Abdominal Radical Hysterectomy Research Articles

Hysterectomy with Preservation of both Ovaries does not Result in Premature Ovarian Failure

This study investigated ovarian function and adnexial pathology following total abdominal hysterectomy with preservation of both ovaries compared with that in a control group. Data from 29 patients who had undergone total abdominal hysterectomy at age < or =40 years and 42 menopausal patients with no previous ovarian pathology were evaluated retrospectively. The mean (+/- SD) age of menopause was 49.7 +/- 1.5 years in the total abdominal hysterectomy group and 50.1 +/- 1.3 years in the control group; this difference was not statistically significant. The incidences of cyst and hydrosalpinx were 31% and 6.9%, respectively, in the total abdominal hysterectomy group and 44.8% and 0%, respectively, in the control group. The increased incidence of cysts in the total abdominal hysterectomy group was statistically significant. In conclusion, patients who undergo total abdominal hysterectomy without oophorectomy do not experience premature menopause. Preservation of the ovaries may avoid the disadvantages of hormone replacement therapy at the expense of a higher risk of developing adnexial pathology.

Bilateral ovarian metastasis on transposed ovaries from cervical carcinoma

The preservation of ovarian function of young patients with cervical carcinoma is thought to be particularly important to the physiologic and psychosexual well-being of these women [1]. So, the ovarian-sparing radical hysterectomy has become the standard operation for early cervical cancer in young women [2] as the risk of persistence of unnoticed tumor implants in the transposed ovaries is supposed to be extremely unusual. Data are controversial in locally advanced cases [3]. A case of bilateral metastasis on both transposed ovaries in a patient with II-B cervical cancer is exposed. A 33-year old woman was referred to the hospital with a newly diagnosed squamous cell cervical carcinoma. The pelvic exam showed a 45 mm exofitic–ulcerative cervical tumor with proximal infiltration of the left parametrium (IIB FIGO stage). A laparoscopic retroperitoneal left paraaortic lymphadenectomy and the transposition of the ovaries was scheduled before the beginning of the chemo-radiotherapy. The left paraaortic lymphadenectomy produced a total of 10 lymph nodes free of metastasis. Afterwards the patient was started on a chemoradiotherapy scheme with cis-platin alongside with pelvic external beam radiotherapy. The treatment was supplemented with brachytherapy. There was an apparent partial response, and a salvage type II (Rutledge's classification) abdominal radical hysterectomy was performed. The transposed ovaries were left in place. There was no evidence of relapse during one year until a progressive increase of the carcinoembryonic antigen (CEA) plasma level raised the suspicion of recurrent disease. The abdominal CT scan showed an enlargement of both transposed ovaries (left 5 cm, right 4 cm) (Fig. 1). A PETCT study also revealed another hypermetabolic left paraaortic focus. A laparotomy was performed which included resection of bilateral solid ovarian masses, and dissection of the retroperitoneal paraaortic space that revealed a 3 cm adenopathy that was unable to be completely removed. Final pathology confirmed metastatic squamous cell cancer on both ovaries and in the paraaortic node, but with a small component of adenosquamous cancer. Revision of the initial specimen (cervical biopsies) revealed also this small component of adenosquamous histological type. The patient then received chemotherapy and paraaortic radiotherapy and died 8 months later. The risk for occult ovarian metastasis in early (less than II stage) squamous cell carcinoma of the uterine cervix is well known to be less than 1% (1). When it comes to the adenocarcinomas, there is a slightly higher (1–2%) risk. Therefore, when planning the surgical treatment of early cervical cancer in young women, the ovarian sparing radical hysterectomy should be borne in mind. Metastatic spread to the ovary does occur in more advanced tumors with some frequency. Data such high as an incidence of 17% has been reported [4]. The combination of radiotherapy with radiosensitizing chemotherapy, achieves the control of the locally advanced disease in more than 70% of cases. However, the loss of ovarian function is one of the usual consequences of this therapy. The ovarian function can be maintained by

A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer

To compare the feasibility, morbidity, and survival outcome of the laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH+LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy (ARH+APL) for FIGO stage Ib-IIa cervical carcinoma. The consecutive cases with FIGO Ib-IIa cervical cancer from August 1998 to December 2005 were documented, including 90 patients underwent LRH+LPL, and 35 patients underwent ARH+APL as control group. The clinic data of perioperative periods and survival were compared between groups. In laparoscopy group the operating time increased significantly (262.99+/-67.6 min vs. 217.2+/-71.56 min, P=0.001), and the recovery time of bowel decreased significantly (1.96+/-0.62 days vs. 2.40+/-1.06 days, P=0.025). No significant difference was found between groups when the blood loss during operation (369.78+/-249.94 ml vs. 455.14+/-338.05 ml, P=0.125), numbers of the pelvic lymph nodes resected (21.28+/-8.39 vs. 18.77+/-9.47, P=0.151), recovery time of bladder function and postoperative hospital stays were compared. All laparoscopic procedures were completed successfully except 2 cases converted to laparotomy. The median follow-up was 26 months (range 5 to 84 months). Ten and five cases lost to follow-up in laparoscopy and laparotomy group, respectively. Excluding the lost cases, the recurrence rate (13.75% vs. 12%, P>0.05) and the mortality rate (10% vs. 8%, P>0.05) between groups was similar. Our data demonstrated that cervical cancer could be treated successfully with LRH+LPL with similar efficacy and recurrence rates to ARH+APL. LRH+LPL is a safe and effective alternative to conventional abdominal surgery for stage Ib-IIa cervical cancer, and should be used if the surgeon is sufficiently trained. Its clinical value should be confirmed by multicenter randomized clinic trials.

Urological complications after radical hysterectomy: Incidence rates and predisposing factors

[corrected] Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient's age; the International Federation of Ginecology and Obstetrics (FIGO) stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentoned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal fistuls had abscess of vaginal cuff. The stage of the disease seem to be the most significant factor in the development of intraoperative ureter and bladder injuries. The stage of the disease, intraoperative bladder injury, diabetes mellitus and postoperative infection of surgical site are the most significant factors in the development of postoperative fistuls.

Schauta radical vaginal hysterectomy

The vaginal radical hysterectomy was initially described by the surgeon Anton Pawlik [1], but it was popularized by the Austrian Frederik Schauta [2], who described this surgical treatment option for patients with cervical cancer. The procedure was associated with a decreased postoperative mortality when compared with the abdominal route that was championed by Wetheim [3]. Schauta's technique was eventually modified by Peham and Americh [4] and Stockel [5]. As pelvic lymphadenectomy became incorporated into the surgical treatment of this disease, however, the vaginal approach gave way to the abdominal radical hysterectomy, which allowed for both procedures to be performed through one incision.

Fertility-sparing radical abdominal trachelectomy for cervical carcinoma

A laparotomy and a bilateral complete pelvic lymphadenectomy are performed usually via a transverse lower abdominal incision in a similar manner to patients undergoing a radical abdominal hysterectomy. The limits of nodal dissection are the deep circumflex iliac vein caudally and the proximal common iliac artery cephalad. Any suspicious lymph nodes are sent for frozen-section analysis. A fertility-sparing approach should be abandoned if positive lymph nodes are identified. Sentinel lymph node identification is also a reasonable option and may allow for pathologic ultra-staging of these sentinel nodes.

0501: Comparative Study of Laparoscopic Radical Hysterectomy and Abdominal Radical Hysterectomy in Patients with Early Cervical Cancer

0501: Comparative Study of Laparoscopic Radical Hysterectomy and Abdominal Radical Hysterectomy in Patients with Early Cervical Cancer

0565: The Influence of Body Mass Index On Outcomes in Cervical Cancer Patients Treated with Radical Abdominal Hysterectomy

0565: The Influence of Body Mass Index On Outcomes in Cervical Cancer Patients Treated with Radical Abdominal Hysterectomy

0563: A Case Controlled Study of Total Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy (Tlrh) Versus Radical Abdominal Hysterectomy (Rah) in a Fellowship Training Program

0563: A Case Controlled Study of Total Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy (Tlrh) Versus Radical Abdominal Hysterectomy (Rah) in a Fellowship Training Program

Psychological wellbeing after laparoscopic and abdominal hysterectomy—a randomised controlled multicentre study

To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. A prospective, open, randomised multicentre trial. Five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy. Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively. Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time. No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group. General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta): a comparison with open Wertheim/Meigs hysterectomy

The objective of this study was to compare the safety, efficacy, and short-term benefits of the Coelio-Schauta procedure with open Wertheim/Meigs radical abdominal hysterectomy. We retrospectively analyzed records of our first 35 consecutive patients undergoing laparoscopically assisted radical vaginal hysterectomy (LARVH) for early cervical cancer and 32 consecutive patients of open radical hysterectomy (ORH) performed between 1999 and 2005 in our institution. We analyzed patient age, bodyweight, previous abdominal surgery, operating time, blood loss, perioperative complications, postoperative bladder dysfunction, other postoperative complications, and histologic type. The FIGO stage, excision margins, node count and node status, follow-up, and recurrence rates were also taken into account. We excluded stage IA and stage II disease patients to reduce the impact of tumor size on the outcome of the surgery. This left 27 patients with stage IIB disease who had LARVH and 28 patients with stage IB disease who had ORH. These patients formed the study group. The cohorts were similar in age, bodyweight, previous abdominal surgery, histologic subtype, FIGO stage, resection margins, node count and node status, length of follow-up, and recurrence. There were statistically significant differences between LARVH and ORH for duration of surgery (mean 160 vs 132 min), intraoperative blood loss (479 vs 715 mL), hospital stay (mean 5 vs 9.3 days), postoperative complications (6 vs 20 patients), and duration of bladder catheterization (mean 4.4 vs 8.8 days). Four LARVH patients and no ORH patients had urinary tract injury that was repaired. None had long-term sequelae. Our data confirm that LARVH is a suitable alternative to ORH hysterectomy for small-volume stage IB1 cervical cancer with similar clinical efficacy and a superior postoperative recovery and postoperative morbidity profile. Urinary tract trauma is a clear risk in the early stages of the learning curve.

Lymph Node Mapping and Sentinel Node Detection in Patients With Cervical Carcinoma: A 2-Year Experience

The authors present their experience with the detection of the sentinel node, which is the first node to receive drainage from a malignant tumor, in patients with cervical cancer. Fifty women who were scheduled to undergo radical abdominal hysterectomy and systematic pelvic lymphadenectomy for treatment of stage IA2 to IIA primary carcinoma of cervix from January 2003 to January 2005 served as study subjects. Sentinel lymph node (SNL) mapping was done with an intracervical injection of 4 mL methylene blue. Pelvic lymph nodes appeared blue 15 minutes after dye injection and remained colored for 70 minutes. A 25-gauge standard needle was used to slowly, under constant pressure, inject the dye into the cervix to a depth of 5 to 10 mm at 3, 6, 9, and 12 o'clock positions, taking care to avoid injecting into the tumor itself. The abdomen was then opened, and the right retroperitoneal space on the right pelvis was opened. Using blunt dissection, the avascular paravesical and pararectal spaces were developed. The blue lymphatics could then be followed to the first node with obvious or faint dye uptake. This sentinel node was dissected and removed. The procedure was repeated on the left side before proceeding with lymphadenectomy. After the SNLs were removed on both sides, bilateral pelvic lymphadenectomy followed by radical hysterectomy was performed in all patients. The technique was considered to have failed when no sentinel node was identified or when there was inadequate injection of the dye. If the SNL was negative on histology, but other nodes in the drainage area were positive, the outcome was considered to be a false-negative. Sentinel nodes were considered positive when they contained macrometastases, micrometastases, or isolated tumor cells. Sentinel nodes were processed in the routine fashion with hematoxylin & eosin staining, but negative sentinel nodes underwent additional processing using serial step sections and wide-spectrum cytokeratin immunohistochemical analysis. The mean age of participants was 45.9 years. The most common preoperative diagnosis was clinical stage IB1 cervical cancer. Two women had microinvasive cancer stage IA2. Seventeen patients underwent a cone biopsy before surgery. Residual carcinoma in situ was diagnosed in 18% of these patients, one third of whom had lesions larger than 2 cm. A total of 1093 lymph nodes were retrieved (mean, 21.9 per patient). Eighty-six sentinel nodes were identified in 45 patients (detection rate, 90%). Forty SNLs were on the right side in 34 patients, and 46 SNLs were on the left side in 38 patients. Twenty-five women (50%) had two SNLs identified and 18 (26%) had one SNL identified. In five women, there were three SNLs, and two patients had four sentinel nodes. No sentinel nodes were identified in five patients (failure rate, 10%). Inadequate injection technique with intraperitoneal spillage accounted for two of the failures. A third was attributed to injection of the methylene blue into the tumor in a woman with bulky cervical cancer. After this, patients with bulky tumors were excluded from the study. The external iliac and obturator areas were the most common sites of SNL (55% and 38%, respectively). SNLs were similarly distributed on both sides of the pelvis. In this series, sentinel nodes detected in the common iliac area (n = 5) typically were the only positive nodes found on the same side. There was one parametrial SNL, but no dye could be seen beyond it. Twenty-five positive nodes were identified in 10 patients (20%), including seven with unilateral involvement and three with bilateral spread. Thirteen of the 25 positive nodes were identified as sentinel nodes and were found in nine of the 10 patients. In five patients, the SNL was the only positive node detected. The one woman with a false-negative SNL had stage IB 1 squamous cervical cancer and one positive right parametrial lymph node and 35 negative pelvic lymph nodes. Bilateral SNLs identified in this patient were negative by serial step and wide-spectrum cytokeratin immunohistochemical analysis.

Early cervical cancer and parametrial involvement: Is it significant?

Objective. To determine the incidence of parametrial involvement in clinical stage IA and IB1 cervical cancer and whether pelvic lymph node status is a predictor of parametrial status. Methods. Retrospective review of 120 patients with FIGO stage IA/IB1 cervical carcinoma treated by class II radical abdominal hysterectomy between January 1997 and December 2001 was performed. The parametria were examined for microscopic involvement of parametrial lymph nodes and/or tissue. Continuous variables were compared using Wilcoxon rank sum test, and Fisher's exact test was used to categorical variables. Kaplan–Meier curves were constructed for overall survival (OS) and recurrence-free survival (RFS). Cox proportional hazards model was used to investigate prognostic factors. Results. One hundred ten patients were eligible. Five patients (5%) had positive parametria and 13 patients (12%) had positive pelvic lymph nodes. Four (80%) patients with positive parametria had positive pelvic lymph nodes. The groups did not differ significantly in terms of age ( P = 0.92), histology ( P = 0.15), or LVSI ( P = 0.20). Positive parametria was associated with larger tumor size (3.0 vs. 2.0 cm, P < 0.05), greater depth of invasion (16 mm vs. 5 mm, P = 0.03), and pelvic lymph node metastases (80% vs. 10%, P = 0.001). The only variable that was significant in the proportional hazards model was lymph node status ( P = 0.02). After median follow-up of 48 months, there was a significant difference in recurrence (40% vs. 4%, P = 0.03) and RFS (0.0003). Conclusions. Acknowledging small sample size and retrospective study, positive parametrial involvement in stage IA and IB1 cervical cancer is infrequent. There is a significant association with lymph node status. Thus, there may be a role for less radical surgery combined with pelvic lymphadenectomy in this patient population.

A comparison of laparoscopically-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer

Objective：The aim of this study was to compare peri-operative morbidity and safety of patients treated by laparoscopicallyassisted radical vaginal hysterectomy (LARVH) with laparoscopic pelvic lymphadenectomy (LPL) and radical abdominal hysterectomy (RAH) with pelvic lymph node dissection (PLND) in early stage of cervical cancer. Methods：Since September 2004, all patients with FIGO stage Ia-IIa cervical cancer undergoing radical surgery by members of our division have been entered into a prospective database. Two surgeons at our center have performed LARVH by Schneider method on all surgically appropriate patients. Results：Between September 2004 and May 2005, 26 patients were performed LARVH with LPL, 30 patients were performed RAH with PLND. There were no differences in estimated blood loss, the number of lymph nodes, duration of hospital stay and postoperative complications. But operative time was significantly prolonged in LARVH group. Intraoperative complications in the LARVH with LPL group included: bladder injuries (2), shift to laparotomy due to ureter injury (1). There was one case of vesicovaginal fistula in the RAH group. Conclusion：LARVH with LPL in early stage of cervical cancer is a safe and technically effective alternative to RAH. Despite the inherent limitations of LARVH with LPL and its associated learning curve, the procedure conveys many advantages over the open laparotomy technics in terms of postoperative wound pain and recovery. However further study is needed to evaluate long-term recurrence rate and survival rate.

Laparoscopic-Assisted Vaginal Hysterectomy versus Abdominal Hysterectomy in Stages I and II Endometrial Cancer: Operating Data, Follow up and Survival

At Principe De Asturias Hospital in Madrid, Spain, between January 1997 and December 2003, 75 women with stage I or II endometrial cancer were treated either with laparoscopic-assisted vaginal hysterectomy and pelvic lymphadenectomy (n = 38) or with total abdominal hysterectomy and pelvic lymphadenectomy (n = 37). This article presents a comparison of these two groups. Patients were not randomized to treatment; abdominal surgeries were more frequent in the early years, and laparoscopic procedures more common in the later years. All patients underwent initial pelvic and abdominal washing and inspection followed by pelvic lymphadenectomy. Paraaortic lymphadenectomy was performed after hysterectomy if there were positive pelvic lymph nodes. In laparoscopic procedures, a 10-mm umbilical and another inter-xipho-umbilical port and two 5-mm punctures in each lower abdominal quadrant were used. Lymph nodes were collected in a bag that was placed in the pouch of Douglas at the beginning of the procedure and then removed through the 10-mm umbilical trocar. The uterine vessels were sutured by either the laparoscopic or vaginal route. A midline incision was used for abdominal procedures. Patients were seen at a follow-up visit every 6 months for 5 years and then once a year. The mean operating time for the laparoscopic vaginal hysterectomy (LPS) group was 165 minutes (range, 77-240 minutes) compared with 130 minutes (range, 60-180 minutes) for the abdominal hysterectomy (LPM) group (P <0.05). There were seven (19%) intraoperative complications in the LPM group, including blood loss greater than 1000 mL in three patients and bladder and bowel injury in two patients each. In the LPS group, two patients had excessive bleeding, two patients with an uncontrollable hypercapnia were converted to laparotomy, and one patient with a ureteral abnormality had a double-J catheter inserted to maintain patency (five total intraoperative complications; 13%). Postoperative complications were seen in 39% of the LPM group compared with 18% of the LPS group. Overall, nine women had an abscess or hematoma, which was in the abdominal incision in five LPM and one LPS patient and in the vaginal vault in three LPS patients. There were five instances of fever in the LPM group and three in the LPS group. One LPM patient had a deep vein thrombosis and three LPM patients had postoperative ileus greater than 3 days. Four women who had laparotomy required postoperative blood transfusion. Three patients in this group were readmitted to the hospital for treatment of abscess or fever. No patient in the laparoscopically treated group required transfusion or readmission. There were no differences between the two groups in the number or location of lymph nodes removed or in the pathologic results. Postoperative adjuvant radiotherapy was given to all patients with a pathologic diagnosis of stage IB,G2 or greater. After a mean follow up of 53 months (range, 5-90 months) in patients who had laparotomy, 30(81%) are free of disease, two (5%) are alive with recurrence, three (8%) are dead, and two have been lost to follow up. The mean follow up for women who underwent laparoscopy was 36 months (range, 9-65 months). Thirty-one (82%) of these women are alive, two (5%) are alive with disease, four (10.5%) are dead, and one has been lost to follow up. A total of four patients developed recurrent disease. There was one recurrence in the retroperitoneum, one in the lung (LPM group), one in the vaginal vault, and one bone metastasis (LPS group). All were alive at the time of publication.

Laparoscopically Assisted Radical Vaginal Hysterectomy vs Radical Abdominal Hysterectomy for Cervical Cancer: A Match Controlled Study

Laparoscopically Assisted Radical Vaginal Hysterectomy vs Radical Abdominal Hysterectomy for Cervical Cancer: A Match Controlled Study

271: Comparative Study of Laparoscopic Radical Hysterectomy and Abdominal Radical Hysterectomy in Patients with Early Cervical Cancer

To evaluate the outcomes of patients treated by laparoscopic radical hysterectomy and to compare surgical parameters and recurrence rates to those of patients treated by conventional abdominal radical hysterectomy. Retrospective study. From October 1997 to December 2004. Inclusion criteria for the laparoscopic group were patients with FIGO stage IA to IB. As a control, we selected 142 cases for the RH group. These groups had the same FIGO stage and the same age. We performed 185 cases of LRH (laparoscopic radical hysterectomy) with +PLN (pelvic lymphadenectomy) ± paraaortic lymph node sampling. The mean surgery duration, the number of lymph nodes and the rate of perioperative and postoperative complications were similar in both the laparoscopic and the conventional laparotomy group. The mean length of hospital stay was significantly shorter in patients treated by laparoscopic surgery (LRH vs. RH; 13 vs. 21 days). The positive rates of pelvic lymph nodes metastasis in both groups were similar at 6.4%. Six (3.2%) of 185 LRH patients and four (2.8%) of 142 RH patients had recurrences. The three year progression-free survival rates were 94.2% in the LRH group and 96.4% in the RH group (p=0.174). Overall, there were 27 (27/185, 14.6%) major perioperative complications including bladder, ureter, vessels and bowel injuries in laparoscopic group. 15 (30%) of those complications occurred during the first 50 cases, compared to 12 (8.9%) of the later cases (p>0.001). Laparoscopic surgery for treatment of early cervical cancer is a safe and effective alternative to conventional abdominal radical hysterectomy.

293: A Comparison of Total Laparoscopic and Abdominal Radical Hysterectomy in the Treatment of Early Cervical Cancer in a Gynecologic Oncology Fellowship Program: 5-Year

To asses the feasibility and safety of total laparoscopic versus abdominal radical hysterectomy with pelvic and paraaortic lymphadenectomy in the treatment of early cervical cancer in a fellowship program.

Lymph node mapping and sentinel node detection in patients with cervical carcinoma: A 2-year experience

Objective. To describe our experience with the sentinel lymph node biopsy in cervical cancer patients, using a laparotomic approach and blue dye technique. Methods. Between January 2003 and January 2005, patients with histologically proven FIGO stage IA 2 to IIA carcinoma of the uterine cervix were submitted to SLN procedure if they were scheduled to have radical abdominal hysterectomy and pelvic lymphadenectomy. The SLN mapping was done after intracervical methylene blue (4 ml) injection. Final pathologic evaluation of SLNs included serial step sections and wide spectrum cytokeratin immunohistochemical analysis. Results. Fifty patients were accrued to this prospective observational double-center study. A total of 86 SLNs (mean 1.9) were identified in the 45 patients with fruitful quest for SLN detection. The SLN detection rate per patient was 90%, and for the side of dissection, 72%. Bilateral SLNs were detected in 60% of cases. SLNs were identified in the external iliac and obturator areas in 55% and 38%, respectively; 5 isolated SLNs were discovered in the common iliac region. Ten patients (20%) had lymph node metastases; one of these had false-negative SLN. The false-negative rate and the negative predictive value, calculated by patient and by side of dissection, were 10% and 97.2%, and 8.3% and 98.4%, respectively. Conclusions. SLN detection with blue dye is a feasible procedure, particularly useful as a surgical staging procedure in young patients with small tumors. The true morbidity-sparing role of this technique in cervical cancer treatment is yet to be found.

Occult tumor cells in pelvic lymph nodes and parametrial tissue of small-sized FIGO IB1 squamous cell carcinomas of the uterine cervix – results of a pilot study

Micrometastases (MM) and occult tumor cell deposits (OTCD) in pelvic tissue may cause recurrences, and immunohistochemistry may improve their detection. We used cytokeratine-immunohistochemistry to investigate 263 pelvic lymph nodes and parametrial tissue for MM and OTCD obtained from eight squamous cell carcinomas (maximum tumor size: 2.5 cm). These patients were treated with radical abdominal hysterectomy (Piver type III) with complete tumor resection without receiving any adjuvant therapy. The mean count of resected pelvic lymph nodes was 32.9 (range 24–47). All lymph nodes were completely embedded, and three step sections were performed for routine histopathologic evaluation. Three patients developed pelvic side wall and five central tumor recurrences within a median time of 25.9 (range 8–55) months. On immunohistochemistry, only one case (12.5%) showed OTCD in a venule in the parametrial tissue. In patients with small cervical carcinomas (<2.5 cm in largest dimension), OTCD can only rarely be detected by immunohistochemistry after careful handling of resected lymph nodes using step sectioning for routine histologic examination and complete processing of parametrial pelvic tissue. Therefore, tumor recurrence in those patients appears to be due to occult residual tumor cells that were not resected during the classical Wertheim–Meigs procedure or that were disseminated during the surgical procedure and persisted in situ.