Extrafascial Hysterectomy Research Articles

Evaluation of physical function and quality of life before and after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 cervical cancer (GOG-278)

Evaluation of physical function and quality of life before and after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 cervical cancer (GOG-278)

Evaluation of efficacy and fertility after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 (GOG-278) cervical cancer

Evaluation of efficacy and fertility after non-radical surgical therapy (extra fascial hysterectomy or cone biopsy with pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2–IB1 (GOG-278) cervical cancer

Role of Extrafascial Hysterectomy Following Concurrent Chemoradiation in Patients Diagnosed with Adenocarcinoma of Cervix Stage IB2-IIB

Role of Extrafascial Hysterectomy Following Concurrent Chemoradiation in Patients Diagnosed with Adenocarcinoma of Cervix Stage IB2-IIB

Adjuvant Hysterectomy in Patients After Radiation for Locally Advanced Cervical Cancer: A Single-Center Prospective Longitudinal Study.

Residual or recurrent cervical cancer post-CCRT is a challenging clinical issue, even though there has been much effort in recent decades to increase patient survival after radiation. There is a paucity of literature regarding the role of hysterectomy in recurrent/residual disease after radiation in LACC patients. Such a procedure is controversial and not routinely performed because of difficulties in obtaining tumor-free margins and the high rate of associated morbidity. Evaluate outcomes and morbidities in patients who had undergone hysterectomy for residual or recurrent disease after radiation in LACC patients. This is a prospective observational study on radiotherapy-treated LACC patients (IIB-III) with residual disease or recurrent disease who have undergone adjuvant hysterectomy. This study has been conducted at AHPGIC, Cuttack, with a sample size of 30 patients. 18/30 patients underwent extrafascial hysterectomy, and rest 12 patients had radical hysterectomy. No significant difference in complications, achieving tumor free margins or recurrences post adjuvant hysterectomy based on the radicality of surgery was observed. 5 cases of recurrences post-adjuvant hysterectomy were detected. Some of the factors which had significant association with recurrences post adjuvant hysterectomy were non squamous histology, no preoperative brachytherapy, deep stromal invasion and positive surgical margins. Median follow-up time was 14months (12-27months). This study shows that adjuvant hysterectomy is feasible with good outcome and acceptable morbidity after chemoradiotherapy in cervical cancer patients "If selection of patients for adjuvant hysterectomy is appropriate."

Neoadjuvant radiotherapy followed by hysterectomy in locally advanced endometrial cancer: Outcomes from a tertiary government hospital in the Philippines

ObjectiveManaging endometrial cancer with suspected or gross cervical involvement lacks a standard approach. This study evaluated outcomes in patients with cervical and/or parametrial involvement treated with neoadjuvant radiation followed by hysterectomy. MethodsFourteen patients from 2007 to 2022 with locally advanced endometrial cancer and cervical and/or parametrial involvement were retrospectively analyzed. They received neoadjuvant external beam radiotherapy (45–50.4 Gy in 25–30 fractions) and high-dose rate brachytherapy (5.5–7.0 Gy per fraction in 3–4 fractions), followed by extrafascial hysterectomy. Clinical data, pathologic response, and survival outcomes were assessed, along with factors associated with pathologic response. ResultsMost patients (86%) had stage III disease with cervical extension, 93% had parametrial involvement, and 14% had nodal involvement. Chemotherapy was given to 86% either concurrently or adjuvantly. Post-surgery, 86% had no pathologic cervical involvement, and 93% had negative surgical margins. Pathologic complete response was seen in 43%. Locoregional recurrence occurred in 14%. Median follow-up was 30 months, with recurrence-free survival and overall survival rates of 86% and 100%, respectively. Lower grade tumors significantly correlated with pathologic complete response (Φ = 0.72, p = 0.026). No significant correlation was found between pathologic complete response and other factors. No late grade 3–4 toxicities were reported. ConclusionNeoadjuvant radiation followed by hysterectomy, with or without chemotherapy, is a viable strategy for managing endometrial cancer with cervical and/or parametrial involvement. This approach enhances resectability, yielding high rates of pathologic complete response and negative resection margins, showing promise for this challenging patient group.

Analysis of the clinical characteristics and surgical methods of high-grade squamous intraepithelial lesions of the cervix in postmenopausal women: A retrospective case study.

The purpose of this study was to thoroughly evaluate the clinical features and surgical options for high-grade squamous intraepithelial lesions (HSIL) in postmenopausal women. A total of 308 patients diagnosed with HSIL through colposcopic cervical biopsy and endocervical curettage were included. Their clinical characteristics, surgical treatments, and postoperative pathology were analyzed. Key findings include: 1. Patients with positive preoperative thinprep cytologic test (TCT) results and postoperative pathology indicating HSIL or squamous cell carcinoma (≥HSIL) were significantly more frequent than those with negative preoperative TCT results (P < .05). 2. Univariate analysis indicated significant impacts of TCT, human papillomavirus (HPV) type, transformation zone (TZ) location, and surgical technique on postoperative pathology (P < .05). 3. Logistic regression analysis confirmed significant influences of TCT, HPV type, TZ location, and surgical method on postoperative pathology outcomes (P < .05), showing that each unit increase in TZ raised the probability of ≥HSIL in postoperative pathology by 49.7%. In surgical comparisons, cold knife conization (CKC) and extrafascial hysterectomy resulted in 8.379 and 4.427 times higher probabilities of ≥HSIL in postoperative pathology, respectively, compared to loop electrosurgical excision procedure (LEEP). 4. Surgical methods significantly influenced margin results (P < .05). After LEEP, 17.5% of cases had positive margins, compared to 9.4% after CKC, and 3.7% after extrafascial hysterectomy, indicating the highest rate of positive surgical margins occurred with LEEP. 1. Combined TCT and HPV screening is crucial for cervical cancer prevention, early detection, and management in postmenopausal women. Women with positive results for both TCT and HPV should undergo colposcopic cervical biopsy and endocervical curettage. 2. For patients with TZ3, CKC is the recommended surgical option. 3. CKC is the preferred treatment for postmenopausal women with HSIL, as it effectively diagnoses and treats the lesion, showing superior outcomes in managing postmenopausal HSIL.

A New Self-expanding, Large-caliber Ureteral Stent Applied for Bilateral Long-segment Ureteral Strictures — A Case Report

Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage.

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

ObjectiveTo identify the risk factors of cervical high-grade squamous intraepithelial lesion(HSIL) complicated with occult cervical cancer and standardize the management of initial treatment for HSIL.MethodThe clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading.Result1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2–59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244–12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78–23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947–14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892–11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good.ConclusionThere is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.

Assessing the learning curve for transumbilical single-site laparoscopy for endometrial cancer.

Applying transumbilical laparoendoscopic single-site surgery to endometrial cancers is worldwide, and the depiction of the learning curve is rarely described, which leads to the vagueness of young clinical practitioners. We accumulated the data to identify the completion of the learning curve by analyzing the operative and postoperative outcomes of the patients with endometrial cancer for transumbilical laparoendoscopic single-site surgery (TU-LESS). This was a retrospective, consecutive single-center study of patients with endometrial cancer undergoing standard endometrial cancer comprehensive staging surgery (extrafascial hysterectomy, bilateral salpingectomy, and pelvic lymphadenectomy) through TU-LESS by an experienced surgeon from December, 2017 to June, 2021 in the Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, 42 patients were included in the study. The learning curve for this study was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. Applying CUSUM and RA-CUSUM has grouped 42 cases into three phases. The prior five cases represented the learning period. The following six cases were needed to lay a technical foundation (cases 6-11). The third phase was regarded as achieving proficiency (cases 12-42). The operative time decreased drastically with the learning curve. There were no significant differences in terms of postoperative complications and lymph node retrieval among the three phases. More difficult patients were confronted in the third phase. In our study, the learning curve was composed of three phases. According to the results of our study, 11 cases were required for experienced surgeons to achieve a technical foundation.

71 No survival difference in patients receiving radical hysterectomy vs. extrafascial hysterectomy in stage II–IV endometrial cancer patients: a multivariate analysis

71 No survival difference in patients receiving radical hysterectomy vs. extrafascial hysterectomy in stage II–IV endometrial cancer patients: a multivariate analysis

Questionnaire survey regarding current status of minimally invasive surgery for endometrial cancer in Japan: A cross-sectional survey for JSGOE members.

Minimally invasive surgery (MIS) has been introduced as an alternative to more radical surgical procedures. The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy conducted a cross-sectional questionnaire survey to ascertain the status of MIS for endometrial cancer. The survey was conducted between May 10 and June 30, 2022. The questionnaire included information on personal attributes, academic affiliations, qualifications, hysterectomies, and intraoperative procedures performed. The total number of questionnaire respondents was 436 (9.2% of the membership). The hysterectomy methods and percentage performed were as follows: simple total hysterectomy (equivalent to benign surgery), 3%; simple total hysterectomy with care to avoid shaving the cervix, 31%; extended total hysterectomy, 48%; and modified radical hysterectomy, 15%. An analysis of hysterectomies performed using MIS for endometrial cancer by qualified gynecologists of endoscopy or board-certified gynecologic oncologists showed a tendency not to choose simple total hysterectomy compared to the gynecologists who did not hold certification (p = 0.019, p = 0.045, and p = 0.010, respectively). Additionally, 67% of respondents did not use uterine manipulators, and 59% of the respondents did not perform lymph node dissection following the guidelines for treating endometrial cancer in Japan. This study provided the current status of MIS for endometrial cancer in Japan. The hysterectomy method, use of uterine manipulators, and criteria for omitting lymph node dissection were generally in agreement with the guidelines. Currently, an extra-fascial simple hysterectomy, including at least not shaving the cervix, was a major method for early invasive endometrial cancer using MIS.

Sister Mary Joseph Nodule, Umbilical Sentinel for an Endometrioid Endometrial Carcinoma in Postmenopause-Challenges for a Multidisciplinary Approach

A 82 years old, hypertensive, obese, 1 delivery, menopause at 47 yrs, non-smoker, with history of vaginal bleeding in January 2018, is sent by the dermatologist for an irregular umbilical tumor of 2/1 cm, recurrent at 6 weeks post-ablation, microscopically considered as a carcinomatous metastasis. Abdomino-pelvic MRI rises the suspicion of uterine carcinoma, which is confirmed by endometrial biopsy. It is done extrafascial total hysterectomy with bilateral salpingo-oophorectomy, and pelvic lymph dissection and ablation, plus ablation of a skin-adipose-conjunctive peri-and subumbilical area of 5/4 cm. There were no peritoneal metastases, or other viscera abnormalities. The optic microscopy shows moderate differentiated endometrioid endometrial carcinoma, with areas of squamous differentiation, invasion in external myometrial half, without peritoneal invasion, with vessels metastatic embolism, positive pelvic lymph nodes with moderate differentiated endometrioid endometrial carcinoma and desmoplastic reaction; left ovary with mature teratoma. Umbilical specimen has malignant invasion with cribriform and tubular pattern, areas of squamous differentiation, and malignant emboli in vessels. The patient suffered radiotherapy, under oncologic monitoring. The follow up at 6,12,18 and 36 months was with no recurrence in genital, pelvis, peritoneum, abdominal wall. Sister Mary Joseph Nodule (SMJN) has an old history: first observations of assistant catholic nun Mary Joseph Dempsey (Saint Mary’s Hospital, Rochester, Minnesota, USA), William Mayo (1928) description, Hamilton Bailley (1949) characterization. Literature associates SMJN to cancers originating in gastro-intestinal, colonic tract, respiratory, urinary and genital tract: primary ovarian and endometrial cancers; Romanian case is the 36th with endometrial origin. Umbilical invasion may be due to direct vessels’ embolization by malignant endometrial cells, via lymphatics which run along the obliterated umbilical vein, or via the remnant structures of the falciform and umbilical ligaments. Patient is under oncologic monitoring on hormone therapy (Megesin®), with good prognosis up to four years of follow up, different from literature mentioned bad prognosis.

Phase III clinical trials of radical hysterectomy with minimal parametrectomy for patients with early-stage cervical cancer: a review

The standard surgery for patients with International Federation Gynecology and Obstetrics (FIGO) stage IB–II cervical cancer is a Piver-Rutledge-Smith class III radical hysterectomy with pelvic lymphadenectomy involving a wide resection of parametrial and paravaginal tissue to control parametrial involvement. However, adverse events can occur such as severe long-term neurogenic bladder due to parametrectomy. This review evaluates ongoing and completed phase III clinical trials of less radical hysterectomy with regard to parametrectomy. The PubMed database, Clinical Trials.gov, and Cochrane Central Register of Controlled Trials were used to extract information on two completed and four ongoing clinical trials. Less radical surgery led to similar oncologic outcomes to standard surgery in two phase III randomized controlled trials (Piver class II vs. class III, and class I vs. class III radical hysterectomy with pelvic lymphadenectomy). Less radical surgery also led to fewer complications, including urologic morbidity; however, more than 50% of patients received radiotherapy following such surgery, and showed higher morbidity rates because their enrolment was due to the presence of a large tumor (&gt;4 cm). Three phase III randomized controlled trials and a phase III nonrandomized confirmatory trial are presently ongoing. Major inclusion criteria include FIGO stage IA, IB, or IIA1, a mainly ≤2-cm tumor, limited depth of stromal invasion, and/or no lymph node metastasis. Surgery for the standard arm is a class II or class III radical hysterectomy, and the experimental surgery is a simple extrafascial hysterectomy or class II radical hysterectomy. Primary endpoints are overall, disease-free, or recurrence-free survival. Although primary endpoints, eligibilities or types of radical hysterectomy differ between trials, if noninferiority in overall, disease-free or recurrence-free survival is observed in any trial, new standard, less radical, curative hysterectomy may be established for early-stage, small-sized, invasive, cervical cancer.

Comparison of Urodynamics Parameters with Intrafascial or Extrafascial Hysterectomy Techniques

Objectives: The aim of this study was to compare urodynamics parameters at pre- and postoperative periods in patients undergoing intrafascial or extrafascial abdominal hysterectomy. Background: Hys...

Neoadjuvant radiotherapy and brachytherapy in endometrial cancer with gross cervical involvement: a CHIRENDO research group study

BackgroundHistorically, radical hysterectomy followed by adjuvant radiotherapy has been offered to patients with endometrial cancer who have gross cervical involvement; however, this approach is known to carry considerable morbidity. Neoadjuvant...

The Landmark Series: Minimally Invasive Surgery for Cervical Cancer.

Cervical cancer incidence and mortality have declined in developed countries during the past few decades as a result of screening programs and vaccination. However, it remains a significant cause of cancer-related mortality in young women. Early-stage cervical cancer, defined as disease limited to the cervix, has traditionally been treated with abdominal radical hysterectomy via laparotomy. Although most early-stage cervical cancers can be cured with open radical hysterectomy, the morbidity associated with open radical hysterectomy is significant compared with simple extrafascial hysterectomy. Since the early 1990s, minimally invasive surgery has been explored for the treatment of this disease, with the goal of minimizing the morbidity associated with open surgery, as reported for endometrial cancer surgery. This report reviews the landmark studies describing and evaluating minimally invasive surgery in the treatment of patients with early-stage cervical cancer.

Post-radiotherapy hysterectomy does not benefit females with cervical adenocarcinoma.

Cervical adenocarcinoma is associated with a poor prognosis, which may be caused by the infiltrative growth pattern and metastasis of tumor cells. There is a lack of consensus on hysterectomy after radiotherapy for the improvement of selected cases. The present study aimed to assess the oncological outcome of post-radiotherapy hysterectomy in females with cervical adenocarcinoma. A total of 39 females with cervical adenocarcinoma at stages IB1 to IIIB, managed primarily with radiotherapy with complete response, and underwent extrafascial hysterectomy as consolidation therapy between 1988 to 2015 were studied. Surgery complications and residual disease were evaluated. A comparison group was constructed, comprising 41 females with cervical adenocarcinoma managed with exclusive radiotherapy or chemoradiotherapy demonstrating complete response, without surgery. Descriptive and survival analysis was performed. The groups were comparable in terms of age, cancer stage, radiotherapy (dose and duration) and follow-up, although 67% of hysterectomies were performed prior to 2002 and 46% of the radiotherapy group received chemoradiation. Late complications were similar. There were nine recurrences (23%) in the case series and 10 recurrences (24%) in the radiotherapy group. Residual disease was detected in 56% (22/39) of uterine specimens, of which 12 were up to 10 mm. Residual disease was associated with recurrence (31% vs. 6%, P=0.028). The overall survival rate was 75% for the case series vs. 88% for the radiotherapy group (P=0.579), and the disease-free survival rate was 79-80% for both. Removal of residual disease by hysterectomy did not improve the overall survival rate (P=0.283) and disease-free survival rate (P=0.072). Post-radiotherapy hysterectomy in cervical adenocarcinoma is a feasible procedure with acceptable complications, however, it did not bring relevant benefits in recurrences, disease-free survival, and overall survival rates.

Operative efficacy of 13 malignant uterine tumors after Cf-252 intracavitary irradiation

Objective: To investigate the surgical therapeutic efficacy of uterine tumors patients underwent Cf-252 neutron intra-cavity and external radiotherapy, and evaluate the application value of Cf-252 neutron radiotherapy. Methods: Thirteen cases of uterine tumor with local suspicious lesions or poor prognostic factors after CF-252 neutron intracavity and external radiotherapy were treated with surgery. Among them, 12 cases underwent extrafascial hysterectomy, 1 case underwent extensive hysterectomy and lymphadenectomy. The postoperative pathology and follow-up results were used to evaluate the efficacy. Results: Nine cases showed severe response to radiotherapy in postoperative cervical pathological tissues without residual tumor, and survived for more than 3-14 years, the median survival time was 8 years. All of 4 cases with residual tumor died within 1 year. Delayed healing of vaginal wounds occurred in 3 of the 12 cases. Conclusions: Cf-252 is a good brachytherapy source. The cervical tissue shows severe response to radiotherapy and prolonged healing time of vaginal wound is observed in some cases after CF-252 radiotherapy. To those uterine tumor patients with local suspicious lesions or poor prognostic factors after CF-252 neutron intracavity and external radiotherapy, extrafascial hysterectomy is a safe and feasible treatment method.

Regional Control and Chemoradiotherapy Dose Response for Clinically Involved Lymph Nodes in Patients with Locally Advanced Endometrial Cancers Who are Not Candidates for Upfront Surgical Staging Extrafascial Hysterectomy

AimsThere are limited data in endometrial cancer for nodal control and appropriate treatment volume for non-surgically resected nodes treated with chemoradiotherapy (CRT) for patients who are not candidates for upfront extrafascial hysterectomy. Materials and methodsPatients (n = 105) with clinical stage ≥ II endometrial cancer who were not candidates for upfront extrafascial hysterectomy treated with preoperative CRT were retrospectively reviewed. CRT included pelvic nodes to the common iliac for node-negative disease and para-aortic nodes to the renal vessel for any node-positive disease. Involved nodes most commonly received a boost of 55 Gy in 25 fractions ± additional 4–6 Gy sequential boost for nodes >2 cm. ResultsOf the included 95 patients, 55 patients were node positive, with a total of 300 positive nodes. At a median follow-up of 25 months (interquartile range 9–46), the 3-year regional control was 91%. The 3-year involved nodal control rate was 96%. Involved nodal control was significantly higher in type I histology, nodes <2 cm and by radiation dose (75% for <55 Gy, 98% for 55 Gy in 25 fractions and 89% for >55 Gy, P = 0.03). The 3-year para-aortic failure rate for node negative patients treated with pelvis-only CRT was significantly higher with positron emission tomography/computed tomography (PET/CT) versus computed tomography (CT)-based staging (0% versus 20%). ConclusionThis is the largest study examining regional control rates of involved lymph nodes with CRT for patients who were not candidates for upfront extrafascial hysterectomy. Nodal failure was low following CRT and dose ≥55 Gy in 25 fractions seems to be adequate for involved nodes.

Endocervical adenocarcinoma in situ with ovarian metastasis: a case report

Background: Ovarian metastases, which may simulate primary ovarian neoplasms, can occur in advanced stage primary cervical adenocarcinoma (AC). However, such tumors are very rarely observed in cases of endocervical adenocarcinoma in situ (AIS) with early or even no obvious signs of tumor invasion. Case: We present a case of ovarian metastasis occurring in a 37-year-old triparous premenopausal woman with a diagnosed case of endocervical AIS. The patient presented with a rapidly growing and painful abdominal mass 22 months after a cold knife cone biopsy and 19 months after a simple extrafascial hysterectomy. She was subsequently treated with a combination of surgery and chemotherapy and is currently free of disease seven years after the initial diagnosis of endocervical AIS lacking unequivocally recognizable stromal invasion. Conclusion: Endocervical AIS with early or even no obvious detectable invasion may spread to the ovaries, but this situation is exceptionally rare. We propose that, in such cases, ovary sparing surgery is justifiable for initial treatment. Medical care strategies for patients affected by rare diseases largely depend on experience gained from reported cases in published literature, this is what compelled us to report this particular case.