Pelvic Lymphadenectomy For Cervical Cancer Research Articles

Preventing lower limb lymphedema after pelvic lymphadenectomy with progressive resistance exercise training: A randomized controlled trial

ObjectiveThis study aimed to assess the efficacy of a self-designed progressive resistance exercise training program for preventing the development of lower limb lymphedema. MethodsAn open-label randomized controlled trial was conducted in patients who underwent radical surgery for cervical cancer treatment in our department between October 7, 2019, and October 7, 2021. The participants were randomly assigned to one of three groups: progressive resistance exercise training, graduated compression stocking, and control group. ResultsA total of 267 patients were enrolled (89 in each group). The incidence of lower limb lymphedema was 9.0% (n = 8) in the progressive resistance exercise training group, 28.1% (n = 25) in the graduated compression stocking group, and 42.7% (n = 38) in the control group. Over the 2-year follow-up period, the risk of lower limb lymphedema was significantly lower in the progressive resistance exercise training group than in the control group, with a hazard ratio (HR) (95% confidence interval [CI]) of 0.156 (0.073–0.335). The study was underpowered to demonstrate a statistically significant reduction in risk in the graduated compression stocking group, with an HR (95% CI) of 0.624 (0.376–1.033). ConclusionsProgressive resistance exercise training is an effective strategy for preventing lower limb lymphedema after pelvic lymphadenectomy for cervical cancer. It imposes no additional economic burden and can be performed conveniently without the need for dedicated exercise facilities. This makes it particularly accessible to patients in developing countries, allowing them to exercise at their convenience. Trial registrationChiCTR1800014905.

Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study

BackgroundThe study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy.MethodsThis retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb).ResultsAmong 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4–21 days). All cases resolved in a median 10 days (range, 3–56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289–8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95%CI, 1.033–10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248–17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112–5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047–18.148; P = 0.012) were associated with PLL.ConclusionNeoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.

Internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer: a case report and literature review

BackgroundThe common complications of radical hysterectomy and pelvic lymphadenectomy usually include wound infection, hemorrhage or hematomas, lymphocele, uretheral injury, ileus and incisional hernias. However, internal hernia secondary to the orifice associated with the uncovered vessels after pelvic lymphadenectomy is very rare.Case presentationWe report a case of internal hernia with intestinal perforation beneath the superior vesical artery that occurred one month after laparoscopic pelvic lymphadenectomy for cervical cancer. A partial ileum resection was performed and the right superior vesical artery was transected to prevent recurrence of the internal hernia.ConclusionsRetroperitonealization after the pelvic lymphadenectomy should be considered in patients with tortuous, elongated arteries which could be causal lesions of an internal hernia.

Sentinel lymph node biopsy versus pelvic lymphadenectomy in early-stage cervical cancer: a multi-center randomized trial (PHENIX/CSEM 010)

BackgroundThere is no accepted strategy for applying sentinel lymph node (SLN) biopsy as an alternative to pelvic lymphadenectomy in cervical cancer. It is unclear whether and when pelvic lymphadenectomy can...

Pretreatment neutrophil-lymphocyte and platelet-lymphocyte ratio predict clinical outcome and prognosis for cervical Cancer

Variations in systemic inflammatory response biomarker levels have been associated with adverse clinical outcome in various malignancies. In this study, we aimed to evaluate the predictive and prognostic role of the pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in cervical cancer. We retrospectively investigated 616 patients who underwent initial radical hysterectomy with pelvic lymphadenectomy for cervical cancer between July 2012 and December 2014 in China. Their clinical and histopathological markers and complete blood counts were obtained and analyzed. Then we chose the group of 339 of the total 616 patients who were not combined preoperative radiotherapy or chemotherapy for the survival analysis. Prognostic factors were assessed by univariate and multivariate analyses. The ROC curve revealed NLR and PLR had significant ability to predict parametrial involvement, and the cutoff values for NLR and PLR were 2.5 and 138.8 respectively. Clinicopathologic analysis showed that NLR was linked to age, parametrial involvement, tumor-invasion depth and histologic grade, and PLR was related to age, parametrial involvement, tumor-invasion depth and FIGO stage. Univariate analysis identified high PLR as a significant poor predictor for progression-free survival (PFS) and overall survival (OS), and NLR exhibited no predict power on OS or PFS. Multivariable analysis showed that PLR was an independent predictor of PFS, but not OS. NLR and PLR were associated with the clinical characteristics of cervical cancer. Additionally, PLR had independence prognostic value for PFS in patients with cervical cancer receiving radical hysterectomy with pelvic lymphadenectomy.

Incidence of Lymph Node Metastases in Women With Low-Risk Early Cervical Cancer (

To determine the incidence of lymph node metastasis in women with low-risk cervical cancer stage IA2 or IB1 (<2 cm) without lymph-vascular space invasion. A multicenter retrospective study was performed in patients who underwent radical or simple hysterectomy, conization, or trachelectomy plus pelvic lymphadenectomy for cervical cancer between January 2000 and June 2016. A total of 271 patients were included in the study. Median age and body mass index were 46 years (range, 23-77 years) and 24 kg/m (range, 18-48 kg/m), respectively. Twenty-two patients had stage IA2 (8.1%), and 249 (91.9%) had stage IB1. The median tumor size was 14 mm (range, 5-20 mm). Tumor grades were 1 (n = 63 [23.2%]), 2 (n = 120 [44.3%]), 3 (n = 63 [23.2%]), and unknown (25 [9.2%]). Median depth stromal invasion was 6 mm (range, 3-20 mm). Histologic subtypes included squamous (n = 171 [63.1%]), adenocarcinoma (n = 92 [33.9%]), and adenosquamous (n = 8 [3.0%]). Overall incidence of lymph node metastasis was 2.9% (n = 8). The incidence of lymph node involvement in G1, G2, and G3 was 0% (0/63), 5% (6/120), and 3.1% (2/63), respectively. No patient with stage IA2 (regardless of grade or histology) or G1 cervical cancer less than 2 cm (stage IB1) had lymph node metastasis. Patients with stage IA2 or IB1 (G1) with tumor size of less than 2 cm and no lymph-vascular space invasion may not need lymph node evaluation. On the other hand, 95% and 98% of patients with grade 2 or 3 tumors, respectively, could potentially undergo an unnecessary lymphadenectomy. Further studies with bigger sample size are required to confirm these results.

Key anatomies of DeLancey's three levels of vaginal support theory: an observation in laparoscopic surgery

To observe and verify the key anatomies of DeLancey's three levels of vaginal support theory through laparoscopic surgery by space dissection technique. The features and stress performance of related anatomies were observed and analyzed in laparoscopic type C hysterectomy and pelvic lymphadenectomy for cervical cancer by natural space exposures. The main ligament-like structure at level Ⅰ was the uterosacral ligament, which acted as the main apical fixation in the sacral direction, while the cardinal ligament was mainly composed of vascular system, lymph-vessels and loose connective tissue around them, lacking the tough connective tissue structures, which was connected to the internal iliac vascular system. There were no strong ligaments connected to the tendinous arch of pelvic fascia (ATFP) at the lateral side of vaginal wall at level Ⅱ. ATFP was the edge of the superior fascia of pelvic diaphragm, which was bounded by the fascia of the obturator. Its surface was smooth and close to the levator ani muscle and fuses with the vaginal fascia in about one thirds of middle lower segments of the vagina. When the ureter tunnel is separated, dense connective structures can be found in both anterior and posterior walls near the intersection of the ureter across uterine artery, fixing the bilateral angle of the bladder triangle, starting from the cervix and vagina and ending in the tunica muscularis vesicae urinariae. Based on the laparoscopic anatomy, the pelvic floor fascia ligament support above the levator ani muscle can be considered mainly around the vagina, and fascial ligament above the levator ani muscle can be simply considered as two parallel planes forming a "double hammock" structure, which may provide more anatomic data for pelvic floor reconstruction.

Strangulated Bowel Obstruction Caused by Bowel Migration into the Space between the Exposed Structures after Pelvic Lymphadenectomy for Cervical Cancer

Strangulated Bowel Obstruction Caused by Bowel Migration into the Space between the Exposed Structures after Pelvic Lymphadenectomy for Cervical Cancer

Integrated ovary-specific DNA methylation profiling and transcriptome reveals novel regulatory features in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women. However, to date, little is known about epigenomics, especially the DNA methylation profiles in the pathophysiology of PCOS. Differentially methylated and expressed profiling were analyzed by the Infinium HumanMethylation450 BeadChip and Affymetrix Human Genome U133 Plus 2.0 Array, respectively. Fresh ovarian tissue was obtained from cervical cancer patients at the follicular phase, with regular menstrual cycles and younger than 40 years, who underwent radical hysterectomy and pelvic lymphadenectomy for cervical cancer. Fresh ovarian tissue was obtained from PCOS patients at the follicular phase, with irregular menstrual cycle and younger than 40 years, who underwent laparoscopic wedge resection. PCOS was defined according to the 2003 Rotterdam criteria. DNA methylation profiling data were processed by the Methylation Module of GenomeStudio v1.9 software using default parameters. Expression profiling data were assessed using the Affymetrix GeneChip Operating Software. Here, combining the DNA methylation profiling together with transcriptome analysis, we showed that (i) there were 7929 differentially methylated CpG sites (b> 0.1, P < 0.05) and 650 differential transcripts (fold change > 1.5, P < 0.005) in PCOS compared to normal ovaries; (ii) 54 genes were identified with methylated levels that were correlated with gene transcription in PCOS, and these genes were further verified by pyrosequencing. Notably, PCOS ovarian tissues exhibit a significant differences of methylation status of DDB2, KCNMA1, CCL2, fibrillin 1 gene (unpublished data), and TNIK gene (published data). In addition, our previous study suggests that several significant pathways, including the type I diabetes mellitus pathway, p53 signaling pathway and NOD-like receptor signaling pathway, may be involved in PCOS development. However, recent studies further indicated that the functional significance of type I diabetes mellitus pathway, may play an essential and nonredundant role in PCOS (unpublished data). These results suggested that differences in genome-wide DNA methylation and expression patterns exist between PCOS ovaries and normal ovaries; epigenetic mechanisms may in part be responsible for the different gene expression and PCOS phenotype.

The learning curves of robotic and three-dimensional laparoscopic surgery in cervical cancer.

BACKGROUND: The 3D laparoscopy systems and robotic systems have been introduced into clinical practice for a few years. But the comparison of robotic and 3D laparoscopic gynecologic surgery is still needed.OBJECTIVE: To retrospectively compare the learning curves of robotic and 3D laparoscopic hysterectomy and pelvic lymphadenectomy in cervical cancer.STUDY DESIGN: The operational duration, blood loss, peritoneal drainage of first 24 hours after operation, total hospitalization days, hospitalization days after operation, lymph nodes collected, learning curves and cost of robotic and 3D laparoscopic hysterectomy and pelvic lymphadenectomy in cervical cancer performed by one experienced surgeon were studied.RESULTS: There was one surgeon who performed 37 cases of robotic and 24 cases of 3D laparoscopic hysterectomy and pelvic lymphadenectomy, and the turning point of learning curves was case 13th and case 10th. The differences of duration of operation, blood loss, peritoneal drainage of first 24 hours after operation, total hospitalization days, hospitalization days after operation, lymph nodes collected and perioperative complications were not statistically significant. But the cost of each robotic operation was higher than 3D operation.CONCLUSIONS: The turning point of the learning curve of 3D laparoscopic hysterectomy and pelvic lymphadenectomy is earlier than that of robotic sugery in patients with cervical cancer, and there is no obvious benefit from robotic surgery than 3D surgery in the terms of short-term medical index and hospitalization cost.

Robotic Laparoendoscopic Single Site Radical Hysterectomy With Sentinel Lymph Node Mapping and Pelvic Lymphadenectomy for Cervical Cancer

Objective. Laparoendoscopic single site (LESS) radical hysterectomy has been previously described but has not gained wide acceptance [1,2]. The role of sentinel lymph node (SLN) mapping in cervical cancer continues to evolve [3]. Recent advances in the single site robotic platform have made the performance of robotic LESS radical hysterectomy feasible [4]. The aim of this video is to demonstrate the feasibility of robotic LESS radical hysterectomy, with sentinel lymph node mapping and complete lymphadenectomy.

Robotic laparoendoscopic single site radical hysterectomy with sentinel lymph node mapping and pelvic lymphadenectomy for cervical cancer

Objective. Laparoendoscopic single site (LESS) radical hysterectomy has been previously described but has not gained wide acceptance [1,2]. The role of sentinel lymph node (SLN) mapping in cervical cancer continues to evolve [3]. Recent advances in the single site robotic platform have made the performance of robotic LESS radical hysterectomy feasible [4]. The aim of this video is to demonstrate the feasibility of robotic LESS radical hysterectomy, with sentinel lymph node mapping and complete lymphadenectomy.

Role of Minimally Invasive Surgery in Gynecologic Oncology: An Updated Survey of Members of the Society of Gynecologic Oncology.

To evaluate the current patterns of use of minimally invasive surgical procedures, including traditional, robotic-assisted, and single-port laparoscopy, by Society of Gynecologic Oncology (SGO) members and to compare the results to those of our 2004 and 2007 surveys. The Society of Gynecologic Oncology members were surveyed through an online or mailed-paper survey. Data were analyzed and compared with results of our prior surveys. Four hundred six (32%) of 1279 SGO members responded. Eighty-three percent of respondents (n = 337) performed traditional laparoscopic surgery (compared with 84% in 2004 and 91% in 2007). Ninety-seven percent of respondents performed robotic surgery (compared with 27% in 2007). When respondents were asked to indicate procedures that they performed with the robot but not with traditional laparoscopy, 75% indicated radical hysterectomy and pelvic lymphadenectomy for cervical cancer. Overall, 70% of respondents indicated that hysterectomy and staging for uterine cancer was the procedure they most commonly performed with a minimally invasive approach. Only 17% of respondents who performed minimally invasive surgery performed single-port laparoscopy, and only 5% of respondents indicated that single-port laparoscopy has an important or very important role in the field. Since our prior surveys, we found a significant increase in the overall use and indications for robotic surgery. Radical hysterectomy or trachelectomy and pelvic lymphadenectomy for cervical cancer and total hysterectomy and staging for endometrial cancer were procedures found to be significantly more appropriate for the robotic platform in comparison to traditional laparoscopy. The indications for laparoscopy have expanded beyond endometrial cancer staging to include surgical management of early-stage cervical and ovarian cancers, but the use of single-port laparoscopy remains limited.

Laparoscopic parametrectomy and pelvic lymphadenectomy for cervical cancer after simple hysterectomy with sentinel lymph node dissection

Laparoscopic parametrectomy and pelvic lymphadenectomy for cervical cancer after simple hysterectomy with sentinel lymph node dissection

Laparoscopic Transection and Repair of Obturator Nerve during Pelvic Lymphadenectomy for Cervical Cancer

Laparoscopic Transection and Repair of Obturator Nerve during Pelvic Lymphadenectomy for Cervical Cancer

Schauta-Amreich Operation vs Piver II Procedure with Pelvic Lymphadenectomy for Cervical Cancer

INTRODUCTION: The aim of this study was to compare two groups of patients with early stage cervical cancer who underwent either abdominal or vaginal surgery, in terms of post-operative findings and survival. MATERIALS AND METHODOLOGY: 55 patients with diagnosed cervical cancer were retrospectively selected for this study. They were preoperatively staged according to FIGO criteria. Forty four patients had disease between stages Ib and IIa with no evidence of extra-pelvic lymph node involvement and 10 patients had stage ≥ IIb. RESULTS: Of the 55 patients, 17 had been operated by Schauta-Amreich radical vaginal hysterectomy and 38 by Piver type II abdominal hysterectomy. No significant statistical differences have been found between two groups about age (median age was 49 for Schauta and 54 for Piver p=0.494) and parity of the patients (Median parity was 2 (range: 0-5) for Piver II group and 1 (range: 0-4) for Schauta group (p=0.607)) and about histotype and stage of the cervical cancer (34 patients with squamous cell carcinoma among Piver II Group vs 16 patients from Schauta Group; 4 women with adenocarcinoma from Piver II Group vs 1 subject from the Schauta Group; p value 1.000). Among the two groups there were significant statistical differences regarding the mean operative time (86 ± 28 minutes for Vaginal surgery and 115 ± 31 minutes for Abdominal surgery, p=0.038) and the average hospital stay (8.65 ± 4.42 days for abdominal surgery and 5.65 ± 2.3 days for vaginal surgery, p=0.020). Significant statistical difference was reported as regarding adjuvant RT, increased in the Piver II group with respect to the Schauta group (22 vs 4 pts; p=0.028). The survival rate at 5-years was without significant difference between the two groups (23 patients frof Piver II Group vs 11 patients from Schauta Group, p=0.510). DISCUSSION: This study confirms the benefits of the Schauta-Amreich vaginal radical hysterectomy in terms of hospital stay, mean operative time and early complications. CONCLUSION: We believe that this surgery is a plausible alternative to radical abdominal hysterectomy and could be considered to be a valid approach for the treatment of patients with cervical neoplasms, but still randomized trials are needed on this topic with respect to the ethical issues involved.

Life-threatening bleeding after pelvic lymphadenectomy for cervical cancer: endovascular management of ruptured false aneurysm of the external iliac artery

Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.

Twelve-year experience with laparoscopic radical hysterectomy and pelvic lymphadenectomy in cervical cancer

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.

Experience and Efficacy of a Bipolar Vessel Sealing System for Radical Abdominal Hysterectomy

The present study evaluated the efficacy of an electrosurgical bipolar vessel sealing system for radical abdominal hysterectomy (RAH). A total of 85 consecutive patients who underwent RAH with pelvic lymphadenectomy for cervical cancer or endometrial cancer were analyzed; in 18 patients, the LigaSure system (Valleylab, Boulder, Colo) was used to secure the vascular pedicles, and in the remaining 67 patients, clamps were used, and the pedicles suture ligated. Compared with the conventional suture group, the patients in the LigaSure group had a significantly shorter operation time (mean, LigaSure 242.8 +/- 36.1 minutes vs conventional, 349.1 +/- 82.6) minutes; P < 0.001) and lower blood loss (mean, 583.1 +/- 287.6 mL vs 999.0 +/- 524.2 mL; P < 0.005). Only 1 (0.06%) of the 18 patients in the LigaSure group was transfused, whereas 27 (40.2%) of the 67 patients in the conventional suture group were transfused. Because transfusion requirements may be affected by the surgeon's bias, we compared blood loss among untransfused patients and found that the LigaSure group still had significantly lower blood loss than the conventional suture group (mean, 550.9 +/- 233.1 mL vs 745.49.0 +/- 230.4 mL; P < 0.01). Hemoglobin level reduction after surgery in untransfused patients was significantly lower in the LigaSure group than in the conventional suture group (mean, 2.31 +/- 2.22 mg/dL vs 3.22 +/- 1.11 mg/dL; P < 0.05). These findings indicate that the LigaSure vessel sealing system is useful to reduce blood loss and shorten operating time at RAH.

Pelvic lymphadenectomy in cervical cancer—surgical anatomy and proposal for a new classification system

Background Pelvic lymphadenectomy is an integral component of gynecologic cancer surgery, yet there is a lack of standardization in the terminology used, the extent of the procedure, and the definition of anatomic landmarks. This lack of standardization if corrected will likely facilitate a more clear communication and analysis of outcomes from various institutions, and reduce confusion to trainees about the procedure being performed. Methods We summarize the anatomic data concerning pelvic lymphatic drainage; describe the procedure based on clearly defined anatomic landmarks; and finally propose a new classification system to facilitate standardization, communication, and comparison of results. The accompanying video demonstrates the anatomic landmarks. Results We list and define four commonly used terms related to pelvic lymph node harvesting: sentinel node mapping, excision of bulky nodes, pelvic lymph node sampling, and systematic pelvic lymphadenectomy. We list the five specific anatomic regions of the pelvic lymphatic basin: external iliac, obturator, internal iliac, common iliac, and presacral. We highlight the important neural structures located in regions of the pelvic lymphadenectomy: genitofemoral nerve, obturator nerve, cranial part of the lumbosacral plexus, hypogastric plexus, and splanchnic nerves. Finally, we propose a new, four-part classification system of types of pelvic lymph node dissection. Conclusion In this report and video, we demonstrate anatomy and offer a new classification system for pelvic lymphadenectomy.