevance of robotic surgery in this context.
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Affiliation(s)
- J S M Zimmermann
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany.
| | - J C Radosa
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - M P Radosa
- Department of Gynecology and Obstetrics, Klinikum Bremen Nord, Bremen, Germany
| | - P Sklavounos
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - P A Schweitzer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
| | - E F Solomayer
- Department of Gynecology and Obstetrics, Saarland University Hospital, Kirrbergerstraße 100, 66421, Homburg, Saar, Germany
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7
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Doğan Durdağ G, Alemdaroğlu S, Yılmaz Baran Ş, Alkaş Yağınç D, Yüksel Şimşek S, Çelik H. Laparoscopic para-aortic lymphadenectomy: Technique and surgical outcomes. J Gynecol Obstet Hum Reprod 2020; 50:101917. [PMID: 32961327 DOI: 10.1016/j.jogoh.2020.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pelvic and para-aortic lymph node dissection is an important part of staging surgery. Aim of this study is to evaluate perioperative outcomes of patients, who underwent laparoscopic para-aortic lymphadenectomy for gynecological cancer in a single center over a period of 7 years, based on body mass index (BMI), and to present the surgical technique in steps. METHODS Data of patients who underwent para-aortic lymphadenectomy at gynecological oncology department of a tertiary center in between March 2013 and July 2020 were analyzed retrospectively. Patients were evaluated in two groups according to their BMI (< 30 kg/m2 as non-obese and ≥ 30 kg/m2 as obese groups). Surgical technique is described in steps. Perioperative outcomes of the two groups were evaluated. RESULTS A total of 230 patients were included in the study. BMI was ≥30 at 58.46 % of the patients. Peri-operative features were not significantly affected by the patient's BMI with the presented surgical technique, however, collected para-aortic lymph node numbers were higher in the group with BMI < 30, though sufficient number of lymph nodes were achieved in both groups. CONCLUSION Although some technical difficulties may be encountered, laparoscopic para-aortic lymphadenectomy is feasable in gynecologic oncological surgery independent of BMI. However, surgical experience is important.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey.
| | - Songül Alemdaroğlu
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Şafak Yılmaz Baran
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Didem Alkaş Yağınç
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Seda Yüksel Şimşek
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Hüsnü Çelik
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
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8
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Šimičević M, Juras J, Lovrić Gršić H, Mikuš M, Planinić P, Ćorić M. Comparison of laparoscopic and laparotomic approach in lymphadenectomy in women with gynaecological cancer. J OBSTET GYNAECOL 2020; 41:329-330. [PMID: 32148157 DOI: 10.1080/01443615.2020.1716312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Maša Šimičević
- Department of Gynaecological Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Josip Juras
- Department of Gynaecological Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Helena Lovrić Gršić
- Department of Gynaecological Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Gynaecological Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Pavao Planinić
- Department of Gynaecological Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Mario Ćorić
- Department of Gynaecological Surgery, University Hospital Center Zagreb, Zagreb, Croatia
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9
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Reyes Claret A, Martínez Canto MC, Robles Gourley A, Llull Gomila M, Martín Jiménez Á. Transperitoneal Laparoscopic Para-Aortic Lymphadenectomy and Body Mass Index: Is It Really a Limiting Factor for the Procedure? J Laparoendosc Adv Surg Tech A 2020; 30:416-422. [PMID: 32023169 DOI: 10.1089/lap.2019.0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To explore if obesity measured by body mass index (BMI) ≥30 kg/m2 represents a limiting factor for para-aortic lymphadenectomy done with a transperitoneal laparoscopic approach. Materials and Methods: Retrospective observational study with 146 consecutive patients, diagnosed with a gynecological cancer submitted to para-aortic surgical staging between January 2010 and December 2018. The mean age was 52 years and the mean BMI was 27 kg/m2. 72.6% (106 patients) had BMI <30 kg/m2 and 27.4% (40 patients) had BMI ≥30 kg/m2. Half of the patients did not have prior abdominal surgeries. Results: The statistical analysis showed that there were no significant differences between two groups depending on their BMI in the lymph node count: BMI <30 kg/m2 14 nodes versus BMI ≥30 kg/m2 10 nodes (P = .122); rate of intraoperative complications: BMI <30: 6.3% versus BMI ≥30: 0% (P = .180), postoperative complications: BMI <30: 6.6% versus BMI ≥30: 5% (P = .723); feasibility rate: BMI <30: 97.1% versus BMI ≥30: 95.6% (P = .063) or the mean hospital stay BMI <30: 2.47 ± 2.05 days (standard deviation [SD]), BMI ≥30: 2.64 ± 0.93 days (SD) (P = .171). The only significant difference observed was due to the operating time: BMI <30: 103.1 ± 60.8 (SD) versus BMI ≥30: 146.9 ± 82.5 (SD) (P = .019), being longer in obese patients. Conclusions: Obesity, estimated by BMI, does not seem to represent a limiting factor for this surgical procedure in our series. We feel it is a feasible and justified approach in obese patients when other surgical procedures have to be carried out in the same surgical act. Probably, other factors and anthropometric measurements are more accurate to select patients in which this approach is feasible.
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Affiliation(s)
- Albert Reyes Claret
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | | | - Ana Robles Gourley
- Obstetrics and Gynaecology Department, Hospital Comarcal d'Inca, Inca, Spain
| | - Marina Llull Gomila
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Ángel Martín Jiménez
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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The impact of complete embedding of remaining tissue in gynecological lymph node dissection specimen in surgical pathology on lymph node yield: is it clinically relevant? Virchows Arch 2018; 473:183-188. [DOI: 10.1007/s00428-018-2363-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/24/2022]
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Report of the survey on current opinions and practice of German Society for Gynecologic Endoscopy (AGE) members regarding the laparoscopic treatment of ovarian malignancies. Arch Gynecol Obstet 2018. [PMID: 29520665 DOI: 10.1007/s00404-018-4709-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this survey was to assess the opinions of members of the German Society of Gynecologic Endoscopy (AGE) regarding the laparoscopic treatment of ovarian malignancies and current practice at their institutions. METHODS Between February and October 2015, the AGE sent an anonymous online survey via mail to its members. The questionnaire solicited participants' opinions about the laparoscopic treatment of ovarian cancers according to T stage and borderline tumors, and information about current practice at their institutions. Participants were also asked their opinions on currently available data on this issue. RESULTS Of 228 AGE members who completed the survey, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [212 (93%)] respondents stated that < 10% of all ovarian cancer cases were currently treated laparoscopically at their institutions. Most participants indicated that T1 (a, b, c) tumors [145 (64%)] and ovarian borderline tumors [206 (90%)], but not T2 [48 (21%)] or T3/4 [9 (4%) ovarian tumors] should or could be treated laparoscopically. One hundred seventy-two (75%) participants considered currently available data on this topic to be insufficient and 152 (66%) stated that they would take part in a clinical trial assessing a laparoscopic approach to T1/2 ovarian cancer. CONCLUSION According to this survey, to the opinion of the majority of AGE members, laparoscopy might be a considerable option for the treatment of early ovarian malignancies and borderline tumors and should be evaluated further in future studies.
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Lee HJ, Lee YH, Chong GO, Hong DG, Lee YS. Comparison of robotic-assisted versus laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy in patients with endometrial cancer. J Obstet Gynaecol Res 2017; 44:547-555. [DOI: 10.1111/jog.13535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Yoon Soon Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
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Lim H, Kim J, Li L, Lee A, Jeong J, Ko J, Lee S, Kweon OK, Kim WH. Bilateral medial iliac lymph node excision by a ventral laparoscopic approach: technique description. J Vet Med Sci 2017; 79:1603-1610. [PMID: 28781294 PMCID: PMC5627336 DOI: 10.1292/jvms.16-0627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to describe a ventral laparoscopic technique for bilateral medial iliac lymphadenectomy in dogs. Twelve intact male purpose-bred research dogs, weighing less than 15 kg, were positioned in dorsal
recumbency, and a 3-portal technique was used. Bilateral dissection was performed with vessel-sealing devices while tilting the surgical table by up to 30° towards the contralateral side of the target medial iliac lymph node
(MILN) without changing the surgeon’s position. Using a ventral laparoscopic approach, bilateral MILNs were identified and excised in all dogs. The mean times for unilateral and bilateral MILN dissections were 9.7 ± 3.8 and 21.0 ±
6.0 min, respectively. The mean times for the right and left MILN dissections were 10.8 ± 4.3 and 9.8 ± 2.5 min, respectively. The mean total surgery time was 43.7 ± 7.7 min. In total, 26 MILNs were dissected. Several
complications, including mild to moderate capillary hemorrhage from perinodal fat and vessels (controlled laparoscopically), mild spleen trauma caused by the first trocar insertion and capsular damage of MILNs, were observed.
However, there were no other major complications. All MILN samples were evaluated and deemed suitable for histopathologic diagnosis. Laparoscopic excision of MILNs is a useful method of excisional biopsy for histopathologic
diagnosis. Using this ventral laparoscopic approach with the 3-portal technique, bilateral MILN dissection suitable for obtaining histopathologic samples could be achieved in a short time in dogs weighing less than 15 kg.
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Affiliation(s)
- Hyunjoo Lim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Jina Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Li Li
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Aeri Lee
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Junemoe Jeong
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Jonghyeok Ko
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Sungin Lee
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
| | - Wan Hee Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research, Institute for Veterinary Science, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 09926, Republic of Korea
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Safety and Feasibility Analysis of Laparoscopic Lymphadenectomy in Pelvic Gynecologic Malignancies: A Prospective Study. Int J Gynecol Cancer 2016; 25:1704-10. [PMID: 26397158 DOI: 10.1097/igc.0000000000000555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The aims of this study were to evaluate prospectively the safety and feasibility of laparoscopic lymphadenectomy in gynecologic oncology and to analyze risk factors associated with surgical adverse events. MATERIALS AND METHODS This study included 444 consecutive laparoscopic lymphadenectomy procedures conducted in 358 consecutive gynecologic oncology patients, between 2007 and 2014. Surgical adverse events were classified into intraoperative, early postoperative (≤6 weeks after surgery), and late postoperative (>6 weeks after surgery). Logistic regression analysis was used to assess the independent effects of different variables on the probability of complications. Differences were considered to be statistically significant for P values less than 0.05. RESULTS Two hundred forty-four pelvic lymphadenectomy and 200 aortic lymphadenectomy procedures were carried out during the studied period. All pelvic lymphadenectomy procedures were conducted with a transperitoneal approach, whereas 94.5% of aortic lymphadenectomy procedures were conducted with an extraperitoneal approach. A total of 52.2% of tumors were found to originate in the cervix, 38% in the endometrium, 6.4% in the ovary, 2.8% were sarcoma, and 0.6% were in a different region. The laparotomy conversion rate was 2.8%. The rate of intraoperative adverse events was 1.9%, the most frequent ones being vascular injuries followed by ureteral, bowel, or neurologic injuries. The rate of early-postoperative adverse events was 3.3%, the most frequent one being incisional hernia followed by hemoperitoneum, pelvic abscess, intestinal injury, and paralytic ileus. One patient with endometrial cancer died after surgery due to sepsis of unknown origin. The rate of late-postoperative adverse events was 3.6% and consisted mainly of symptomatic lymphocele or lymphedema. A logistic regression analysis showed that factors associated with increased risk of lymphadenectomy surgical complications were surgical bleeding and operative time (odds ratio, 2.6; 95% confidence interval, 1.1-6; P = 0.02 and odds ratio, 2.6; 95% confidence interval, 1-6.7; P = 0.04). CONCLUSIONS Laparoscopic lymphadenectomy is a safe and feasible procedure in gynecologic oncology but not free of complications. We postulate that gynecologic oncologists should be properly trained in the management of such complications and be aware of the importance of adequate hemostasis and operating time during surgery.
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Tse K, Ngan HY. The role of laparoscopy in staging of different gynaecological cancers. Best Pract Res Clin Obstet Gynaecol 2015; 29:884-95. [DOI: 10.1016/j.bpobgyn.2015.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022]
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Kim TJ, Yoon G, Lee YY, Choi CH, Lee JW, Bae DS, Kim BG. Robotic high para-aortic lymph node dissection with high port placement using same port for pelvic surgery in gynecologic cancer patients. J Gynecol Oncol 2015. [PMID: 26197858 PMCID: PMC4510339 DOI: 10.3802/jgo.2015.26.3.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective This study reports our initial experience of robotic high para-aortic lymph node dissection (PALND) with high port placement using same port for pelvic surgery in cervical and endometrial cancer patients. Methods Between July 2013 and January 2014, we performed robotic high PALND up to the left renal vein during staging surgeries. With high port placement and same port usage for pelvic surgery, high PALND was successfully performed without repositioning the robotic column. All data were registered consecutively and analyzed retrospectively. Results All patients successfully underwent robotic high PALND, followed by hysterectomy and pelvic lymph node dissection. Median age was 45 years (range, 39 to 51 years) and median body mass index was 22 kg/m2 (range, 19.3 to 23.1 kg/m2). Median operative time for right PALND and left PALND was 37 minutes (range, 22 to 65 minutes) and 44 minutes (range, 36 to 50 minutes), respectively. Median number of right and left para-aortic lymph node by pathologic report was 12 (range, 8 to 15) and 13 (range, 5 to 26). Conclusion With high port placement and one assistant port, robotic high PALND with the same port used in pelvic surgery is feasible to non-obese patients.
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Affiliation(s)
- Tae Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gun Yoon
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yoo Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Hansen HV, Loft A, Berthelsen AK, Christensen IJ, Høgdall C, Engelholm SA. Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures. Eur J Nucl Med Mol Imaging 2015; 42:1833-9. [DOI: 10.1007/s00259-015-3113-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 06/07/2015] [Indexed: 11/29/2022]
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Steffey MA, Daniel L, Mayhew PD, Affolter VK, Soares JHN, Fuller MC. Laparoscopic Extirpation of the Medial Iliac Lymph Nodes in Normal Dogs. Vet Surg 2014; 44 Suppl 1:59-65. [PMID: 24899462 DOI: 10.1111/j.1532-950x.2014.12207.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 04/01/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe a surgical technique for laparoscopic medial iliac lymph node (MILN) extirpation, and to describe the quality of biopsy specimens obtained. DESIGN Experimental study. ANIMALS Purpose-bred male hound-mix research dogs (n = 8). METHODS Dogs were randomized to groups of left or right-sided laparoscopic surgical approaches. Three transperitoneal portals were established with the dogs in lateral recumbency, and ipsilateral MILN dissection was achieved under CO2 pneumoperitoneum using a vessel-sealing device. RESULTS MILN ipsilateral to the approach were successfully identified and removed laparoscopically in 8 dogs. Observed complications included mild to moderate hemorrhage that was controlled laparoscopically in 4 dogs, and tearing of the MILN capsule during retraction and dissection in 3 dogs. No other major complications occurred and all dogs recovered uneventfully. Areas of either minor peripheral (9/9) or central (4/9) pinch artifact affected a median percentage of 5% of surface area (range, 5-30%) of bisected lymph nodes. CONCLUSIONS Laparoscopic MILN extirpation is feasible in dogs with normal MILN and may serve as a minimally invasive approach for excisional biopsy in the diagnostic staging of canine onocologic patients with normal-sized MILN. This lateral laparoscopic approach allows dissection of the ipsilateral MILN but precludes removal of the contralateral MILN. Minimal handling of the lymph node during dissection and removal is required to reduce the risk of capsular tear, or introduction of possible histologic artifact by tissue crush that may impact diagnosis.
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Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California
| | - Leticia Daniel
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California
| | - Verena K Affolter
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Joao H N Soares
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California
| | - Mark C Fuller
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California
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Coronado PJ, Fasero M, Magrina JF, Herraiz MA, Vidart JA. Comparison of perioperative outcomes and cost between robotic-assisted and conventional laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL). J Minim Invasive Gynecol 2014; 21:674-81. [PMID: 24486680 DOI: 10.1016/j.jmig.2014.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To compare perioperative outcomes and cost of robotic-assisted and laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) for treatment of gynecologic malignant conditions. DESIGN Prospective non-randomized study (Canadian Task Force classification II-2). SETTING Tertiary center for women's health. PATIENTS Sixty-two patients with gynecologic cancer operated on by the same surgical team. INTERVENTIONS Thirty-two patients underwent TIPAL via robotic-assisted laparoscopy, and 30 via conventional laparoscopy. Comparison analyses of perioperative outcomes and estimated costs were performed. MEASUREMENTS AND MAIN RESULTS There were no differences between robotic-assisted and laparoscopy insofar as age, body mass index, presurgical morbidity, operating time (92.5 minutes for robotics vs 96.6 minutes for laparoscopy), number of aortic nodes (12 vs. 12), hospitalization stay (2 vs. 2 days), or rate of complications (12.5% vs. 13.3%). Blood loss tended to be lower in the robotic group (75.0 vs. 92.5 mL; p = .08). Surgical cost was higher in the robotic group ($3.42 vs. $2.55; p < .001), although hospitalization cost was similar. CONCLUSION Robotic-assisted and laparoscopy provide similar perioperative outcomes. However, the robotic-assisted approach is associated with higher surgical cost.
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Affiliation(s)
- Pluvio J Coronado
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain.
| | - María Fasero
- Service of Obstetrics and Gynecology, Hospital Sanitas La Zarzuela, Madrid, Spain
| | - Javier F Magrina
- Department of Gynecologic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Miguel A Herraiz
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - José A Vidart
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
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Para-aortic Lymph Node Dissection for Women With Endometrial Adenocarcinoma and Intermediate- to High-Risk Tumors: Does It Improve Survival? Int J Gynecol Cancer 2014; 24:91-6. [DOI: 10.1097/igc.0000000000000008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
ObjectiveLiterature suggests that para-aortic lymphadenectomy (para-aortic lymph node dissection [PALND]) has a therapeutic benefit for women with intermediate- to high-risk endometrial adenocarcinoma. We hypothesized that the observed survival advantage of PALND is a reflection of the general health of the patient rather than a therapeutic benefit of surgery.MethodsWomen with intermediate- to high-risk endometrial adenocarcinoma diagnosed from 2002 to 2009 at a single institution were identified. Medical comorbidities, pathology, and survival information were abstracted from the medical record. The χ2 test or the t test was used for univariate analysis. Overall survival (OS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.ResultsA total of 253 women with a mean age of 64 years were identified. Of these women, 174 had a pelvic lymphadenectomy (pelvic lymph node dissection [PLND]) and 82 had PLND and PALND. The rate of positive nodes was 13% (23/174) for the women who had PLND and was 7% (6/82) for those who had PLND and PALND. Only 1.2% (1/82) of the women who had PLND and PALND had negative pelvic but positive para-aortic nodes. The patients who had PALND had a lower body mass index and were less likely to have significant medical comorbidities. The patients who had PALND had improved 5-year OS (96% vs 82%, P = 0.007) but no difference in 5-year DSS (96% vs 89%, P value = not significant).ConclusionsWomen with intermediate- to high-risk endometrial adenocarcinoma who undergo PALND have improved OS but no improvement in DSS. The lack of difference in DSS supports the hypothesis that underlying comorbidities as opposed to lack of PALND result in poorer outcome.
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Lanowska M, Brink-Spalink V, Mangler M, Grittner U, von Tucher E, Schneider A, Köhler C. Vaginal-assisted laparoscopic radical hysterectomy (VALRH) versus laparoscopic-assisted radical vaginal hysterectomy (LARVH) in the treatment of cervical cancer: surgical results and oncologic outcome. Arch Gynecol Obstet 2013; 289:1293-300. [PMID: 24362556 DOI: 10.1007/s00404-013-3121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the morbidity and survival rates of patients with early-stage cervical cancer treated by vaginal-assisted laparoscopic radical hysterectomy (VALRH) with pair-matched laparoscopic-assisted vaginal radical hysterectomy (LARVH) controls. METHODS One hundred nine patients who underwent VALRH for cervical cancer stage FIGO Ia1, L1 to IIb between 2007 and 2009 and 200 patients who underwent LARVH between 1994 and 2002 were analysed in their entirety and in a group of matched pairs. RESULTS In both groups, there was no conversion to laparotomy due to an intraoperative complication. Prevalence of blood transfusions was significantly lower in the VALRH group (2 vs. 39 patients; P < 0.001). Bladder function resumed sooner (P < 0.001), and patients were discharged earlier after VALRH (P < 0.001). There were no intraoperative injuries in the VALRH group. In the LARVH group, the most common intraoperative injury occurred to the bladder (7.0 %). Postoperatively, the most common complication in the VALRH group was ureterovaginal fistula (2.7 %) and fever (2.7 %) and in the LARVH ureterostenosis (3.5 %), uretero/bladder fistula (1 %), and fever (7 %). For patients with tumour stage Ib1 the 5-year recurrence-free survival was 92.8 % and 5-year overall survival 95.2 % following VALRH and 88.2 and 90.5 %, respectively, following LARVH. No significant difference in the survival rate was found (log rank, P = 0.740). CONCLUSION VALRH is a feasible and oncologically safe surgical option for patients with early-stage cervical cancer. We believe the complication rate is lowered in VALRH by the combination of the laparoscopic and vaginal approach.
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Affiliation(s)
- Malgorzata Lanowska
- Department of Gynecology, Charité-University Medicine Berlin, Campus Mitte and Benjamin Franklin, Charitéplatz 1, 10117, Berlin, Germany,
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Chen CH, Chang WH, Chiu LH, Chiu YH, Wang ID, Yen YK, Liu WM. Surgical advantages of laparoscopic pelvic and para-aortic lymph node dissection using the thermal welding instrument compared with conventional laparotomy for lymph node dissection. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Brockbank E, Harry V, Kolomainen D, Mukhopadhyay D, Sohaib A, Bridges J, Nobbenhuis M, Shepherd J, Ind T, Barton D. Laparoscopic staging for apparent early stage ovarian or fallopian tube cancer. First case series from a UK cancer centre and systematic literature review. Eur J Surg Oncol 2013; 39:912-7. [DOI: 10.1016/j.ejso.2013.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/30/2013] [Accepted: 05/08/2013] [Indexed: 01/29/2023] Open
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Robotic-assisted transperitoneal aortic lymphadenectomy as part of staging procedure for gynaecological malignancies: single institution experience. Obstet Gynecol Int 2013; 2013:931318. [PMID: 23983700 PMCID: PMC3747409 DOI: 10.1155/2013/931318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/24/2013] [Accepted: 06/15/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. This study was designed to confirm the feasibility and safety of robotic-assisted transperitoneal aortic lymphadenectomy as part of staging procedure for gynecologic malignancies. Methods. Chart review of 51 patients who had undergone robotic staging with aortic lymphadenectomy for different gynaecologic malignancies was performed. Results. The primary diagnosis was as follows: 6 cases of endometrial cancer, 31 epithelial ovarian cancer, 9 nonepithelial ovarian cancer, 4 tubal cancer, and 1 cervical cancer. Median BMI was 23 kg/m2. Except for a single case of aortic lymphadenectomy only, both aortic and pelvic lymphadenectomies were performed at the time of the staging procedure. All the para-aortic lymphadenectomies were carried out to the level of the renal veinl but 6 cases were carried out to the level of the inferior mesenteric artery. Hysterectomy was performed in 24 patiens (47%). There was no conversion to LPT. The median console time was 285 (range 195–402) with a significant difference between patients who underwent hysterectomy and those who did not. The median estimated blood loss was 50 mL (range 20–200). The mean number of removed nodes was 29 ± 9.6. The mean number of pelvic nodes was 15 ± 7.6, whereas the mean number of para-aortic nodes was 14 ± 6.6. Conclusions. Robotic transperitoneal infrarenal aortic lymphadenectomy as part of staging procedure is feasible and can be safely performed. Additional trocars are needed when pelvic surgery is also performed.
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Fastrez M, Goffin F, Vergote I, Vandromme J, Petit P, Leunen K, Degueldre M. Multi-center experience of robot-assisted laparoscopic para-aortic lymphadenectomy for staging of locally advanced cervical carcinoma. Acta Obstet Gynecol Scand 2013; 92:895-901. [DOI: 10.1111/aogs.12150] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 04/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Maxime Fastrez
- Obstetrics and Gynecology Department; St Pierre Hospital; University of Brussels; Brussels; Belgium
| | - Frédéric Goffin
- Obstetrics and Gynecology Department; La Citadelle Hospital; University of Liège; Liège; Belgium
| | - Ignace Vergote
- Obstetrics and Gynecology Department and Leuven Cancer Institute; KU/University Hospital Leuven; Leuven; Belgium
| | - Jean Vandromme
- Obstetrics and Gynecology Department; St Pierre Hospital; University of Brussels; Brussels; Belgium
| | - Philippe Petit
- Obstetrics and Gynecology Department; La Citadelle Hospital; University of Liège; Liège; Belgium
| | - Karin Leunen
- Obstetrics and Gynecology Department and Leuven Cancer Institute; KU/University Hospital Leuven; Leuven; Belgium
| | - Michel Degueldre
- Obstetrics and Gynecology Department; St Pierre Hospital; University of Brussels; Brussels; Belgium
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Lambaudie E, Narducci F, Leblanc E, Bannier M, Jauffret C, Cannone F, Houvenaeghel G. Robotically assisted laparoscopy for paraaortic lymphadenectomy: technical description and results of an initial experience. Surg Endosc 2012; 26:2430-5. [DOI: 10.1007/s00464-012-2205-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 01/27/2012] [Indexed: 11/30/2022]
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Höckel M, Horn LC, Tetsch E, Einenkel J. Pattern analysis of regional spread and therapeutic lymph node dissection in cervical cancer based on ontogenetic anatomy. Gynecol Oncol 2011; 125:168-74. [PMID: 22155677 DOI: 10.1016/j.ygyno.2011.12.419] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/25/2011] [Accepted: 12/01/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In cervical cancer lymph node dissection is applied for regional tumor staging. Up to now, the use of (chemo)radiation in the nodal positive patient has prevented the exact pattern analysis of regional tumor spread and the evaluation of the therapeutic role of lymph node dissection. New surgical techniques founded on ontogenetic instead of functional anatomy for the treatment of cervical cancer dispensing with adjuvant radiotherapy offer the possibility to accurately determine the topography of regional lymph node metastases which is the prerequisite for optimized diagnostic and therapeutic lymph node dissection. METHODS Patients with cervical cancer FIGO stages IB-IIB were treated with total mesometrial resection (TMMR) and lymph node dissection after exposing the ontogenetic visceroparietal compartments of the female pelvis. Resected lymph nodes were allocated to regions topographically defined by the embryonic development of the iliac, lumbar and mesenteric lymph systems prior to histopathological assessment. RESULTS 71 of 305 treated patients had lymph node metastases. Topographic distribution of these metastases at primary surgery and analysis of pelvic failures showed a spatial pattern related to the ontogenesis of the abdominopelvic lymphatic system. Five-year locoregional tumor control probability was 96% (95% CI: 94-98) for the whole group and 87% (95% CI: 77-97) for nodal positive patients. CONCLUSIONS The pattern of regional spread in cervical cancer can be comprehended and predicted from ontogenetic lymphatic compartments. In patients with early cervical cancer lymph node dissection based on ontogenetic anatomy achieves high regional tumor control without adjuvant radiation.
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Affiliation(s)
- Michael Höckel
- Department of Gynecology, University of Leipzig, Leipzig, Germany.
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Laparoscopic pelvic lymphadenectomy: experience of a Gynaecological Cancer Centre in the UK. Arch Gynecol Obstet 2011; 285:1133-8. [PMID: 22002408 DOI: 10.1007/s00404-011-2103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 09/29/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The role of laparoscopic lymphadenectomy in the management of gynaecological cancers has been established over the last two decades, having been first described in Dargent and Selvat (L'envahissement ganglionnaire pelvin. Medsi-Mcgraw Hill, Paris, 1989). It has been shown that laparoscopic lymphadenectomy can be performed in the majority of patients and is associated with a low complication rate. However, the technique continues to be undertaken in only a relatively small number of Gynaecological Cancer Centres in the UK owing to the long learning curve and wide variations in training. MATERIALS AND METHODS At the Royal Wolverhampton NHS Trust Gynaecological Cancer Centre in the Greater Midlands Cancer Network laparoscopic lymphadenectomy has been performed since 1999 in the management of early cervical and high grade endometrial cancers. We have undertaken a retrospective audit (1999-2009) of these 42 cases to assess the feasibility of the procedure as well as to assess the complication rate. CONCLUSION We are presenting the first reported series of exclusive laparoscopic transperitoneal lymphadenectomies from a Gynaecological Cancer Centre in the UK.
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Laparoscopic lymphadenectomy for gynecologic malignancies: evaluation of the surgical approach and outcomes over a seven-year experience. Arch Gynecol Obstet 2011; 285:823-9. [DOI: 10.1007/s00404-011-2056-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 08/02/2011] [Indexed: 11/26/2022]
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Zanvettor PH, Filho DF, Neves AR, Amorim MJN, Medeiros SM, Laranjeiras LCF, Morais JA, Araujo IO, Barbosa HS. Laparoscopic surgical staging of locally advanced cervix cancer (IB2 to IVA):initial experience. Gynecol Oncol 2011; 120:358-61. [DOI: 10.1016/j.ygyno.2010.12.335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 12/06/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
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A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer. Am J Obstet Gynecol 2010; 203:483.e1-6. [PMID: 20723873 DOI: 10.1016/j.ajog.2010.06.053] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 05/08/2010] [Accepted: 06/22/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This prospective randomized pilot study compared the use of the Ligaclip (Ethicon Endo-Surgery, Cincinnati, OH) with bipolar coagulation in preventing lymphoceles after laparoscopic pelvic lymphadenectomy for gynecologic cancer. STUDY DESIGN Thirty patients with gynecologic malignancy, who had laparoscopic pelvic lymphadenectomy were randomly assigned for lymphadenectomy in 1 side of the pelvis using the Ligaclip, whereas, in the other side, the bipolar coagulation to seal lymphatic vessels was used. RESULTS At ultrasound examination, we detected lymphocele in 10 patients (33%). Lymphocele developed in 9 (30%) patients on the side where laparoscopic pelvic lymphadenectomy was perfomed using bipolar coagulation, and in 1 (3.3%) patient on the side where laparoscopic pelvic lymphadenectomy was performed using the Ligaclip. Univariate analysis revealed that the Ligaclip's use compared with electrocoagulation in the laparoscopic pelvic lymphadenectomy is an independent predictive factor for development of lymphocele (P = .006). CONCLUSION This study demonstrates that the use of the Ligaclip to close lymphatic vessels may reduce the incidence of lymphoceles in patients undergoing laparoscopic pelvic lymphadenectomy.
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Uzan C, Gouy S, Pautier P, Haie-Meder C, Duvillard P, Narducci F, Leblanc E, Morice P. [Para-aortic lymphadenectomy in advanced-stage cervical cancer: standard procedure in 2010?]. ACTA ACUST UNITED AC 2010; 38:668-71. [PMID: 20965771 DOI: 10.1016/j.gyobfe.2010.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/27/2010] [Indexed: 10/18/2022]
Abstract
With tumour size, node involvement is the most important prognosis factor in advanced stage cervical cancer. Para-aortic (PA) disease is observed in 15 to 30% of these patients. CT scan and magnetic resonance imaging (MRI) are not efficient enough to detect these lesions and PET CT have false negatives. Surgical staging is useful to detect carcinosis associated and to adapt therapy (radiotherapy fields are extended if PA nodes are involved). Laparoscopy was crucial to develop this staging because its morbidity associated to chemoradiotherapy is limited. If prognosis impact of PA lymphadenectomy is well established, therapeutic impact is still discussed. The systematic extension of this staging to pelvic nodes that are included in the basic radiotherapy fields is debated because it does not modify therapeutic management and is morbid. Radiotherapy progress, especially with boost and combination to MRI (MRIT), will impact on future therapeutic management.
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Affiliation(s)
- C Uzan
- Département de chirurgie, institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif cedex, France.
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Kavallaris A, Kalogiannidis I, Chalvatzas N, Hornemann A, Bohlmann MK, Diedrich K. Standardized technique of laparoscopic pelvic and para-aortic lymphadenectomy in gynecologic cancer optimizes the perioperative outcomes. Arch Gynecol Obstet 2010; 283:1373-80. [PMID: 20607263 DOI: 10.1007/s00404-010-1580-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 06/21/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The main objective of this study is to illustrate the effectiveness and the safety of standardized technique of laparoscopic lymphadenectomy (LNE), newly introduced in a University Hospital, in patients with gynecologic malignancy. MATERIALS AND METHODS A cohort of 104 patients with gynaecologic malignancies (71 with endometrial and 33 with cervical cancer), who underwent laparoscopic pelvic with or without para-aortic LNE between September 2008 and March 2010, were analyzed. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH & BSO) was the standard approach for patients with endometrial cancer (n = 71), while laparoscopic (nerve sparing) radical hysterectomy (n = 29), laparoscopic-assisted radical vaginal hysterectomy (n = 2) and radical trachelectomy was the treatment for patients with cervical cancer. All LNE were performed by a learning team under the supervision of an expert surgeon, familiar with the technique. RESULTS The median number of pelvic lymph nodes yielded was 22 (range 16-34) and of para-aortic 14 (range 12-24). The mean operative time ± standard deviation for pelvic LNE for each side was 29 ± 17 and 64 ± 29 min for para-aortic LNE. The overall complication rate was 7.6% (n = 8). Two patients were reoperated laparoscopically, one because of postoperative hemorrhage and the other because of lymphocyst formation; laparoconversion was not necessary. DISCUSSION Laparoscopic lymphadenectomy performed by a learning team with standardized technique is effective with adequate number of harvested nodes, in acceptable operative time and with low rate of perioperative complications.
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Affiliation(s)
- Andreas Kavallaris
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Parkash V, Bifulco C, Feinn R, Concato J, Jain D. To count and how to count, that is the question: interobserver and intraobserver variability among pathologists in lymph node counting. Am J Clin Pathol 2010; 134:42-9. [PMID: 20551265 DOI: 10.1309/ajcpo92dzmucgeuf] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Optimal cancer staging requires retrieval of a minimal number of nodes. However, variability among pathologists in counting on a slide has not been studied. To study the differences in node counting among pathologists, 10 pathologists counted nodes on 15 slides on 2 occasions. They also opined on whether selected "structures" represented countable nodes. There was no slide on which all pathologists agreed on all occasions. The greatest variability was on slides on which the number of nodes exceeded 8. There was disagreement on the size of the smallest countable node, on how to count 2 closely related structures, and when the gross disagreed with the microscopic finding. With a mean count of 5.7 nodes per slide, the 95% confidence interval was +/- 2.6, which could be clinically significant when the count approaches the set minimum. Uniform criteria are necessary to allow for meaningful comparisons between studies on minimal nodal counts for cancer lymphadenectomies.
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Total laparoscopic hysterectomy with pelvic/aortic lymph node dissection for endometrial cancer—a consecutive series without case selection and comparison to laparotomy. Gynecol Oncol 2010; 117:216-23. [DOI: 10.1016/j.ygyno.2009.12.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/27/2009] [Accepted: 12/30/2009] [Indexed: 11/21/2022]
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Seiler R, von Gunten M, Thalmann GN, Fleischmann A. Pelvic lymph nodes: distribution and nodal tumour burden of urothelial bladder cancer. J Clin Pathol 2010; 63:504-7. [PMID: 20364028 PMCID: PMC2981017 DOI: 10.1136/jcp.2009.075077] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aims To evaluate the number of lymph nodes and the lymph node tumour burden in different anatomical pelvic regions to better asses the impact of variations in the extent of lymphadenectomy on reported LN parameters and pelvic tumour clearance. Methods 162 patients with lymph-node-positive urothelial carcinoma of the bladder were treated by cystectomy and extended pelvic lymphadenectomy. Various lymph node parameters were determined separately for the three pelvic regions (external iliac, obturator and internal iliac). Results Of 4080 evaluated lymph nodes (median 25 per patient, range 8–55) 39%, 35% and 26% (p<0.05) were found in the external iliac, obturator and internal iliac region, respectively. The distribution of the 625 lymph node metastases (median two per patient, range 1–35) was not significantly different between the regions (external iliac 33%, obturator 38%, internal iliac 29%). However, the median diameter of largest metastasis and total diameter of all metastases were smallest in the internal iliac region (external iliac 0.85 cm, 1.1 cm; obturator 0.8 cm, 1.0 cm; internal iliac 0.6 cm, 0.8 cm; p<0.03, p<0.05; for median diameter of largest metastasis and total diameter of all metastases, respectively). Metastases in only one region were found in 33% of patients (external iliac 13%, obturator 10%, internal iliac 10%); these three groups showed no significant difference in survival. No difference was detected in lymph node parameters between genders. Conclusions Lymph node counts and retrieval of metastases depends on the extent of pelvic lymphadenectomy. Dissection not including the internal iliac region misses 26% of all pelvic lymph nodes, 29% of metastases, and understages a substantial number of patients as pN0 (10%).
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Affiliation(s)
- Roland Seiler
- Department of Pathology, University of Bern, Switzerland
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Voie d’abord cœlioscopique du curage lombo-aortique. ACTA ACUST UNITED AC 2010; 38:135-41. [DOI: 10.1016/j.gyobfe.2009.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 12/17/2009] [Indexed: 11/19/2022]
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Magrina JF, Long JB, Kho RM, Giles DL, Montero RP, Magtibay PM. Robotic Transperitoneal Infrarenal Aortic Lymphadenectomy. Int J Gynecol Cancer 2010; 20:184-7. [DOI: 10.1111/igc.0b013e3181c208e4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Capmas P, Bats AS, Bensaid C, Huchon C, Scarabin C, Nos C, Lécuru F. Place de la cœlioscopie dans le traitement des cancers de l’endomètre à un stade précoce (stade I). ACTA ACUST UNITED AC 2009; 38:537-44. [DOI: 10.1016/j.jgyn.2009.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 08/24/2009] [Accepted: 09/09/2009] [Indexed: 11/28/2022]
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Chong GO, Park NY, Hong DG, Cho YL, Park IS, Lee YS. Learning Curve of Laparoscopic Radical Hysterectomy With Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer. Int J Gynecol Cancer 2009; 19:1459-64. [DOI: 10.1111/igc.0b013e3181b76640] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mehra G, Weekes A, Vantrappen P, Visvanathan D, Jeyarajah A. Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: morbidity and long-term follow-up. Eur J Surg Oncol 2009; 36:304-8. [PMID: 19800194 DOI: 10.1016/j.ejso.2009.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 08/19/2009] [Accepted: 08/23/2009] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To study the feasibility, morbidity and outcome of cervical cancer patients treated with laparoscopic assisted radical vaginal hysterectomy (LARVH). METHODS The study group included 53 women with cervical cancer (stage-Ib). They included women undergoing LARVH at the joint cancer-centres between 1994 and 2002. Data was collected on operating-time, nodal-yield, hospital-stay, complications recurrence rate and survival rate. The group was followed up until 2006. RESULTS Of 53 women who were selected for LARVH, in 2 women LARVH was abandoned when nodes were positive at frozen section. The median age was 42 years while the operating-time was 210 min with a nodal-yield of 23 and a hospital-stay of 5 days. Final histology revealed 10 women with lympho-vascular invasion, 1 nodal metastases and invasion of parametrium/vagina in 2 women. 7 received adjuvant radiotherapy. 3 had chemo-radiation. Complications included voiding difficulty (6), urinary tract infection (5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late complications included lymphoedema (4), urinary incontinence (4), voiding-problems (2), lymphocyst (1), venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months. 4 women had recurrence, of which 3 women died. The five-year survival was 89%. CONCLUSIONS Vaginal radical hysterectomy with laparoscopic pelvic lymphadenectomy is feasible and safe with regards to mortality and has low morbidity.
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Affiliation(s)
- G Mehra
- Gynaecological Oncology Cancer Centre, St. Bartholomew's Hospital, London, UK.
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Fastrez M, Vandromme J, George P, Rozenberg S, Degueldre M. Robot assisted laparoscopic transperitoneal para-aortic lymphadenectomy in the management of advanced cervical carcinoma. Eur J Obstet Gynecol Reprod Biol 2009; 147:226-9. [PMID: 19786318 DOI: 10.1016/j.ejogrb.2009.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 07/09/2009] [Accepted: 09/07/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Adequate staging of advanced cervical cancer is essential in order to optimally treat the patient. FIGO clinical staging, imaging techniques such as CT scan, MRI and PET sometimes underestimate the extension of tumors. The presence of para-aortic lymph node metastases in advanced cervical cancer identifies patients with poor prognosis who need to be treated aggressively. Laparoscopic para-aortic lymph node dissection is now proposed as a diagnostic tool in many guidelines. We evaluated the feasibility and safety of a robot assisted laparoscopic transperitoneal approach to para-aortic lymph node dissection. STUDY DESIGN Eight patients with advanced cervical carcinoma who were eligible for primary pelvic radiotherapy combined with concurrent cisplatin chemotherapy or pelvic exenteration underwent a pre-treatment robot assisted transperitoneal laparoscopic para-aortic lymphadenectomy. RESULTS We isolated from 1 to 38 para-aortic nodes per patient and had one para-aortic node positive patient who was treated with extended doses of pelvic radiotherapy. We did not encounter any major complications and post-operative morbidity was low. CONCLUSIONS Robot assisted transperitoneal laparoscopic para-aortic lymphadenectomy is feasible and provides the surgeon with greater precision than classical laparoscopy. Larger prospective multicentric trials are needed to validate the generalised usefulness of this technique.
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Affiliation(s)
- Maxime Fastrez
- Obstetrics and Gynecology Department, St Pierre University Hospital, Rue Haute 322, 1000 Brussels, Belgium.
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Pristauz G, Bader AA, Regitnig P, Haas J, Winter R, Tamussino K. How accurate is frozen section histology of pelvic lymph nodes in patients with endometrial cancer? Gynecol Oncol 2009; 115:12-17. [PMID: 19654070 DOI: 10.1016/j.ygyno.2009.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 07/01/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Recent prospective data support the trend towards systematic retroperitoneal lymphadenectomy in patients with high-risk endometrial cancer. Because para-aortic node involvement in the absence of pelvic node involvement is uncommon, a reliable finding of negative pelvic lymph nodes (PLN) at intraoperative frozen section examination might allow omitting para-aortic dissection. We analyzed the diagnostic accuracy of frozen section examination of PLN in patients with endometrial cancer. METHODS We reviewed 131 patients with endometrial cancer who underwent surgery including systematic pelvic lymphadenectomy (n=101) or pelvic and para-aortic lymphadenectomy (n=27). Intraoperative frozen section examination of PLN was performed in 72 (55%) patients. Results of frozen section examination were compared with those of final histopathology and the diagnostic accuracy of frozen section examination of PLN was calculated. One pathologist measured the diameters of PLN metastases retrospectively. RESULTS A total of 1063 and 2666 PLN were analyzed by frozen section examination and by final histopathology, respectively. PLN metastases were found in 7 cases (10%) at frozen section examination, and in 17 cases (24%) at final histopathology (false negative rate, 59%). No false positive cases were noted. The mean diameter of all PLN metastases at final histopathology was 4.3 mm, as compared to 9.0 mm for the metastases detected at frozen section analyses. The mean diameter of PLN metastases missed at frozen section examination was 2.0 mm. CONCLUSION In this review at a single institution, intraoperative frozen section histology missed nearly two of three endometrial cancer patients with positive nodes. These results do not support tailoring the extent of lymphadenectomy according to the results of frozen section examination.
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Affiliation(s)
- Gunda Pristauz
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
| | - Arnim A Bader
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Peter Regitnig
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Josef Haas
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Raimund Winter
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Karl Tamussino
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
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Warwick J, Vardaki E, Fattizzi N, McNeish I, Jeyarajah A, Oram D, Hassan L, Covens A, Duffy S, Reynolds K. Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management strategies. BJOG 2009; 116:1225-41. [PMID: 19485991 DOI: 10.1111/j.1471-0528.2009.02213.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Warwick
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
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Martínez Gómez E, Zapico Goñi Á, Fuentes Castro P, Arnanz Velasco F, Juez Martel P. Cáncer de endometrio en grandes obesas: tratamiento quirúrgico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mortier DG, Stroobants S, Amant F, Neven P, VAN Limbergen E, Vergote I. Laparoscopic para-aortic lymphadenectomy and positron emission tomography scan as staging procedures in patients with cervical carcinoma stage IB2IIIB. Int J Gynecol Cancer 2008; 18:723-9. [PMID: 17868275 DOI: 10.1111/j.1525-1438.2007.01061.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED The objective of this study was to determine the role of laparoscopic lower para-aortic lymphadenectomy and positron emission tomography (PET) scan in the staging of cervical carcinoma. Ninety consecutive patients with FIGO stage IB2-IIIB were scheduled for laparoscopic para-aortic lymphadenectomy. EXCLUSION CRITERIA obvious metastatic para-aortic nodes on computed tomography (CT)/PET or PET-CT. The procedure was stopped when a node was positive on frozen section. In ten patients, no para-aortic lymphadenectomy was performed as scheduled. Forty-seven patients were operated retroperitoneally, 22 transperitoneally, and 21 cases were converted from retroperitoneally to transperitoneally. Median number of removed nodes was 6 (1-24). In 10 of 80 patients, para-aortic metastases were diagnosed. Despite a nonsuspect PET result, 5 of 44 patients had positive para-aortic nodes. Two-year survival was 76% and 16% without and with para-aortic metastases, respectively (P = 0.0001). Laparoscopic para-aortic lymphadenectomy showed metastases in 13% of the patients. In the subgroup with negative PET scan, 11% had metastases. The procedure had a low morbidity and identified a group with an extremely poor prognosis.
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Affiliation(s)
- D G Mortier
- Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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Lim MC, Bae J, Park JY, Lim S, Kang S, Seo SS, Kim JY, Rho JW, Park SY. Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study. J Gynecol Oncol 2008; 19:123-8. [PMID: 19471562 DOI: 10.3802/jgo.2008.19.2.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 05/09/2008] [Accepted: 06/09/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. METHODS From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. RESULTS Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. CONCLUSION Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.
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Affiliation(s)
- Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Semaan AY, Abdallah RT, Mackoul PJ. The role of laparoscopy in the treatment of early ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 2008; 139:121-6. [PMID: 18433977 DOI: 10.1016/j.ejogrb.2008.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/10/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022]
Abstract
Laparoscopic management of early ovarian cancer (EOC) has constituted a controversial issue since it was first described. Recent data reinforced the arguments supporting the use of laparoscopy in the management of EOC. Advances in laparoscopy have enabled surgeons to meet the International Federation of Gynecology and Obstetrics' criteria for staging of EOC. Although most study results are encouraging, the sample size is still too small to be able to draw definite conclusions. Frequently cited concerns such as accuracy of staging, intraabdominal tumor rupture and port site metastasis should not be used as arguments against laparoscopic management of EOC. Clinical evidence is clearly in favor of a larger role for laparoscopy in the management of EOC. This should encourage studies with larger sample sizes to confirm the validity of laparoscopic management of EOC.
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Affiliation(s)
- Assaad Y Semaan
- The George Washington University, Department of Obstetrics and Gynecology, Washington, DC 20037, USA.
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Park JY, Bae J, Lim MC, Lim SY, Seo SS, Kang S, Park SY. Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety. Int J Gynecol Cancer 2008; 18:1202-9. [PMID: 18284455 DOI: 10.1111/j.1525-1438.2008.01190.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety. A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) surgical staging at the Center for Uterine Cancer, National Cancer Center, Korea, between January 2001 and August 2006. During the study period, 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging. No cases were converted from laparoscopy to laparotomy. The two groups were similar in terms of age, body mass index, procedures performed, number of lymph nodes retrieved, and operating time. The laparoscopy group had less estimated blood loss (P = 0.001), faster return of bowel movement (P < 0.001), and a shorter postoperative hospital stay (P = 0.002) compared to the laparotomy group. Transfusions were required only in two laparotomy patients, and postoperative complications occurred only in four laparotomy patients. However, two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease. The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach, and the surgical outcomes were more favorable than laparotomic approach. However, the oncologic safety of laparoscopic staging was not certain. This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer. In the absence of a large prospective trial, this technique should be performed cautiously.
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Affiliation(s)
- J-Y Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Ilsan-gu, Goyang-si, Gyeonggi-do 411-351, Korea
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