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Serouart B, Cordoba A, Martinez-Gomez C, Bogart E, Le Deley MC, Leblanc É, Hudry D, Escande A, Le Tinier F, Pasquesoone C, Taieb S, El Hajj H, Narducci F. Results of a 20 Year Retrospective Analysis of Early-Stage Cervical Cancer: Should 3 cm Be Considered the New Ariadne's Thread in Early Cervical Cancer Treatment? Cancers (Basel) 2023; 15:cancers15051570. [PMID: 36900360 PMCID: PMC10001182 DOI: 10.3390/cancers15051570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, including all patients managed with MIS for ESCC. (3) All 239 patients included in the study underwent pelvic lymphadenectomy followed by radical hysterectomy without the use of an intrauterine manipulator. Preoperative brachytherapy was performed in 125 patients with tumors measuring 2 to 4 cm. The 5-year OS and RFS rates were 92% and 86.9%, respectively. Multivariate analysis found two significant factors associated with recurrence: previous conization with HR = 0.21, p = 0.01, and tumor size > 3 cm with HR = 2.26, p = 0.031. Out of the 33 cases of disease recurrence, we witnessed 22 disease-related deaths. Recurrence rates were 7.5%, 12.9%, and 24.1% for tumors measuring ≤ 2 cm, 2 to 3 cm, and > 3 cm, respectively. Tumors ≤ 2 cm were mostly associated with local recurrences. Tumors > 2 cm were frequently associated with common iliac or presacral lymph node recurrences. (4) MIS may still be considered for tumors ≤ 2 cm subject to first conization followed by surgery with the Schautheim procedure and extended pelvic lymphadenectomy. Due to the increased rate of recurrence, a more aggressive approach might be considered for tumors > 3 cm.
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Affiliation(s)
- Benjamin Serouart
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Abel Cordoba
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | - Emilie Bogart
- Department of Biostatistics, Oscar Lambret Center, 59000 Lille, France
| | | | - Éric Leblanc
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Alexandre Escande
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | | | - Sophie Taieb
- Department of Imaging, Oscar Lambret Center, 59000 Lille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
- Correspondence: ; Tel.: +33-7-69-21-12-99
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
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Silvestris E, Paradiso AV, Minoia C, Daniele A, Cormio G, Tinelli R, D’Oronzo S, Cafforio P, Loizzi V, Dellino M. Fertility preservation techniques in cervical carcinoma. Medicine (Baltimore) 2022; 101:e29163. [PMID: 35512072 PMCID: PMC9276378 DOI: 10.1097/md.0000000000029163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/08/2022] [Indexed: 01/04/2023] Open
Abstract
The usefulness of this review is to highlight how a fertility preservation (FP) approach is currently feasible for patients diagnosed with uterine cervical cancer. To this regard, a fertility sparing surgery has just overcome its traditional limits, gained acceptance within the major gynecologic oncology societies thanks to the ability to identify the "ideal" candidates to this conservative treatment. On the other hand, the use of other FPs for oocyte and ovarian cortex cryopreservation is still extremely debated. In fact, the existing risk of tumor spreading during oocyte retrieval necessary for oocyte cryostorage for patients' candidates for neo-adjuvant therapy, as well as the potential hazard of cancer cell dissemination after ovarian tissue replacement in cases of non-squamous type cervical carcinomas should not be underestimated. Therefore, in consideration of the encountered limitations and the need to ensure adequate reproductive health for young uterine cervical cancer survivors, translational research regarding the FP has progressively collected innovative insights into the employment of stemness technology. In this context, the property of ovarian stem cells obtained from the ovarian cortex to generate functional oocytes in women could represent a promising therapeutic alternative to the current procedures for a novel and safer FP approach in cancer survivors.
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Affiliation(s)
- Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II” Bari, Italy
| | - Angelo Virgilio Paradiso
- Institutional BioBank, Experimental Oncology and Biobank Management Unit, IRCCS Istituto Tumori “Giovanni Paolo II,” Bari, Italy
| | - Carla Minoia
- Unit of Hematology and Cell Therapy, Laboratory of Hematological Diagnostics and Cell Characterization, Bari, Italy
| | - Antonella Daniele
- Experimental Oncology, Center for Study of Heredo-Familial Tumors, IRCCS Istituto Tumori ”Giovanni Paolo II“ Bari, 70124 Bari, Italy
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari Aldo Moro, Bari, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, ”Valle d’Itria" Hospital, Martina Franca, Italy
| | - Stella D’Oronzo
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Paola Cafforio
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari Aldo Moro, Bari, Italy
| | - Miriam Dellino
- Department of Obstetrics and Gynecology, “San Paolo” Hospital, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari Aldo Moro, Bari, Italy
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Cai J, He X, Wang H, Dong W, Zhang Y, Zhao J, Willborn KC, Huang B, Wang Z, Jiang P. Topographic distribution of lymph node metastasis in patients with stage IB1 cervical cancer: an analysis of 8314 lymph nodes. Radiat Oncol 2021; 16:54. [PMID: 33743714 PMCID: PMC7981976 DOI: 10.1186/s13014-021-01781-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment. Methods A total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification. Results Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases.
Conclusions The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.
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Affiliation(s)
- Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Xiaoqi He
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Weihong Dong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jing Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Kay C Willborn
- University Clinic for Medical Radiation Physics, Medical Campus Pius-Hospital, Carl von Ossietzky University Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Bangxing Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| | - Ping Jiang
- University Clinic for Medical Radiation Physics, Medical Campus Pius-Hospital, Carl von Ossietzky University Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany.
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Alliende RI, Carrasco ÁM, Levancini M, Kovoor E, Guzmán-Rojas RA, Miranda-Mendoza I. 5,926 hysterectomies: complications described by Clavien-Dindo classification. J OBSTET GYNAECOL 2021; 41:1102-1106. [PMID: 33432854 DOI: 10.1080/01443615.2020.1835843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hysterectomy is the most common major gynaecological surgery. Due to its high volume, the analysis of its results is relevant. The objective of this study was to describe intraoperative complications and reoperations, for both benign and malignant causes, using the Clavien-Dindo classification (approved by local ethics committee, number 100220). Between 2000 and 2019, 5926 elective hysterectomies were performed, of which 90.2% were for benign aetiology and 9.8% for malignant causes. The abdominal route was 52.7%, vaginal 40.1% and laparoscopic 7.2%. Intraoperative complications and reoperations (grade III Clavien-Dindo) were 4% and 2.1%, respectively. Oncological surgery had significantly more intraoperative complications (10% vs. 3.4%) and reoperations (3.6% vs. 1.9%) than benign procedures. Noteworthy, intraoperative complications required a new operation in only 3.4% for malignant and 2.8% for benign surgery. Our data showed the relevance of detecting and rectifying intraoperative complications during surgery, which consequently leads to a lower reoperation rate, minimising postoperative morbidity and mortality for patients.Impact StatementWhat is already known on this subject? The surgical complications of hysterectomy, both intraoperative and postoperative, are extensively described. However, this information is not well systematised, in which elective and emergency surgery are mixed. In addition to the above, there are few documents comparing the results of hysterectomies due to benign versus malignant causes.What the results of this study add? Using the Clavien-Dindo classification, this study adds an organised description of intraoperative complications and reoperations of hysterectomy in the context of elective surgery. In addition, it provides information on the comparison between surgery for benign versus malignant causes, as well as information on intraoperative complications requiring a new operation.What the implications are of these findings for clinical practice and/or further research? These findings provide clear and orderly data about the risks of elective hysterectomy and showed the relevance of detecting and rectifying intraoperative complications during the procedure. This is useful for specialists to preoperatively identify the risks for each hysterectomy group and provide their patients with more detailed information during informed consent.
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Affiliation(s)
- Rodrigo I Alliende
- Department of Obstetrics and Gynecology, Hospital de la Florida, Santiago, Chile
| | - Álvaro M Carrasco
- Department of Obstetrics and Gynecology, Hospital de la Florida, Santiago, Chile
| | - Marco Levancini
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile
| | | | - Rodrigo A Guzmán-Rojas
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile.,Department of Obstetrics and Gynecology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Ignacio Miranda-Mendoza
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile.,Department of Obstetrics and Gynecology, Hospital Clinico Universidad de Chile, Santiago, Chile
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Martin-Hirsch P, Wood N, Whitham NL, Macdonald R, Kirwan J, Anagnostopoulos A, Hutson R, Theophilou G, Otify M, Smith M, Myriokefalitaki E, Quinland W, Mahon-Daly F, Clayton RD, Nagar H, Harley I, Dobbs S, Ratnavelu N, Kucukmetin A, Fisher AD, Tailor A, Butler-Manuel S, Madhuri K, Edmondson RJ. Survival of women with early-stage cervical cancer in the UK treated with minimal access and open surgery. BJOG 2019; 126:956-959. [PMID: 30658010 DOI: 10.1111/1471-0528.15617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 01/10/2023]
Affiliation(s)
- P Martin-Hirsch
- Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - N Wood
- Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - N L Whitham
- Sharoe Green Unit, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | | | - J Kirwan
- Liverpool Women's Hospital, Liverpool, UK
| | | | - R Hutson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - M Otify
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Smith
- Christie NHS Foundation Trust, Manchester, UK
| | | | - W Quinland
- Christie NHS Foundation Trust, Manchester, UK
| | - F Mahon-Daly
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R D Clayton
- St Mary's Hospital, Manchester University Foundation NHS Trust, Manchester, UK
| | - H Nagar
- Belfast City Hospital, Belfast, UK
| | - I Harley
- Belfast City Hospital, Belfast, UK
| | - S Dobbs
- Belfast City Hospital, Belfast, UK
| | - N Ratnavelu
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - A Kucukmetin
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - A D Fisher
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK
| | - A Tailor
- Royal Surrey County Hospital NHS Trust, Guildford, UK
| | | | - K Madhuri
- Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - R J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester University Foundation NHS Trust, Manchester, UK
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Yang L, Cai J, Dong W, Shen Y, Xiong Z, Wang H, Min J, Li G, Wang Z. Laparoscopic radical hysterectomy and pelvic lymphadenectomy can be routinely used for treatment of early-stage cervical cancer: a single-institute experience with 404 patients. J Minim Invasive Gynecol 2014; 22:199-204. [PMID: 25281840 DOI: 10.1016/j.jmig.2014.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The aim of our study was to determine if laparoscopic radical hysterectomy (LRH) can be routinely used for the treatment of early-stage cervical cancer. DESIGN From May 2008, LRH was planned for all primarily operable cervical cancer patients after receiving informed consent in our department. The surgical and oncologic outcomes were retrospectively evaluated (Canadian Task Force classification III). SETTING University teaching hospital. PATIENTS AND INTERVENTIONS By August 2013, 404 patients with invasive cervical cancer were deemed operable, and all of them were subjected to upfront LRH, except 1 patient who insisted on open surgery. MEASUREMENTS AND MAIN RESULTS The planned LRH was abandoned in 3 patients because of inoperability. The median operative time was 240 minutes (range, 100-410 minutes). The median blood loss was 300 mL (range, 50-800 mL). The median number of harvested pelvic lymph nodes was 23.5 (range, 11-54). Two patients had positive surgical margins. Intraoperative complications occurred in 7 of the patients, and a conversion to open surgery was mandatory for 2 patients (conversion rate = 0.5%). Postoperative urinary tract fistula developed in 3 patients. Sixty-nine patients underwent adjuvant therapy. The median duration of follow-up was 31 months (range, 7-69 months). Thirty patients developed recurrent disease with a median disease-free interval of 12 months (range, 6-23 months), and 24 died of disease. The estimated 3-year overall survival rate was 94.9% in the women with a tumor ≤ IB1 and 81.3% in those with a tumor >IB1, and the 3-year progression-free survival rates were 94.1% and 79.6%, respectively. CONCLUSION LRH is adequate, safe, and feasible for women with cervical cancer, and it can be routinely used for the treatment of early-stage tumors as a primary modality.
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Affiliation(s)
- Lu Yang
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Weihong Dong
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yi Shen
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jie Min
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Guiling Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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Minilaparoscopic radical hysterectomy for cervical cancer: Multi-institutional experience in comparison with conventional laparoscopy. Eur J Surg Oncol 2013; 39:1094-100. [DOI: 10.1016/j.ejso.2013.07.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/11/2013] [Accepted: 07/25/2013] [Indexed: 12/16/2022] Open
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8
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Jo EJ, Lee YY, Kim TJ, Choi CH, Lee JW, Bae DS, Kim BG. Management and Outcome of Rectal Injury During Gynecologic Laparoscopic Surgery. J Minim Invasive Gynecol 2013; 20:166-71. [PMID: 23295198 DOI: 10.1016/j.jmig.2012.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/01/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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Hwang JH, Lim MC, Joung JY, Seo SS, Kang S, Seo HK, Chung J, Park SY. Urologic complications of laparoscopic radical hysterectomy and lymphadenectomy. Int Urogynecol J 2012; 23:1605-11. [PMID: 22531954 DOI: 10.1007/s00192-012-1767-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 03/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to evaluate the intra- and postoperative urologic complications and management in patients with cervical or endometrial cancer treated with laparoscopic radical hysterectomy and lymphadenectomy. METHODS We retrospectively reviewed the medical records of 146 patients with cervical or endometrial cancer who underwent total laparoscopic radical hysterectomy with lymphadenectomy between August 2002 and April 2011. The intra- and postoperative urologic complications were analyzed. RESULTS Double ureteral stents were inserted prophylactically in 13 patients (8.9 %), 2 of whom had postoperative urologic complications. Nine patients (6.2 %) had postoperative urologic complications. Of four patients with ureterovaginal fistulas, two were treated conservatively with cystoscopic placement of ureteral stents and two underwent ureteroneocystostomies. Vesicovaginal fistulas occurred in two patients, both of whom underwent vesicovaginal fistula repairs. One patient noted to have a bladder injury intraoperatively had a laparoscopic repair, and one patient noted to have a ureteral injury postoperatively was treated conservatively with cystoscopic placement of ureteral stents. CONCLUSIONS Iatrogenic lower urinary tract injuries during laparoscopic radical hysterectomy are relatively common complications. Intraoperative prophylactic ureteral stent insertion and the early detection of urologic complications postoperatively is advised for patients who undergo laparoscopic radical hysterectomies.
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Affiliation(s)
- Jong Ha Hwang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323 Illsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea
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Surgical and Oncological Outcome of Total Laparoscopic Radical Hysterectomy in Obese Women With Early-Stage Cervical Cancer. Int J Gynecol Cancer 2012; 22:101-6. [DOI: 10.1097/igc.0b013e3182358b56] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveTo evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m2) and nonobese (BMI <30 kg/m2) women.MethodsData were collected prospectively on intraoperative and postoperative parameters and complications for all women undergoing a TLRH for cervical cancer. Patients were classified as obese, BMI >30 kg/m2, or nonobese, BMI <30 kg/m2. Assessment of surgical radicality was made by comparing the excision specimens in the 2 groups with a cohort of open radical hysterectomy cases performed before the introduction of the TLRH.ResultsA total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2–13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3–42 months). She belonged to the nonobese group.ConclusionsThe TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.
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11
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Vizza E, Pellegrino A, Milani R, Fruscio R, Baiocco E, Cognetti F, Savarese A, Tomao F, Chen C, Corrado G. Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy. Eur J Surg Oncol 2011; 37:364-9. [DOI: 10.1016/j.ejso.2010.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/03/2010] [Accepted: 12/06/2010] [Indexed: 11/28/2022] Open
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Tinelli R, Malzoni M, Cosentino F, Perone C, Fusco A, Cicinelli E, Nezhat F. Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: a multicenter study. Ann Surg Oncol 2011; 18:2622-8. [PMID: 21394663 DOI: 10.1245/s10434-011-1611-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively compare the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and total robotic radical hysterectomy (RRH) with lymphadenectomy for early cervical carcinoma in a series of 99 consecutive women. MATERIALS AND METHODS We studied 99 consecutive patients with FIGO stage Ia1 (LVSI), Ia2, Ib1, Ib2, and IIa cervical cancer, 76 of whom underwent TLRH and 23 underwent RRH with pelvic lymph node dissection. Para-aortic lymphadenectomy, with the superior border of the dissection being the inferior mesenteric artery, was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation. RESULTS The mean blood loss was 157 ml in the RRH group (95% confidence interval [95% CI] 50-400) and 95 ml in the TLRH group (95% CI 30-500) (not significant [NS]). The median length of hospital stay was 3 days in the RRH group (95% CI 2-7) and 4 days in the TLRH group (95% CI 3-7) (NS). The mean operating time was 255 min for the TLRH group (95% CI 182-415) compared with 323 min in the RRH group (95% CI 161-433) (P < 0.05). No significant difference was found between the 2 groups when comparing the recurrence rate. CONCLUSIONS Robotic radical hysterectomy can be considered a safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences, if compared with laparoscopic radical hysterectomy, in terms of the recurrence rate and intraoperative and postoperative complications, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.
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Affiliation(s)
- Raffaele Tinelli
- Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
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Kruijdenberg C, van den Einden L, Hendriks J, Zusterzeel P, Bekkers R. Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review. Gynecol Oncol 2011; 120:334-9. [DOI: 10.1016/j.ygyno.2010.12.342] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
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Yan X, Li G, Shang H, Wang G, Han Y, Lin T, Zheng F. Twelve-year experience with laparoscopic radical hysterectomy and pelvic lymphadenectomy in cervical cancer. Gynecol Oncol 2010; 120:362-7. [PMID: 21168904 DOI: 10.1016/j.ygyno.2010.11.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/01/2010] [Accepted: 11/23/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to evaluate the morbidity, oncological outcome, and prognostic factors of cervical cancer patients treated with laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH). METHODS Patients with cervical cancer undergoing LRH at the First People's Hospital of Foshan between August 1998 and March 2010 were enrolled in this study. The medical records were reviewed. RESULTS A total of 240 patients were identified. According to FIGO stage, the number of patients with stage Ia2, Ib1, Ib2, IIa, and IIb was 2, 163, 34, 35, and 6, respectively. The conversion rate was 1.25%. Intraoperative and postoperative complications occurred in 7.08% and 9.16% patients, respectively. Other medical problems included 74 cases (30%) of bladder dysfunction. Excluding the lost cases, the median follow-up of 221 cases was 35 months, and 5-year survival rate for Ia2, Ib1, Ib2, IIa was 100%, 82%, 66%, 60%, respectively. Univariate analysis showed factors impacting the survival rate were FIGO stage>Ib1, non-squamous histologic type, deep cervical stromal invasion, and lymph node metastasis (P=0.027, 0.023, 0.007, 0.000). The Cox-proportional hazards regression analysis indicated that only lymph node metastasis (OR=3.827, P=0.000) was independent of poor prognostic factor. The 5-year survival rates in Ib1 were 88% with negative lymph nodes and 59% with positive lymph nodes (P=0.000). CONCLUSIONS Our data demonstrate that LRH can be performed in stage Ia2-Ib1 or less advanced node negative cervical cancer patients without compromising survival. The feasibility of LRH for more advanced patients needs further investigations.
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Affiliation(s)
- Xiaojian Yan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical College, 325000 Wenzhou, China
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Controversies in the management of endometrial carcinoma. Obstet Gynecol Int 2010; 2010:862908. [PMID: 20613958 PMCID: PMC2896852 DOI: 10.1155/2010/862908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/01/2009] [Accepted: 04/13/2010] [Indexed: 01/03/2023] Open
Abstract
Endometrial carcinoma is the most common type of female genital tract malignancy. Although endometrial carcinoma is a low grade curable malignancy, the condition of the disease can range from excellent prognosis with high curability to aggressive disease with poor outcome. During the last 10 years many researches have provided some new valuable data of optimal treatments for endometrial carcinoma. Progression in diagnostic imaging, radiation delivery systems, and systemic therapies potentially can improve outcomes while minimizing morbidity. Firstly, total hysterectomy and bilateral salphingo-oophorectomy is the primary operative procedure. Pelvic lymhadenectomy is performed in most centers on therapeutic and prognostic grounds and to individualize adjuvant treatment. Women with endometrial carcinoma can be readily segregated intraoperatively into “low-risk” and “high-risk” groups to better identify those women who will most likely benefit from thorough lymphadenectomy. Secondly, adjuvant therapies have been proposed for women with endometrial carcinoma postoperatively. Postoperative irradiation is used to reduce pelvic and vaginal recurrences in high risk cases. Chemotherapy is emerging as an important treatment modality in advanced endometrial carcinoma. Meanwhile the availability of new hormonal and biological agents presents new opportunities for therapy.
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Robotic Radical Hysterectomy Using a Side-Docking Approach. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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