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Gil-Ibañez B, Gil-Moreno A, Torné A, Martín Jimenez A, Gorostidi M, Zapardiel I, Tejerizo Garcia A, Diaz-Feijoo B. Tumor Size and Oncological Outcomes in Patients with Early Cervical Cancer Treated by Fertility Preservation Surgery: A Multicenter Retrospective Cohort Study. Cancers (Basel) 2022; 14:2108. [PMID: 35565238 PMCID: PMC9105143 DOI: 10.3390/cancers14092108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The aim of this study was to analyze the impact of tumor size > 2 cm on oncological outcomes of fertility-sparing surgery (FSS) in early cervical cancer in a Spanish cohort. Methods: A multicenter, retrospective cohort study of early cervical cancer (stage IA1 with lymphovascular space invasion -IB1 (FIGO 2009)) patients with gestational desire who underwent FSS at 12 tertiary departments of gynecology oncology between 01/2005 and 01/2019 throughout Spain. Results: A total of 111 patients were included, 82 (73.9%) with tumors < 2 cm and 29 (26.1%) with tumors 2−4 cm. Patients’ characteristics were balanced except from lymphovascular space invasion. All were intraoperative lymph node-negative. Median follow-up was 55.7 and 30.7 months, respectively. Eleven recurrences were diagnosed (9.9%), five (6.0%) and six (21.4%) (p < 0.05). The 3-year progression-free survival (PFS) was 95.7% (95%CI 87.3−98.6) and 76.9% (95% CI 55.2−89.0) (p = 0.011). Only tumor size (<2 cm vs. 2−4 cm) was found to be significant for recurrence. After adjusting for the rest of the variables, tumor size 2−4 cm showed a Hazard Ratio of 5.99 (CI 95% 1.01−35.41, p = 0.036). Conclusions: Tumor size ≥ 2 cm is the most important negative prognostic factor in this multicenter cohort of patients with early cervical cancer and gestational desire who underwent FSS in Spain.
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Affiliation(s)
- Blanca Gil-Ibañez
- Gynecological Oncology and Minimally Invasive Surgery Unit, Department of Obstetrics and Gynecology, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Antonio Gil-Moreno
- Gynecological Oncology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, 28041 Madrid, Spain
| | - Aureli Torné
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.T.); (B.D.-F.)
| | | | - Mikel Gorostidi
- Obstetrics and Gynecology, Hospital Universitario de Donostia, 20014 San Sebastian, Spain;
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain;
| | - Alvaro Tejerizo Garcia
- Gynecological Oncology and Minimally Invasive Surgery Unit, Department of Obstetrics and Gynecology, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (A.T.); (B.D.-F.)
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Vaginal fertility-sparing surgery and laparoscopic sentinel lymph node detection in early cervical cancer. Retrospective study with 15 years of follow-up. Eur J Obstet Gynecol Reprod Biol 2020; 251:23-27. [PMID: 32480177 DOI: 10.1016/j.ejogrb.2020.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the oncological outcomes of vaginal fertility-sparing surgery plus laparoscopic sentinel lymph node biopsy in patients with early cervical cancer over a 15-years period. PATIENTS AND METHODS From March 2005 to April 2018, 38 patients diagnosed with early stage cervical cancer underwent vaginal fertility-sparing surgery at the Hospital Clínic, Barcelona, Spain. Patients with FIGO stage IA1 with lymphovascular space invasion and stage IA2 underwent simple trachelectomy and patients with stage IB1 underwent radical vaginal trachelectomy. All cases underwent laparoscopic sentinel lymph node biopsy. In the first 19 cases, laparoscopic bilateral pelvic lymphadenectomy was completed immediately after sentinel lymph node biopsy. Clinical and oncological follow-up data were collected. RESULTS The median age at diagnosis was 33.5 years (range 22-44). Simple trachelectomy was performed in seven cases (18.4%) and vaginal radical trachelectomy in 31 (81.6%). Nineteen patients were exclusively treated with laparoscopic sentinel lymph node biopsy and 19 with sentinel lymph node biopsy plus laparoscopic bilateral pelvic lymphadenectomy. There were no significant differences between the two lymph node assessment groups regarding histology and tumour size. The median follow-up was 73 months (range 1-160 months). There were 4 recurrences (3 patients with IB1 and 1 with IA2). Two occurred in the sentinel lymph node biopsy group and 2 in the sentinel lymph node biopsy plus laparoscopic bilateral pelvic lymphadenectomy group. All the recurrences were diagnosed in patients with adenocarcinoma and in 3 patients without lymphovascular space invasion. CONCLUSION Vaginal fertility-sparing surgery combined with laparoscopic sentinel lymph node biopsy seems to be a safe oncological procedure in selected patients with early stage cervical cancer. Further studies are needed to clarify the role of sentinel lymph node biopsy in fertility- sparing surgery in cervical cancer. Adenocarcinoma histology seems to be an important risk factor for recurrence.
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Prodromidou A, Iavazzo C, Fotiou A, Psomiadou V, Douligeris A, Vorgias G, Kalinoglou N. Short- and long term outcomes after abdominal radical trachelectomy versus radical hysterectomy for early stage cervical cancer: a systematic review of the literature and meta-analysis. Arch Gynecol Obstet 2019; 300:25-31. [PMID: 31062151 DOI: 10.1007/s00404-019-05176-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/24/2019] [Indexed: 12/09/2022]
Abstract
PURPOSE Cervical cancer (CC) ranks 2nd for mortality among women of reproductive age in the United States. Abdominal radical trachelectomy (ART) is a fertility sparing approach that has been proposed in women with early stage CC who wish to preserve their fertility. The aim of the present meta-analysis was to evaluate the short- and long-term outcomes of RH vs ART for early stage CC. METHODS A total of 5 electronic databases were searched for articles published up to December 2018. Prospective and retrospective trials reporting outcomes for women who underwent ART or RH for the management of early stages CC, were considered eligible for inclusion. Statistical meta-analysis was performed using the RevMan 5.3 software. RESULTS A total of 5 studies which included 840 women who underwent ART or radical trachelectomy (RH) were included in the present meta-analysis. Among them, 324 underwent ART whereas the remaining 516 had RH. Despite the fact that ART was associated with significantly prolonged operative time compared to RH (840 patients MD 36.82 min, 95% CI 20.15-53.49, p < 0.001), neither 5-year OS nor 5-year DFS were different among the two groups (714 patients OR 1.39, 95% CI 0.53-3.62, p = 0.51 and 682 patients OR 1.08, 95% CI 0.52-2.25, p = 0.84, respectively). CONCLUSIONS ART is a more complex and time consuming technique, but equally safe compared to RH in terms of oncological outcomes for selected women with early stage CC and allows for more CC survivors of childbearing age to preserve their fertility.
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Affiliation(s)
- Anastasia Prodromidou
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece.
- Department of Surgical Oncology, Metaxa Memorial Anticancer Hospital, Mpotasi 51, Piraeus, Greece.
| | - Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Alexandros Fotiou
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Victoria Psomiadou
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Athanasios Douligeris
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Georgios Vorgias
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Nikolaos Kalinoglou
- Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
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Matsuo K, Chen L, Mandelbaum RS, Melamed A, Roman LD, Wright JD. Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy. Am J Obstet Gynecol 2019; 220:469.e1-469.e13. [PMID: 30802438 DOI: 10.1016/j.ajog.2019.02.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/19/2019] [Accepted: 02/18/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND A recent trial demonstrated decreased survival in women with early-stage cervical cancer who underwent radical hysterectomy via minimally invasive surgery compared with laparotomy; however, outcomes following trachelectomy have yet to be studied. OBJECTIVE To examine trends, characteristics, and survival of reproductive-aged women with early-stage cervical cancer who underwent minimally invasive trachelectomy. STUDY DESIGN This is a retrospective study examining the National Cancer Database between 2010 and 2015. Women aged <50 years who underwent trachelectomy for stage IA2-IB cervical cancer were grouped by mode of surgery. Clinicopathologic characteristics and outcomes were compared between minimally invasive surgery and laparotomy groups. RESULTS A total of 246 women were included, 144 (58.5%, 95% confidence interval, 52.4%-64.7%) of whom had trachelectomy with a minimally invasive surgery approach. Median age was similar between the minimally invasive surgery and laparotomy groups (median, 31 vs 29 years, P = .20). There was a significant increase in the use of minimally invasive surgery from 29.3% in 2010 to 75.0% in 2015 (P < .001). Specifically, minimally invasive surgery became the dominant approach for trachelectomy by year 2011 (54.8%). Hospitals registered in the West (75.0% vs 25.0%) were more likely, whereas those registered in the Midwest (46.9% vs 53.1%) were less likely, to perform minimally invasive surgery (P = .02). Median follow-up was 37 months (interquartile range, 23-51) for the minimally invasive surgery group and 40 months (interquartile range, 26-67) for the laparotomy group. During follow-up, there were 11 (5.3%) deaths, 4 (3.5%) in the minimally invasive surgery group and 7 (7.6%) in the laparotomy group (P = .25). CONCLUSION Minimally invasive surgery has become the dominant modality for trachelectomy in reproductive-aged women with stage IA2-IB cervical cancer after year 2011. Survival of women with stage IA2-IB cervical cancer who underwent trachelectomy is generally good regardless of surgical modality. Although our study showed no difference in survival between the minimally invasive surgery and laparotomy approaches, effects of MIS on survival remain unknown and further study is warranted.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Ling Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Salvo G, Ramirez PT, Leitao M, Cibula D, Fotopoulou C, Kucukmetin A, Rendon G, Perrotta M, Ribeiro R, Vieira M, Baiocchi G, Falconer H, Persson J, Wu X, Căpilna ME, Ioanid N, Mosgaard BJ, Berlev I, Kaidarova D, Olawaiye AB, Liu K, Nobre SP, Kocian R, Saso S, Rundle S, Noll F, Tsunoda AT, Palsdottir K, Li X, Ulrikh E, Hu Z, Pareja R. International radical trachelectomy assessment: IRTA study. Int J Gynecol Cancer 2019; 29:635-638. [PMID: 30765489 DOI: 10.1136/ijgc-2019-000273] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Radical trachelectomy is considered a viable option for fertility preservation in patients with low-risk, early-stage cervical cancer. Standard approaches include laparotomy or minimally invasive surgery when performing radical trachelectomy. PRIMARY OBJECTIVE To compare disease-free survival between patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive (laparoscopic or robotic) radical trachelectomy. STUDY HYPOTHESIS We hypothesize that minimally invasive radical trachelectomy has similar oncologic outcomes to those of the open approach. STUDY DESIGN This is a collaborative, multi-institutional, international, retrospective study. Patients who underwent a radical trachelectomy and lymphadenectomy between January 1, 2005 and December 31, 2017 will be included. Institutional review board approval will be required. Each institution will be provided access to a study-specific REDCap (Research Electronic Data Capture) database maintained by MD Anderson Cancer Center and will be responsible for entering patient data. INCLUSION CRITERIA Patients with squamous, adenocarcinoma, or adenosquamous cervical cancer FIGO (2009) stages IA2 and IB1 (≤2 cm) will be included. Surgery performed by the open approach or minimally invasive approach (laparoscopy or robotics). Tumor size ≤2 cm, by physical examination, ultrasound, MRI, CT, or positron emission tomography (at least one should confirm a tumor size ≤2 cm). Centers must contribute at least 15 cases of radical trachelectomy (open, minimally invasive, or both). EXCLUSION CRITERIA Prior neoadjuvant chemotherapy or radiotherapy to the pelvis for cervical cancer at any time, prior lymphadenectomy, or pelvic retroperitoneal surgery, pregnant patients, aborted trachelectomy (intra-operative conversion to radical hysterectomy), or vaginal approach. PRIMARY ENDPOINT The primary endpoint is disease-free survival measured as the time from surgery until recurrence or death due to disease. To evaluate the primary objective, we will compare disease-free survival among patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive radical trachelectomy. SAMPLE SIZE An estimated 535 patients will be included; 256 open and 279 minimally invasive radical trachelectomy. Previous studies have shown that recurrence rates in the open group range from 3.8% to 7.6%. Assuming that the 4.5-year disease-free survival rate for patients who underwent open surgery is 95.0%, we have 80% power to detect a 0.44 HR using α level 0.10. This corresponds to an 89.0% disease-free survival rate at 4.5 years in the minimally invasive group.
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Affiliation(s)
- Gloria Salvo
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Leitao
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - David Cibula
- General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Gabriel Rendon
- Instituto de Cancerologia de las Americas, Medellin, Colombia
| | - Myriam Perrotta
- Ginecologia y Obstetricia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Reitan Ribeiro
- IOP Instituto de Oncologia do Parana, Curitiba, Brazil.,Hospital Erasto Gaertner, Curitiba, Brazil
| | | | | | | | | | - Xiaohua Wu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mihai Emil Căpilna
- First Clinic of Obstetrics and Gynecology, University of Medicine and Pharmacy of Târgu Mureş, Târgu Mureş, Romania
| | - Nicolae Ioanid
- The Regional Institute of Oncology of Iasi, Iasi, Romania
| | | | - Igor Berlev
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Dilyara Kaidarova
- Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
| | | | - Kaijiang Liu
- RenJi Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Roman Kocian
- General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Srdjan Saso
- Department of Gynecologic Oncology, Imperial College London, London, UK
| | | | - Florencia Noll
- Ginecologia y Obstetricia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Audrey Tieko Tsunoda
- IOP Instituto de Oncologia do Parana, Curitiba, Brazil.,Hospital Erasto Gaertner, Curitiba, Brazil
| | | | - Xiaoqi Li
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Elena Ulrikh
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Zhijun Hu
- RenJi Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rene Pareja
- Oncological surgery, Clinica Astorga, Envigado, Colombia.,Instituto Nacional del Cancer, Bogota, Colombia
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Kisu I, Banno K, Matoba Y, Adachi M, Aoki D. Basic research on uterus transplantation in nonhuman primates in Japan. J Obstet Gynaecol Res 2018; 44:1871-1881. [PMID: 29974599 DOI: 10.1111/jog.13724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/01/2018] [Indexed: 12/15/2022]
Abstract
Uterus transplantation (UTx) is now a potential option for women with uterine factor infertility to have a child. However, UTx is still in an experimental stage and basic animal studies including in nonhuman primates are needed for accumulation of data that will provide important information for establishment of UTx in humans. Herein, we summarized our experiences using cynomolgus macaques, with the goal of promoting further development of UTx studies in nonhuman primates. Our basic studies using cynomolgus macaques were summarized, including the results of other teams in nonhuman primates. Our team in Japan launched UTx research in 2009 using cynomolgus macaques and has accumulated a large archive of results in the UTx research field, including examination of uterine blood flow, surgical procedures of autologous and allogeneic UTx, organ perfusion methods in deceased donor models, immunological response and rejection and ischemia/reperfusion injury. We achieved the first delivery after autologous UTx in primates and the first periodic recovery of menstruation after allogeneic UTx in nonhuman primate models. Results from animal studies, including those in nonhuman primates, provide the basis for clinical application of UTx. Therefore, our accumulated data since 2009 and our basic experience in cynomolgus macaque are meaningful for future UTx trials in Japan. In addition, more validation in nonhuman primate models is needed for resolution of medical issues and further development of UTx in humans, despite clinical application of UTx in several countries.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Adachi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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The safety of fertility preservation for microinvasive cervical adenocarcinoma: a meta-analysis and trial sequential analysis. Arch Gynecol Obstet 2018; 298:465-475. [PMID: 29876746 DOI: 10.1007/s00404-018-4799-0] [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] [Received: 02/23/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE This study sought to evaluate the safety of conservative treatment in the management of patients with microinvasive cervical adenocarcinoma. METHODS The PubMed, PMC, EMBASE, Web of Science and Cochrane databases were searched to collect correlational studies published in English between January 1949 and May 2018. Series reports that evaluating the oncological prognoses of patients with microinvasive cervical adenocarcinoma who were treated with fertility-sparing surgery versus hysterectomy were pooled for meta-analysis and trial sequential analysis. RESULTS A total of 8 articles with 1256 patients were collected, including 7 retrospective reviews and 1 prospective study. Only one (0.08%) patient had parametrial involvement. Positive margins of surgical specimens were identified in 6 patients (2.2%). Lymph node metastasis was found in 5 patients (0.4%). The progression-free survival and overall survival rates were 99.3 and 98.2%. Fertility-sparing surgery had no adverse impact on recurrence or survival (P = 0.524 and 0.485, respectively). Regarding potential selection bias, significantly more patients with stage IA2 tumors than those with stage IA1 disease were treated with hysterectomy (P < 0.001). The trial sequential analysis indicated that the cumulative number of patients failed to meet the required sample size (number of patients). CONCLUSIONS The prognosis for patients with microinvasive cervical adenocarcinoma is excellent. Fertility preservation is at least appropriate for young women with stage IA1 adenocarcinoma. Further studies are still warranted to evaluate the safety of this procedure in managing patients with microinvasive cervical adenocarcinoma.
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Gordon C, Carmichael JC, Tewari KS. Oncofertility in the setting of advanced cervical cancer - A case report. Gynecol Oncol Rep 2018; 24:27-29. [PMID: 29845104 PMCID: PMC5966584 DOI: 10.1016/j.gore.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/16/2018] [Accepted: 03/01/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To consider fertility options in women with advanced cervical cancer. Design Case report. Setting Large tertiary care center. Patient A 30-year-old nulligravida woman diagnosed with FIGO Stage IBI squamous cell carcinoma of the cervix that had metastasized to a pelvic lymph node. Interventions Robotic radical trachelectomy with pelvic lymphadenectomy and cerclage placement, followed by ovarian stimulation with oocyte retrieval and in vitro fertilization. Subsequent therapy included adjuvant chemoradiation and embryo transfer to a surrogate mother. Main outcome measures Cervical cancer remission, live birth from surrogate pregnancy. Results 33-year-old woman in her third year of remission from advanced cervical cancer with healthy twin girls. Conclusions Fertility options may exist for patients even in the setting of metastatic cervical cancer. Early involvement of a reproductive endocrinologist is imperative. This case emphasizes the importance of cross-specialty communication. Approximately 40% of women diagnosed with cervical cancer are under the age of 45. Fertility sparing treatment options should be considered when appropriate. We present a case of preserved fertility in a patient with advanced cervical cancer. Radical trachelectomy is as a viable option for those desiring childbearing. Early involvement of a reproductive endocrinologist is imperative in these cases.
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Affiliation(s)
- Catherine Gordon
- Department of Obstetrics & Gynecology, University of California, Irvine 333 City Blvd, West, Suite 1400, Orange, CA 92868, United States
| | - Joseph C. Carmichael
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine 333 City Blvd, West, Suite 850, Orange, CA 92868, United States
| | - Krishnansu S. Tewari
- Department of Obstetrics & Gynecology, University of California, Irvine 333 City Blvd, West, Suite 1400, Orange, CA 92868, United States
- Corresponding author.
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10
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Willows K, Lennox G, Covens A. Fertility-sparing management in cervical cancer: balancing oncologic outcomes with reproductive success. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:9. [PMID: 27795832 PMCID: PMC5073939 DOI: 10.1186/s40661-016-0030-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/27/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, many of who are still within their reproductive lifespan. Advances in screening and treatment have increased the 5-year survival for early stage disease to over 90 % in developed countries. The focus is now shifting to reducing morbidity and improving fertility outcomes for cervical cancer patients. Radical trachelectomy with lymph node assessment became the standard of care for selected women with lesions <2 cm who desire fertility preservation. However, several questions still remain regarding the degree of surgical radicality required for tumors <2 cm, and fertility-sparing options for women with early-stage disesase ≥2 cm, and those with more advanced disease. Here, we compile a narrative review of the evidence for oncologic and pregnancy outcomes following radical trachelectomy, non-radical fertility-sparing surgery, and the use of neoadjuvant chemotherapy prior to surgery for larger lesions. We also review the literature for assisted reproductive technologies in women with more advanced disease. FINDINGS Available literature suggests that the crude recurrence and mortality rates after radical trachelectomy are <5 and <2 %, respectively (approx. 11 and 4 % for tumors ≥ 2 cm). Among 1238 patients who underwent fertility-sparing surgery for early cervical cancer there were 469 pregnancies with a 67 % live birth rate. Among 134 cases with lesions ≥ 2 cm, there were ten conceptions with a live birth rate of 70 %. Outcomes after non-radical surgery (simple trachelectomy or cervical conization) are similar, although only applicable among a highly selected patient population. For patients ineligible for fertility-preserving surgery or who require adjuvant radiation therapy, current options include ovarian transposition and cryopreservation of oocytes or embryos but other techniques are under investigation. CONCLUSION Today, many cervical cancer survivors have successful pregnancies. For those with early-stage disease, minimally invasive and fertility sparing techniques have resulted in improved obstetrical outcomes without compromising oncologic safety. Results from three ongoing trials on non-radical surgery for low-risk tumors <2 cm will further inform the need for radical surgery in such patients. For those in whom natural childbearing is unachievable, advances in assisted reproductive technologies provide reproductive options. Despite our advances, the effects of cervical cancer survivorship on quality of life are not fully elucidated.
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Affiliation(s)
- Karla Willows
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, M5G 2 M9 ON Canada
| | - Genevieve Lennox
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, M5G 2 M9 ON Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, M5G 2 M9 ON Canada
- Division of Gynecologic Oncology, T2051 Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3 M5 ON Canada
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11
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Sato S, Itamochi H, Sugiyama T. Fertility-sparing surgery for uterine cervical cancer. Future Oncol 2016; 12:2345-55. [DOI: 10.2217/fon-2016-0260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The standard treatment for early cervical cancer of the uterus (CC) is radical hysterectomy with resection of the parametrium and pelvic lymphadenectomy. At least 40% of patients develop early-stage CC during child-bearing age, therefore preserving the uterus to maintain fertility has been an important consideration. Several surgical procedures including conization and vaginal or abdominal radical trachelectomy have been reported. These procedures are safe for removing lymph node negative CC tumors with <2 cm diameter. Recently, less radical surgical procedures that maintain fertility, such as conization, simple trachelectomy, minimally invasive surgery and neoadjuvant chemotherapy, have been indicated for tumors greater than 2 cm in diameter. In this review, we discuss the currently accepted surgical approaches for treating CC while maintaining fertility.
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Affiliation(s)
- Seiya Sato
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Hiroaki Itamochi
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Toru Sugiyama
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
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12
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Medlin EE, Kushner DM, Barroilhet L. Robotic surgery for early stage cervical cancer: Evolution and current trends. J Surg Oncol 2016; 112:772-81. [PMID: 26768315 DOI: 10.1002/jso.24008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/27/2015] [Indexed: 12/27/2022]
Abstract
The management of early stage cervical cancer often includes surgery in the form of radical hysterectomy, radical trachelectomy, or radical parametrectomy. Surgical techniques have evolved to include minimal invasive approaches, and more recently, to include robotic assisted techniques. This review highlights the evolution of surgical management of early cervical cancer and specifically explores robotic assisted radical hysterectomy, radical trachelectomy, radical parametrectomy, and the role of neoadjuvant chemotherapy.
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Affiliation(s)
- Erin E Medlin
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - David M Kushner
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Lisa Barroilhet
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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13
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Kim HS, Kim K, Ryoo SB, Seo JH, Kim SY, Park JW, Kim MA, Hong KS, Jeong CW, Song YS. Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis. J Gynecol Oncol 2016; 26:100-10. [PMID: 25872891 PMCID: PMC4397225 DOI: 10.3802/jgo.2015.26.2.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. Methods After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. Results Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. Conclusion NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
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Affiliation(s)
- Hee Seung Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Joung Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min A Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Sup Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Sang Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Major in Biomodulation, World Class University, Seoul National University, Seoul, Korea.
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14
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Rema P, Ahmed I. Conservative Surgery for Early Cervical Cancer. Indian J Surg Oncol 2015; 7:336-40. [PMID: 27651696 DOI: 10.1007/s13193-015-0476-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022] Open
Abstract
There is a rising incidence of early cervical cancer in young patients as a result of screening and early detection. Treatment of cervical cancer by surgery or radiotherapy results in permanent infertility which affects the quality of life of cancer survivors. Now with improved survival rates among early cervical cancer patients, conservative surgery aiming at fertility preservation in those desiring future pregnancy is an accepted treatment. Conservative surgery is possible in early cervical cancer including micro invasive cancer and stage IB cancers less than 2 cm. Stage IA1 cervical cancer is treated effectively by cervical conisation. In stage IA2 cancers and stage IB1 cancers less than 2 cm the fertility preservation surgery is radical trachelectomy. Radical trachelectomy removes the cervix with medial parametrium and upper 2 cm vaginal cuff retaining the uterus and adnexa to allow future pregnancy. Radical trachelectomy is a safe procedure in selected patients with cancer cervix with acceptable oncologic risks and promising obstetric outcome. It should be avoided in tumours larger than 2 cm and aggressive histologic types. This article focuses on the current options of conservative surgery in early cervical cancer.
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Affiliation(s)
- P Rema
- Division of Surgical oncology, Regional Cancer Centre, Trivandrum, Kerala India
| | - Iqbal Ahmed
- Division of Surgical oncology, Regional Cancer Centre, Trivandrum, Kerala India
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15
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Makino H, Kato H, Furui T, Hayasaki Y, Morishige KI, Kanematsu M. Assessment of uterine enhancement rate after abdominal radical trachelectomy using dynamic contrast-enhanced magnetic resonance imaging. Arch Gynecol Obstet 2015; 293:625-32. [DOI: 10.1007/s00404-015-3842-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 08/07/2015] [Indexed: 12/18/2022]
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Abstract
IMPORTANCE Surgery has evolved into the standard therapy for nonbulky carcinoma of the cervix. The mainstay of surgical management is radical hysterectomy; however, less radical procedures have a small but important role in the management of cervical tumors. OBJECTIVE Our objective was to discuss the literature behind the different procedures utilized in the management of cervical cancer, emphasizing the radical hysterectomy. In addition, we aimed to discuss ongoing trials looking at the utility of less radical surgeries as well as emerging technologies in the management of this disease. EVIDENCE ACQUISITION We performed a PubMed literature search for articles in the English language that pertained to the topic of surgical techniques and their outcomes in the treatment of cervical cancer. RESULTS The minimally invasive approaches to radical hysterectomy appear to reduce morbidity without affecting oncological outcomes, although further data are needed looking at long-term outcomes with the robotic platform. Trials are currently ongoing looking at the role of less radical surgery for patients with low-risk disease and the feasibility of sentinel lymph node mapping. CONCLUSIONS AND RELEVANCE Radical hysterectomy with pelvic lymphadenectomy has evolved into the standard therapy for nonbulky disease, and there is a clear advantage in the use of minimally invasive techniques to perform these procedures. However, pending ongoing trials, less radical surgery in patients with low-risk invasive disease as well as sentinel lymph node mapping may emerge as standards of care in selected patients with cervical carcinoma.
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17
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Arimoto T, Kawana K, Adachi K, Ikeda Y, Nagasaka K, Tsuruga T, Yamashita A, Oda K, Ishikawa M, Kasamatsu T, Onda T, Konishi I, Yoshikawa H, Yaegashi N. Minimization of curative surgery for treatment of early cervical cancer: a review. Jpn J Clin Oncol 2015; 45:611-6. [DOI: 10.1093/jjco/hyv048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/10/2015] [Indexed: 11/14/2022] Open
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18
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Li H, Jia J, Xiao Y, Kang L, Cui H. Anatomical basis of female pelvic cavity for nerve sparing radical hysterectomy. Surg Radiol Anat 2014; 37:657-65. [PMID: 25533026 DOI: 10.1007/s00276-014-1405-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The separation and sparing of the vesical branch of the inferior hypogastric plexus (IHP), to preserve the pelvic autonomic nerve, is critical and difficult in nerve sparing radical hysterectomy. Pelvic local anatomy was performed to provide the necessary anatomical information. METHODS Precise pelvic anatomy was performed in 15 adult corpses, and immunohistochemical analysis was carried out on the parametrial tissues of three fresh cadavers to analyze the nerve fiber type and content of the vesical branch of the IHP. RESULTS The deep uterine vein is located in the upper region of the cardinal ligament (CL), with three to six multiple branches and anatomical variation, including one or two cervical branches, and two to four vesical branches. Three branches were found to be most common (63.3 %). The major distribution of the vesical branch of the IHP is dorsomedial to the middle and inferior vesical veins, with less ventral and lateral distribution. There are more sympathetic fibers than parasympathetic fibers in the vesical branch. There is a region rare of vasculature and nerve between the vaginal lateral margin and the vesical branch. CONCLUSION The deep uterine vein is suggested as an anatomical landmark during surgery, to process the CL and preserve the pelvic splanchnic nerves. The middle and inferior vesical veins can be used as the landmark to preserve the vesical branch of the IHP.
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Affiliation(s)
- Haili Li
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
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Dursun P, Doğan NU, Ayhan A. Oncofertility for gynecologic and non-gynecologic cancers: Fertility sparing in young women of reproductive age. Crit Rev Oncol Hematol 2014; 92:258-67. [DOI: 10.1016/j.critrevonc.2014.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022] Open
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Saso S, Sawyer R, O'Neill NM, Tzafetas M, Sayasneh A, Hassan Hamed A, Elliott F, Thum MY, Ghaem-Maghami S, Lee MJ, Smith JR, Del Priore G. Trachelectomy during pregnancy: What has experience taught us? J Obstet Gynaecol Res 2014; 41:640-5. [PMID: 25420436 DOI: 10.1111/jog.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Srdjan Saso
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Renata Sawyer
- Division of Maternal Fetal Medicine; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - Nicole M. O'Neill
- Division of Gynecologic Oncology; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - Menelaos Tzafetas
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Ahmed Sayasneh
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Ali Hassan Hamed
- Division of Gynecologic Oncology; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - Freya Elliott
- Division of Surgery and Cancer; Institute of Reproductive and Developmental Biology; Imperial College London, Hammersmith Hospital Campus; London UK
| | | | - Sadaf Ghaem-Maghami
- West London Gynaecological Cancer Centre; Queen Charlotte's Hospital; Hammersmith Hospital Campus; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Men-Jean Lee
- Division of Maternal Fetal Medicine; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
| | - J. Richard Smith
- West London Gynaecological Cancer Centre; Queen Charlotte's Hospital; Hammersmith Hospital Campus; Imperial College London, Hammersmith Hospital Campus; London UK
| | - Giuseppe Del Priore
- Department of Gynaecologic Oncology; Cancer Treatment Centers of America, Southeastern Branch, Newnan; Georgia USA
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21
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Fertility sparing surgery in gynecologic cancer. J Obstet Gynaecol India 2014; 64:234-8. [PMID: 25136166 DOI: 10.1007/s13224-014-0572-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 05/14/2014] [Indexed: 10/25/2022] Open
Abstract
Fertility preservation is one of the major concerns of young patients diagnosed with gynecological cancer. With newer treatment regimens and better surgical techniques, survival rates after cancer treatment have improved, hence preservation of fertility has recently become an important issue in the treatment of gynecological cancers. Fertility sparing surgery may be an option for early-stage cervical cancer with the development of loop excision techniques and radical trachelectomy which allows a radical approach to cervix cancer at the same time preserving the uterus and thus fertility. Fertility preservation is possible in Stage 1 epithelial ovarian cancers, germ cell ovarian tumors, and borderline cancers. Hormonal therapy with progestin agents is effective in early endometrial cancer. In patients desiring future pregnancy, fertility sparing options must be explored before starting treatment for gynecologic cancers.
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22
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Lloyd PA, Briggs EV, Kane N, Jeyarajah AR, Shepherd JH. Women's experiences after a radical vaginal trachelectomy for early stage cervical cancer. A descriptive phenomenological study. Eur J Oncol Nurs 2014; 18:362-71. [PMID: 24794078 DOI: 10.1016/j.ejon.2014.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This paper reports on a phenomenological study of women's experiences 1-10 years following a radical vaginal trachelectomy and describes the impact on health, sexuality, fertility and perceived supportive care needs. METHOD AND SAMPLE Qualitative telephone interviews employing a descriptive phenomenological approach were conducted using a purposive sample of 12 women. KEY RESULTS Several felt their cancer experience was positive; bringing them closer to family and changed their outlook on life. A few experienced delayed psychological reactions and/or fears of recurrence. Many experienced isolation and the desire to contact others with similar experiences. Women recovered well but a few experienced fears/concerns about lymphoedema and intermenstrual bleeding. Sexual function was not a long-term issue for most. Some that could feel the cerclage (stitch) during intercourse, developed techniques to reduce this. Single women felt vulnerable in new relationships. Pregnancy was an anxious time, especially for those that experienced a miscarriage or pre-term birth. Sources of support included the clinical nurse specialist, family/friends, surgical consultant, online patient forums and a support group. Women needed more information on trachelectomy statistics, pregnancy care recommendations as well as access to counselling, peer support, being seen by the same person and increased public awareness. CONCLUSIONS This study has provided an interesting and detailed insight into women's experiences in the years following a trachelectomy, with results that have important considerations for practice such as provision of statistical information; counselling; peer support; consistent pregnancy recommendations; increased public awareness and increased identification and management or prevention of long-term physical effects.
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Affiliation(s)
- Philippa A Lloyd
- Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - Emma V Briggs
- Florence Nightingale School of Nursing and Midwifery, Kings College London, UK.
| | - Nichola Kane
- Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - Arjun R Jeyarajah
- Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
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Yousefi Z, Kazemianfar Z, Kadghodayan S, Hasanzade M, Kalantari M, Mottaghi M. Less radical surgery for patient with early-stage cervical cancer. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 15:617-9. [PMID: 24396586 PMCID: PMC3871754 DOI: 10.5812/ircmj.5057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 01/20/2013] [Accepted: 01/28/2013] [Indexed: 11/21/2022]
Abstract
Introduction Surgery in cervical cancer should be used with intention of cure. Radical abdominal trachelectomy is a feasible operation for selected patients with stage Iα-1β cervical cancer which fertility can be preserved. Case Report A 30-years-old woman with squamous cell cervical cancer stage (1 A II) diagnosed at September 2011 expressed a wish for fertility-sparing treatment. Radical abdominal hysterectomy and pelvic and para-aortic lymphadenectomy were performed which showed no evidence of lymphatic metastasis. Subsequently, at last follow-up (5 months post-surgery), good oncologic outcomes were found after this procedure. This was the first case of fertility-sparing radical trachelectomy procedures performed at our institution. Conclusions Trachelectomy represents a valuable conservative surgical approach for early stage invasive cervical cancer.
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Affiliation(s)
- Zohreh Yousefi
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Zohreh Yousefi, Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran, Tel.: +98-5118417493, Fax: +98-5118409612, E-mail:
| | - Zahra Kazemianfar
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Sima Kadghodayan
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Malieheh Hasanzade
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmoudreza Kalantari
- Department of Pathology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mansoureh Mottaghi
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Iacoponi S, Diestro MD, Zapardiel I, Serrano M, Santiago JD. Vaginal laparoscopically assisted radical trachelectomy in cervical clear cell adenocarcinoma. Ecancermedicalscience 2013; 7:373. [PMID: 24244219 PMCID: PMC3826807 DOI: 10.3332/ecancer.2013.373] [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: 03/29/2013] [Indexed: 12/02/2022] Open
Abstract
Adenocarcinoma of the cervix is a rare condition that has shown an increase in incidence, especially in the 20- to 34-year-old group. Adenocarcinoma represents about 5–10% of all tumours in this area, and, among these, the clear cell type accounts for 4–9%. This type of tumour affects mainly postmenopausal women but also occurs in young women with a history of prenatal exposure to diethylstilbestrol (DES). The prognosis for adenocarcinoma of the cervix is poor overall and worse for the clear cell variety. This article discusses a case of clear cell adenocarcinoma of the cervix, unrelated to intrauterine exposure to DES, in a woman of childbearing age who wished to preserve her fertility and was therefore treated by radical vaginal trachelectomy and pelvic lymphadenectomy.
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Affiliation(s)
- Sara Iacoponi
- Gynaecological Oncology Unit, La Paz University Hospital, Madrid, Spain
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25
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Large conization and laparoendoscopic single-port pelvic lymphadenectomy in early-stage cervical cancer for fertility preservation. Case Rep Surg 2013; 2013:207191. [PMID: 24223319 PMCID: PMC3816043 DOI: 10.1155/2013/207191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/12/2013] [Indexed: 11/18/2022] Open
Abstract
Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT) is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS) is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.
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Kisu I, Banno K, Mihara M, Suganuma N, Aoki D. Current status of uterus transplantation in primates and issues for clinical application. Fertil Steril 2013; 100:280-94. [DOI: 10.1016/j.fertnstert.2013.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/02/2013] [Accepted: 03/06/2013] [Indexed: 01/14/2023]
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Ardelt M, Dittmar Y, Scheuerlein H, Bärthel E, Settmacher U. Post-operative internal hernia through an orifice underneath the right common iliac artery after Dargent's operation. Hernia 2013; 18:907-9. [PMID: 23793860 DOI: 10.1007/s10029-013-1129-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
We report the case of a 39-year-old woman with ileus resulting from a small bowel incarceration underneath the right common iliac artery. The patient had a history of a radical trachelectomy with laparoscopic pelvic lymphadenectomy ("Dargent's operation") for cervical carcinoma. After dissection of the iliac vessels, a small bowel loop could slide underneath the common iliac artery. The hernia was closed by gluing a collagen patch over the right common iliac artery onto the retroperitoneal cavity. To our knowledge, such a case has not previously been reported in the medical literature.
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Affiliation(s)
- M Ardelt
- Department of General, Visceral and Vascular Surgery, University of Jena, Erlanger Allee 101, 07747, Jena, Germany,
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Lakhman Y, Akin O, Park KJ, Sarasohn DM, Zheng J, Goldman DA, Sohn MJ, Moskowitz CS, Sonoda Y, Hricak H, Abu-Rustum NR. Stage IB1 cervical cancer: role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy. Radiology 2013; 269:149-58. [PMID: 23788721 DOI: 10.1148/radiol.13121746] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine whether magnetic resonance (MR) imaging evaluation of key morphologic tumor characteristics can improve patient selection for radical trachelectomy. MATERIALS AND METHODS The institutional review board approved and waived informed consent for this study of 62 patients (mean age, 32 years; age range, 23-42 years) with International Federation of Gynecology and Obstetrics stage IB1 cervical carcinoma who underwent attempted radical trachelectomy between November 2001 and January 2011 and had preoperative MR imaging. Retrospectively, two radiologists reviewed MR images for tumor presence and size, distance between tumor and internal os, and presence of deep cervical stromal invasion. Associations between MR imaging findings and surgery type were tested. RESULTS Sensitivity and specificity of tumor detection were, respectively, 87% and 100% (reader 1) and 76% and 95% (reader 2). Six of six patients with negative cone biopsy margins and no tumor at postconization MR imaging were without tumor at trachelectomy pathologic analysis. Mean differences between MR imaging and histologic tumor sizes were 0.7 mm (range, -15 to 11 mm) for reader 1 and 2.2 mm (range, -9 to 15 mm) for reader 2. Sensitivities for deep cervical stromal invasion were 75% (reader 1) and 50% (reader 2). For each reader, nine of nine (100%) patients with tumor 5 mm or less from the internal os and three of five (60%) patients with tumor 6-9 mm from the internal os at MR imaging needed radical hysterectomy. For both readers, tumor size of 2 cm or larger (P < .001) and deep cervical stromal invasion (P ≤ .003) at MR imaging were associated with increased chance of radical hysterectomy. CONCLUSION Pretrachelectomy MR imaging can help identify high-risk patients likely to need radical hysterectomy or confirm the absence of residual tumor in the cervix after a cone biopsy with negative margins.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Department of Pathology, Department of Epidemiology and Biostatistics, and Gynecologic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065
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Laparoscopic radical trachelectomy: The choice for conservative surgery in early cervical cancer. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Analysis of a Continuous Series of 34 Young Patients With Early-Stage Cervical Cancer Selected for a Vaginal Radical Trachelectomy. Int J Gynecol Cancer 2013; 23:331-6. [DOI: 10.1097/igc.0b013e31827ef759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Reproducibility and accuracy of robot-assisted laparoscopic fertility sparing radical trachelectomy. Gynecol Oncol 2012; 127:484-8. [DOI: 10.1016/j.ygyno.2012.08.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/09/2012] [Accepted: 08/19/2012] [Indexed: 11/20/2022]
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A prospective single-center study of sentinel lymph node detection in cervical carcinoma: is there a place in clinical practice? Int J Gynecol Cancer 2012; 22:1044-9. [PMID: 22622952 DOI: 10.1097/igc.0b013e318253a9c9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer. MATERIALS AND METHODS Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination. RESULTS The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1-7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8-35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8-80 months). CONCLUSION Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.
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Fertility-sparing surgery for early-stage cervical cancer. Int J Surg Oncol 2012; 2012:936534. [PMID: 22830004 PMCID: PMC3399357 DOI: 10.1155/2012/936534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/12/2012] [Indexed: 11/24/2022] Open
Abstract
Nowadays cervical cancer is diagnosed in many women who still want to have children. This led to the need to provide fertility-sparing treatments. The main goal is to maintain reproductive ability without decreasing overall and recurrence-free survival. In this article, we review data on procedures for fertility preservation, namely, vaginal and abdominal trachelectomy, less invasive surgery and neoadjuvant chemotherapy. For each one, oncological and obstetrical outcomes are analyzed. Comparing to traditionally offered radical hysterectomy, the overall oncologic safety is good, with promising obstetrical outcomes.
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A model for prediction of parametrial involvement and feasibility of less radical resection of parametrium in patients with FIGO stage IB1 cervical cancer. Gynecol Oncol 2012; 126:82-6. [DOI: 10.1016/j.ygyno.2012.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 11/20/2022]
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Kisu I, Banno K, Mihara M, Lin LY, Tsuji K, Yanokura M, Hara H, Araki J, Iida T, Abe T, Kouyama K, Suganuma N, Aoki D. Indocyanine green fluorescence imaging for evaluation of uterine blood flow in cynomolgus macaque. PLoS One 2012; 7:e35124. [PMID: 22606213 PMCID: PMC3335048 DOI: 10.1371/journal.pone.0035124] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/13/2012] [Indexed: 11/20/2022] Open
Abstract
Background Uterine blood flow is an important factor in uterine viability, but the number of blood vessels required to maintain viability is uncertain. In this study, indocyanine green (ICG) fluorescence imaging was used to examine uterine hemodynamics and vessels associated with uterine blood flow in cynomolgus macaque. Methods The uterus of a female cynomolgus macaque was cut from the vaginal canal to mimic a situation during trachelectomy or uterine transplantation surgery in which uterine perfusion is maintained only with uterine and ovarian vessels. Intraoperative uterine hemodynamics was observed using ICG fluorescence imaging under conditions in which various nutrient vessels were selected by clamping of blood vessels. A time-intensity curve was plotted using imaging analysis software to measure the Tmax of uterine perfusion for selected blood vessel patterns. Open surgery was performed with the uterus receiving nutritional support only from uterine vessels on one side. The size of the uterus after surgery was monitored using transabdominal ultrasonography. Results The resulting time-intensity curves displayed the average intensity in the regions of the uterine corpus and uterine cervix, and in the entire uterus. Analyses of the uterine hemodynamics in the cynomolgus macaque showed that uterine vessels were significantly related to uterine perfusion (P = 0.008), whereas ovarian vessels did not have a significant relationship (P = 0.588). When uterine vessels were clamped, ovarian vessels prolonged the time needed to reach perfusion maximum. Postoperative transabdominal ultrasonography showed that the size of the uterus was not changed 2 months after surgery, with recovery of periodic menstruation. The cynomolgus macaque has got pregnant with favorable fetus well-being. Conclusion Uterine vessels may be responsible for uterine blood flow, and even one uterine vessel may be sufficient to maintain uterine viability in cynomolgus macaque. Our results show that ICG fluorescence imaging is useful for evaluation of uterine blood flow since this method allows real-time observation of uterine hemodynamics.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
- * E-mail:
| | - Makoto Mihara
- Department of Plastic and Reconstructive Surgery, Graduates School of Medicine, University of Tokyo, Tokyo, Japan
| | - Li-Yu Lin
- The Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan
| | - Kosuke Tsuji
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
| | - Megumi Yanokura
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery, Graduates School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jun Araki
- Department of Plastic and Reconstructive Surgery, Graduates School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, Graduates School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takayuki Abe
- The Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan
| | - Keisuke Kouyama
- The Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan
| | - Nobuhiko Suganuma
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
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Martinez A, Poilblanc M, Ferron G, De Cuypere M, Jouve E, Querleu D. Fertility-preserving surgical procedures, techniques. Best Pract Res Clin Obstet Gynaecol 2012; 26:407-24. [PMID: 22503435 DOI: 10.1016/j.bpobgyn.2012.01.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/26/2022]
Abstract
As a result of the trend toward late childbearing, fertility preservation has become a major issue in young women with gynaecological cancer. Fertility-sparing treatments have been successfully attempted in selected cases of cervical, endometrial and ovarian cancer, and gynaecologists should be familiar with fertility-preserving options in women with gynaecological malignancies. Options to preserve fertility include shielding to reduce radiation damage, fertility preservation when undergoing cytotoxic treatments, cryopreservation, assisted reproduction techniques, and fertility-sparing surgical procedures. Radical vaginal trachelectomy with laparoscopic lymphadenectomy is an oncologically safe, fertility-preserving procedure. It has been accepted worldwide as a surgical treatment of small early stage cervical cancers. Selected cases of early stage ovarian cancer can be treated by unilateral salpingo-ophorectomy and surgical staging. Hysteroscopic resection and progesterone treatment are used in young women who have endometrial cancer to maintain fertility and avoid surgical menopause. Appropriate patient selection, and careful oncologic, psychologic, reproductive and obstetric counselling, is mandatory.
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Affiliation(s)
- Alejandra Martinez
- Surgical Oncology Department, Claudius Regaud Comprehensive Cancer Center, Toulouse, France.
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Nick AM, Frumovitz MM, Soliman PT, Schmeler KM, Ramirez PT. Fertility sparing surgery for treatment of early-stage cervical cancer: open vs. robotic radical trachelectomy. Gynecol Oncol 2011; 124:276-80. [PMID: 22035808 DOI: 10.1016/j.ygyno.2011.09.035] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/20/2011] [Accepted: 09/24/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the open versus robotic surgical approaches and provide surgical outcome data on patients who have undergone radical trachelectomy (RT). METHODS We identified patients who underwent open (ORT) or robotic radical trachelectomy (RRT) between September 2005 and June 2011. Tumor characteristics, perioperative, operative and obstetrical outcomes were analyzed. RESULTS Thirty-seven patients with early stage cervical cancer that desired future fertility underwent attempted radical trachelectomy, and 32 patients (20 with 1B1, 11 with 1A2, and 5 with 1A1 with LVSI/poorly differentiated histology) had successful completion of RT. Five (1 open/4 robotic) underwent conversion to radical hysterectomy secondary to close (<5mm) endocervical margin (p=0.08). The median age at diagnosis was 28.9 years (range; 21.4-37.2), 70% were nulliparous, and 9 had a visible lesion. Twenty-five patients (68%) underwent ORT and 12 (32%) underwent RRT. RRT was associated with less blood loss (62.5 mL vs. 300 mL, p=0.0001) and decreased length of postoperative stay (1 vs. 4 days, p<0.001), with no difference in operative time or histopathologic outcomes. Twenty-three patients (62%) had no residual cervical disease on final pathology. Common long-term morbidities were irregular menstrual bleeding or amenorrhea (25%), cerclage erosion (13%), or cervical stenosis (9%). Although there was a higher rate of conversion to hysterectomy in the robotic surgery cohort, rates of serious morbidities among the cohorts were comparable (robotic: 33% vs. open: 24%, p=0.70). Eleven (36%) patients are actively attempting pregnancy and three have achieved pregnancy. The median time of follow up is 17.0 months (range 0.30-64.9 months). There are no documented recurrences. CONCLUSIONS RRT results in less blood loss and decreased length of hospital stay with no compromise in histopathologic outcomes.
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Affiliation(s)
- Alpa M Nick
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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XU LI, SUN FUQING, WANG ZANHONG. Radical trachelectomy versus radical hysterectomy for the treatment of early cervical cancer: a systematic review. Acta Obstet Gynecol Scand 2011; 90:1200-9. [DOI: 10.1111/j.1600-0412.2011.01231.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li J, Li Z, Wang H, Zang R, Zhou Y, Ju X, Ke G, Wu X. Radical abdominal trachelectomy for cervical malignancies: Surgical, oncological and fertility outcomes in 62 patients. Gynecol Oncol 2011; 121:565-70. [DOI: 10.1016/j.ygyno.2011.01.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/21/2011] [Accepted: 01/26/2011] [Indexed: 11/27/2022]
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Ottosen C. Trachelectomy for cancer of the cervix: Dargent’s operation. Vaginal hysterectomy for early cancer of the cervix stage IA1 and CIN III. Best Pract Res Clin Obstet Gynaecol 2011; 25:217-25. [DOI: 10.1016/j.bpobgyn.2010.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/31/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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Abstract
Imaging the cervix for benign and malignant disease can be achieved using transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography. The best established role of imaging is in cervical carcinoma where magnetic resonance imaging, CT and increasingly positron emission tomography-CT are the most frequently used imaging modalities. These have a role in staging, treatment selection, recurrent disease, and imaging complications of treatment. Histopathological diagnosis of cervical disorders cannot be made on the basis of imaging alone but certain imaging features may provide an indication as to the underlying diagnosis. We describe the imaging features of some malignant tumor subtypes in which a preoperative diagnosis may alter management. Benign lesions of the cervix are usually detected incidentally or during investigations for dysfunctional vaginal bleeding. We describe the imaging features of the commonly encountered benign cervical lesions.
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Affiliation(s)
- Anju Sahdev
- Department of Radiology, Bartholomew's Hospital, London, UK.
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Wu J, Liu X, Hua K, Hu C, Chen X, Lu X. Effect of nerve-sparing radical hysterectomy on bladder function recovery and quality of life in patients with cervical carcinoma. Int J Gynecol Cancer 2010; 20:905-9. [PMID: 20606542 DOI: 10.1111/igc.0b013e3181df99c0] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To investigate the bladder function recovery and quality of life (QOL) using nerve-sparing radical hysterectomy (NSRH) in treating early invasive cervical carcinoma. METHODS Subjects included patients who underwent radical hysterectomy by laparotomy for early-stage cervical carcinoma. Thirty-one patients were randomly assigned to 2 groups: group A, 15 patients who underwent NSRH; and group B, 16 patients who underwent classical radical hysterectomy. We observed the patients' general clinical information, surgical characteristics, postoperative vital signs, pathological findings, adjuvant therapies, and adverse effects. A urodynamic study was used to assess the bladder function. The patients' QOL was evaluated by Functional Assessment of Cervical Cancer Therapy (FACT-Cx). RESULTS Twenty-nine patients completed the study. No significant differences were found in age, body mass index, surgery characteristics, pathological findings, adjuvant therapies, and main adverse effects between the 2 groups (P > 0.05). The postoperative time of bladder function recovery in group A was obviously earlier than that in group B (P < 0.05). The urodynamic study showed that the extent of bladder function recovery in group A was better than that in group B (P < 0.05). The QOL in group A evaluated 1 year after operation was improved compared with that in group B (P < 0.05). The QOL analysis showed that group A did much better than group B in social and family life, emotional well-being, working status, and the symptom correlated with the operation (P < 0.05). No significant differences were found in basic bodily functions (P > 0.05). CONCLUSIONS Nerve-sparing radical hysterectomy is a safe and reliable technique for early invasive cervical carcinoma. The postoperative bladder function recovery and the patients' QOL were improved after NSRH compared with the control group. Therefore, NSRH could be an alternative management to modify the classical surgery for cervical carcinoma with International Federation of Gynecology and Obstetrics stages IB1 to IIA.
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Affiliation(s)
- Jiahan Wu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Fagotti A, Gagliardi ML, Moruzzi C, Carone V, Scambia G, Fanfani F. Excisional cone as fertility-sparing treatment in early-stage cervical cancer. Fertil Steril 2010; 95:1109-12. [PMID: 21122837 DOI: 10.1016/j.fertnstert.2010.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/16/2010] [Accepted: 11/03/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1), age ≤ 45 years, tumor ≤ 20 mm. INTERVENTION(S) Cold-knife conization and laparoscopic pelvic lymphadenectomy. MAIN OUTCOME MEASURE(S) Recurrence and pregnancy rate. RESULT(S) There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13-51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8-101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery. CONCLUSION(S) In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.
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Affiliation(s)
- Anna Fagotti
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Fertility-sparing options for early stage cervical cancer. Gynecol Oncol 2010; 117:350-7. [DOI: 10.1016/j.ygyno.2010.01.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 01/16/2010] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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Ramirez PT, Schmeler KM, Malpica A, Soliman PT. Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. Gynecol Oncol 2010; 116:512-5. [DOI: 10.1016/j.ygyno.2009.10.063] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 10/15/2009] [Accepted: 10/17/2009] [Indexed: 11/17/2022]
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Martin A, Torrent A. Laparoscopic Nerve-Sparing Radical Trachelectomy: Surgical Technique and Outcome. J Minim Invasive Gynecol 2010; 17:37-41. [DOI: 10.1016/j.jmig.2009.09.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/18/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
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Lousquy R, Delpech Y, Barranger E. Place du ganglion sentinelle dans la stratégie thérapeutique du cancer du col de l’utérus aux stades précoces. ACTA ACUST UNITED AC 2009; 37:827-33. [DOI: 10.1016/j.gyobfe.2009.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Mandic A, Novakovic P, Nincic D, Zivaljevic M, Rajovic J. Radical abdominal trachelectomy in the 19th gestation week in patients with early invasive cervical carcinoma: case study and overview of literature. Am J Obstet Gynecol 2009; 201:e6-8. [PMID: 19527898 DOI: 10.1016/j.ajog.2009.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 04/23/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.
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