Total laparoscopic radical hysterectomy (type II-III) with pelvic lymphadenectomy in early invasive cervical cancer (original) (raw)
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Gynecologic Oncology, 2011
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 N Ib1, non-squamous histologic type, deep cervical stromal invasion, and lymph node metastasis (P = 0.027, 0.023, 0.007, 0.000). The Coxproportional 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.
Journal of Minimally Invasive Gynecology, 2014
Measurements and Main Results: A total of 1476 lymph nodes were removed from 50 patients. SLN was successfully detected. The detection rate of SLN was 100% (50/50). A total of 445 SLNs were detected, accounting for 43.20% (445/1030) of the total number of lymph nodes. SLNB detection sensitivity 100% (50/50), specificity 100.00% (50/50), SLN prediction of pelvic lymph node status and postoperative pathological examination coincidence rate of 100% (50/50), negative predictive value of 100.00% (50/50). Conclusion: The metastatic state of SLN in early cervical cancer is consistent with the true metastatic state of pelvic lymph nodes, which has a more accurate pathological representative significance. Laparoscopic detection of SLN in early cervical cancer using nano-carbon tracer is a comparative method. Safe and feasible, SLNB has to replace traditional cervical cancer pelvic lymphadenectomy, narrowing the scope of surgery and reducing trauma.
Laparoendoscopic single-site radical hysterectomy for treatment of early cervical cancer
Gynecologic Oncology, 2013
Technical developments have made laparoendoscopic single-site (LESS) surgery increasingly more feasible for treating gynecological conditions, including cancer. However, complex surgeries such as radical hysterectomy have rarely been performed with single-port access because of technical difficulties. The majority of the difficulties are due to the inefficient retraction of tissue during dissection. Here, we report a detailed description of LESS radical hysterectomy plus pelvic lymph node dissection that was successfully performed in two patients with stage IB1 cervical cancer. We used our expertise with LESS to perform space development as much as possible before the ligaments were resected. The oncologic clearance was comparable to that of conventional laparoscopic radical hysterectomy.
Cancers
Background: Recent evidence indicates that some minimally invasive surgery approaches, such as laparoscopic and robotic-assisted radical hysterectomy, offer lower survival rates to patients with early-stage cervical cancer than open radical hysterectomy. We evaluated the oncological results of a different minimally invasive surgery approach, that of laparoscopically assisted radical vaginal hysterectomy (LARVH) in this setting. Methods: From January 2001 to December 2018, patients with early-stage cervical cancer were treated by LARVH. Colpotomy and initial closure of the vagina were performed following the Schauta operation, avoiding manipulation of the tumor. Laparoscopic sentinel lymph node (SLN) biopsy was performed in all cases. Women treated between 2001 and 2011 also underwent pelvic lymphadenectomy. Results: There were 115 patients included. Intraoperative complications occurred in nine patients (7.8%). After a median follow-up of 87.8 months (range 1–216), seven women (6%) ...
Objective: To describe our technique of total laparoscopic radical hysterectomy (LRH) in cervical cancer and share our experience. Materials and Methods: Retrospective study of 53 non-consecutive patients with International Federation of Gynaecology and Obstetrics (FIGO) Stage IA2 (n=1), IB1 (n=26), and IB2 (n=26) cervical cancer. All patients underwent total LRH with bilateral pelvic lymphadenectomy. Harmonic shears were the primary instrument used for the dissection, transection, and maintenance of hemostasis. Hemostasis was also achieved using bipolar graspers if deemed necessary. This study was approved by the local institutional review board (Sangini Hospital Ethics Committee), IRB registration number IRB00008709. Results: The median age was 47 (range, 28-70) years, with a median body mass index of 25.7 (range, 16- 32) kg/m2 . The median operative time was 103 (range, 61-150) minutes. There were no intraoperative complications. Median blood loss was 30 (range 20-135) mL. None of the cases required conversion to laparotomy. Postoperative complication rate was seen in 18 (34%) patients. Urinary dysfunction was the most common postoperative complication seen in 13 (24.5%) patients. The median number of pelvic nodes resected was 20 (range, 8-55). The surgical margins were free of disease in all cases. The median length of stay was four (range, 2-8) days. Thirty-five patients required adjuvant therapy post surgery. The median follow-up in this study was 38 (range 0-97) months. Recurrence of the disease was seen in three patients. Four patients expired. The estimated three-year overall survival rate was 92.6% in patients with disease ≤ IB1 and 92.3% in those > IB1. Conclusion: The present technique of LRH is safe, feasible, and associated with less morbidity. It is associated with minimal intraoperative complications, blood loss, shorter operative time, and outcomes comparable to other studies. The present technique consists of simple steps, which are easily reproducible and replicable once the learning curve has been surpassed.
Gynecologic Oncology, 1989
Nine hundred fifty-four patients, who received a radical hysterectomy and a bilateral pelvic lymphadenectomy, were included in this study which ran from The subjects, by in large, ranged in age from 41 to 60. Of these cases, 62.5% were in clinical stage IB, while 26.2% were in stage IIA. Urinary tract fistula formations occurred in 2.4% of the cases and substantially decreased from 6.1% during 1971-1978 to 0.9% in the subsequent period from 1979 to 1986. The operative mortality rate was 0.4%.
Chinese journal of cancer research = Chung-kuo yen cheng yen chiu, 2016
The radical hysterectomy (RH) surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoscopy at our institution. We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery: 1990-1999, 2000-2009 and 2010-2013. Patients?characteristics, pathologic details, intraoperative and postoperative complications were analyzed and compared throughout the time periods. A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% f...
Obstetrics & Gynecology International Journal
Background Cervical carcinoma (CIN) is typically detected through pathological tissue changes at the squamous-columnar epithelial transition zone. As the disease advances, it may extend into the uterine cavity, vaginal canal and pelvis. Cancer screen is routinely done via Papanicolaou smear test. In a majority of cases where pre-cancerous lesions (CIN Stages I, II, and III) are detected by cytology, associated signs and symptoms are absent. Usually, once symptoms present, the disease has spread extensively. 2−4 Risk factors for cervical cancer include tobacco use, immunocompromised status, family history of cervical cancer, sexual contact without barrier protection, low social economic status and multiple full-term pregnancies. Additionally, a known causative agent for cervical cancer is human papillomavirus (HPV). In order to avoid contributory effects from such risk factors and causative agents, clinicians recommend regular cervical cytologic screening, completing the HPV immunization series, routine condom use, and smoking cessation. 3−6 Treatment and diagnosing modalities used in current practice for cervical carcinoma include cone biopsy, loop electrosurgical excision procedure (LEEP), laser and cold knife conization and simple hysterectomy. If the cervical malignancy r is found to be in an advanced stage, it may be necessary to perform a radical hysterectomy via laparotomy or laparoscopy with concomitant localized radiation therapy and/or chemotherapy for widespread disease. 1,5,7 Traditionally, cervical cancer was managed by the previously mentioned techniques; with advancements the Single-Incision Laparoscopic Surgery (SILS) has a high efficacy rate with a minimally invasive approach. 1,8,9 Single-Incision Laparoscopic Surgery (SILS) is one of latest innovations in minimally invasive surgery and has several potential
International Journal of Gynecologic Cancer
IntroductionRecent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.MethodsWe performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with ...