[Utilization of CO2 lasers in continuous or pulsed mode for conizations: apropos of 230 cases]

OBJECTIVE

A retrospective study with the aim of analysing efficiency, anatomical and functional consequences of a conservative methodology for the treatment of cervical intra-epithelial neoplasias (CIN) using carbon dioxide laser.

MATERIALS AND METHOD

Two hundred and thirty patients were treated and studied with an average waiting period of 38 months. During the study new methodology allowed a cut in the pulse regimen with adjustments in high energy levels. This allowed us to subdivide the study into two groups, respectively 113 and 117 patients, and to provide a differential rate of immediate and late complications. The pre-therapy lesion assessment led to a diagnosis of severe dysplasia (53%), carcinoma in situ (19.1%), mild dysplasia (20.4%) and investigational conization 7%; in one case, conization was provided for adenocarcinoma in situ.

RESULTS

The anatomo-pathologic results showed 2.1% microinvasive tumors, 22.2% epidermoid carcinoma in situ, 2.1% adenocarcinoma in situ, 53.6% severe dysplasia, 14% mild dysplasia, 0.9% low dysplasia, and 5.2% viral lesions without dysplasia. The excision limit are in sano in 95.2% of cases, and non in sano for the endocervix in 2.2% of cases and for the ectocervix in 2.6% of cases.

COMPLICATIONS

Needing second surgical intervention hemorrhage rates were 1.8% during the first period (2/113) and 1.7% according to the second period (2/117). No infectious complications were reported in the two series. As for delayed and long-term complications, incomplete stenosis rates (uterine cervix permeability up to n degree 3 Hegar dilatator) reached respectively 3.5% of cases (4/113) and 1.7% (2/117); complete stenosis rates were 2.6% (3/113) and 0% (0/117). RECURRENCES: Nine recurrent cases (5.9%) were divided into two low dysplasia, four moderate dysplasia, one severe dysplasia, one epidermoid carcinoma in situ and one infiltrating carcinoma.

CONCLUSIONS

The less aggressive possible choice of a conservative therapy allows not only young patients to conserve their fertility but also to preserve cervical anatomy and to facilitate diagnosis of a recurrent case. The decrease in the complications rates that we have allocated first to the use of carbon dioxide laser and second to the pulsed beam emphasize quality research throughout our experience.

[Cervical adenocarcinomas: diagnostic, prognostic and therapeutic aspects in a 49 case-control study]

OBJECTIVES

The aim of this study was to search for potential diagnostic, therapeutic and prognosis differences between a series of 49 adenocarcinomas of the cervix and a matched series of epidermoid carcinomas.

METHODS

Forty-nine adenocarcinomas were treated between 1978 and 1992 and retrospectively compared to a series of 98 paired epidermoid carcinomas.

RESULTS

The adenocarcinoma incidence is 5.4%. There was no significant difference for age distribution, parity, or hormonal status. There was also no significant difference for clinical features. Stage I appeared more frequently in the adenocarcinoma group (stage I: 69.4%, stage II: 14.3%, stage III: 14.3%, stage IV: 2%). Stage I are also more frequently found in the adenocarcinoma group (69.4% versus 42. 9%, p< 0,05). Combined radio-surgical treatment was proposed more often for the adenocarcinoma group (respectively radio-surgery combination 73%, radiotherapy alone 18%, surgery 9%); in the epidermoid carcinoma group, combined radio-surgical treatment and radiotherapy were the usual treatment (46%); surgery alone appeared in third rank place (8%). Adenocarcinoma pelvic recurrences appeared more frequently (28.6% for adenocarcinoma group versus 13.3% for epidermoid group p< 0.05), while distant recurrence was the same (12. 2% for adenocarcinoma group versus 11.2% for epidermoid group, p< 0. 05). Five years overall survival rate was worse for the adenocarcinoma group (52% versus 63.7%, p< 0.05) but the difference was not significant for the disease free survival rate. Only for stage Ib, there are also more pelvic recurrences (35.4% versus 13.1%, p< 0.05), more distant recurrences (9.6% versus 2.6%, p< 0.05), and lower overall survival for adenocarcinomas (58.7% versus 88.5%, p< 0. 01).

CONCLUSION

The incidence of adenocarcinomas is slightly increasing (absolute value in our experience) and the low stages seem to be more frequent in our experience probably by staging inaccuracy. Adenocarcinoma prognosis seems to be worse because of its poor radio-sensitivity. It seems necessary to optimize clinical staging and therapeutic protocols excluding radiotherapeutic approach, including surgical purposes or radio-surgical associations if unfavorable histological features or tumoral enlargement (T> 3 cm) are found.

[Hysteroscopic myomectomy. Functional results with an average follow-up of 6 years]

OBJECTIVE

In 1995, we presented our experience in hysteroscopic resection of hemorrhagic submucous fibroids in 196 patients. The objective of the present work was to analyze functional outcome three years later.

PATIENTS

One hundred ninety-six patients with abnormal uterine bleeding were treated between 1987 and 1993. Equipment, techniques, characteristics of the procedures and early results were detailed in the previous article.

RESULTS

With a mean follow-up of 73 months (range 50,104), results were: 13.8% of the patients were lost to follow-up; 68.4% had symptomatic improvement and failure was observed in 17.8% (subsequent hysterectomy in 12.7%). Forty-nine patients had repeat resection in this series; 61 became menopausal after surgery, and 21 were taking hormone replacement therapy with good results.

CONCLUSION

Developed as an alternative to hysterectomy, operative hysteroscopy has proven to be a safe and effective procedure. This treatment modality appears to give satisfactory long-term results, with a low rate of complications.