Surgical Treatment Of Cervical Cancer Research Articles

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients.

Simple SummaryLower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. In an international multicenter trial SENTIX, the group of 150 patients was prospectively evaluated using both objective and subjective LLL assessments in 6 months intervals for 2 years. Contrary to the expectations, our results showed that SLN biopsy does not eliminate the risk of LLL development which occurred in a mild or moderate stage in about 26% of patients with a median interval to the onset of 9 months.Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.

Protective Maneuver to Avoid Tumor Spillage during Laparoscopic Radical Hysterectomy: Vaginal Cuff Closure

To demonstrate the feasibility of a protective maneuver to avoid tumor exposure during laparoscopic radical hysterectomy. This video illustrates the vaginal cuff closure technique in cervical cancer surgery. The Oncologic Gynecology Department at the University Hospital La Fe. After the Laparoscopic Approach to Cervical Cancer trial [1], the laparoscopic approach to the surgical treatment of cervical cancer has been questioned: laparotomic surgery has been associated with a better cancer outcome. This publication has changed the current approach recommendation for performing radical hysterectomy from minimally invasive surgery to open surgery. There are some theories that might justify these findings. In minimally invasive surgery, the use of a uterine manipulator can condition the spread owing to erosion and friction caused on the tumor, even leading to the perforation of the tumor. In addition, intraperitoneal colpotomy can lead to pelvic peritoneum contamination by the tumor. To close the gap between laparoscopy and laparotomy, some protective maneuvers, such as vaginal cuff closure, have been proposed [2,3]. These strategies aim to reduce the possibility of manipulation or exposure of the tumor to the pelvis during colpotomy in laparoscopic radical hysterectomy. These protective maneuvers have been shown to decrease the relapse rate in retrospective studies [4]. However, prospective trials are needed to elucidate and confirm these findings. In this video, we explain step-by-step the technique of vaginal cuff closure before a radical hysterectomy performance for uterine cervical cancer. First, the nodal status is established by laparoscopic sentinel lymph node dissection and frozen section study. Bilateral pelvic lymphadenectomy is completed according to the size of the tumor. In the case of negative nodal status, the vaginal cuff is closed: Approximately 2 to 3 cm from the tumor (depending on its size), a circumferential incision of the vaginal mucosa is performed, followed by the dissection of the vaginal wall, which should be sufficient to allow a tension-free vaginal closure. The vaginal cuff is then closed with a running suture. A laparoscopic radical hysterectomy is then completed, and the surgical specimen is removed without any manipulation of the tumor. Avoiding manipulation of the tumor during cancer surgery is crucial. A vaginal cuff closure technique appears to be an easy protective maneuver that prevents tumor exposure and manipulation during laparoscopic radical hysterectomy.

European Society of Gynaecological Oncology quality indicators for surgical treatment of cervical cancer

BackgroundOptimizing and ensuring the quality of surgical care is essential to improve the management and outcome of patients with cervical cancer.To develop a list of quality indicators for surgical treatment...

DETECTION OF SENTINEL LYMPH NODES IN ORGAN-PRESERVING TREATMENT FOR INVASIVE CERVICAL CANCER

For early stages of cervical cancer, minimally invasive surgery leads to more beneficial outcomes compared to results of more extensive surgery. In this connection, the studies that focus on the assessment of the efficacy of organ-preserving and functionally-sparing approaches to surgical treatment of cervical cancer are of great significance. Sentinel lymph node (SLN) biopsy is the preferred method for assessing pelvic nodal basin status in patients with early stage cervical cancer. The concept of sentinel lymph nodes is especially relevant in cases where the status of lymph nodes is the most important factor in the expediency of performing organ-preserving or adjuvant treatment. The review highlights the problems of the clinical significance of SLN biopsy in detection of metastases that could not be detected using traditional techniques. The diagnostic effectiveness of various routes of tracer injection for SLN visualization was assessed. The comparative results of the use of radiopharmaceuticals used either alone or in combination with blue dye for identification of SLNs were shown. The innovative technique for SLN detection were presented.

The Wertheim hysterectomy: Development, modifications, and impact in the present day

Ernst Wertheim was a pioneer in the history of the surgical treatment of cervical cancer. His English-language manuscript “The extended abdominal operation for carcinoma uteri (based on 500 operative cases),” which was published in 1912, detailed his standardization of the radical hysterectomy and formed the basis of the current treatment for early stage cervical cancer. We contextualize the Wertheim hysterectomy, emphasizing medical advances that allowed for its development and subsequent modification. We then discuss modifications to the originally proposed procedure, including a maximally extended parametrical resection pioneered by Takayama, and the addition of the Taussig en bloc lymph node dissection by Meigs, both of which afforded an improved mortality profile due to decreased disease recurrence. Finally, we discuss progress that has been made in the present day, such as the development of nerve-sparing and fertility-sparing surgeries, as well as the introduction of the robotic platform. In this way, we hope to provide a historical background for the Wertheim hysterectomy—a cornerstone of gynecologic oncology.

Radical hysterectomy with or without para-aortic lymphadenectomy for patients with stage IB2, IIA2, and IIB cervical cancer: outcomes for a series of 308 patients

Although many studies have already shown that lymph node metastasis is one of the major prognostic factors for cervical cancer, the therapeutic significance of para-aortic lymphadenectomy for the surgical treatment of cervical cancer remains controversial. A total of 308 patients diagnosed with stage IB2, IIA2, or IIB cervical cancer and treated with radical hysterectomy were retrospectively investigated to assess the incidence of para-aortic lymph node metastasis and the clinicopathological factors linked to cervical cancer prognosis. Para-aortic lymph node metastases were pathologically confirmed in 13 of the 136 patients (9.6 %) who underwent para-aortic lymphadenectomy. The incidence of para-aortic lymph node metastasis was significantly higher in the patients who had common iliac lymph node metastases (odds ratio 31.5, p < 0.001) according to logistic regression analysis. Common iliac lymph node metastasis was related to risk of recurrence (hazard ratio 2.43, p = 0.003) and death (hazard ratio 2.62, p = 0.007) in Cox regression analysis. Kaplan-Meier analysis and Cox regression analysis showed that para-aortic lymphadenectomy did not have a positive impact on survival in 308 patients or 140 pN1 patients, but para-aortic lymphadenectomy was related to better overall survival with a marginal trend toward significance (p = 0.053) in 30 patients with common iliac lymph node metastasis. Indication for para-aortic lymphadenectomy in the surgical treatment of stage IB2, IIA2, or IIB cervical cancer needs to be individualized. Patients with common iliac lymph node metastasis are possible candidates, and a prospective study is needed to clarify this issue.

Pregnancy and delivery in women after genital-sparing surgical treatment of cervical cancer.

Pregnancy and delivery in women after genital-sparing surgical treatment of cervical cancer.

Radical trachelectomy application status in invasive cervical cancer

Radical trachelectomy (RT) is known as a developing sign of the surgical treatment of cervical cancer in the 21st century.RT brings hope for the patients with early cervical cancer who eager to retain their fertilities.The extent of surgery include RT and pelvic lymphadenectomy.The major methods of radical trachelectomy include abdominal (RAT) and vaginal (RVT) approaches.The efficacy and feasibility of RT is similar with standard treatment,which has great application value in clinical. Key words: Uterine cervical neoplasms; Surgical procedures, operative; Fertility

Nerve-Sparing Minilaparoscopic Versus Conventional Laparoscopic Radical Hysterectomy Plus Systematic Pelvic Lymphadenectomy in Cervical Cancer Patients

To present our preliminary experience with nerve-sparing minilaparoscopic radical hysterectomy plus pelvic lymphadenectomy for the surgical treatment of cervical cancer and to compare outcomes with those of the conventional laparoscopic approach. Data of 87 consecutive women who underwent minimally invasive surgery for early and locally advanced stage cervical cancer were prospectively collected. Ten women who underwent laparoscopic surgery using a nerve-sparing technique performed through 3-mm ancillary ports were compared with the 77 patients who had standard laparoscopic surgery previously with 3 sovrapubic 5-mm trocars. Minilaparoscopic radical hysterectomy was successfully accomplished in every case with no conversion to standard laparoscopy or open surgery. Two (2.6%) conversions to open surgery occurred in the conventional laparoscopy group. Surgical characteristics (operative time, estimated blood loss, and length of stay) and complication rate were similar between the 2 groups. No differences in the amount of parametrial and vaginal tissue removed were observed. The number of lymph nodes retrieved through minilaparoscopy was higher than conventional laparoscopy (30 [range = 26-38] vs 22 [range = 8-49]; P = .002). However, no difference was observed when the analysis was restricted to the last 10 conventional procedures (30 [range = 26-38] vs 29 [range = 24-49]; P = .81). Our data show that minilaparoscopic radical hysterectomy with pelvic lymphadenectomy is a feasible procedure if performed by skilled surgeons.

Clinicopathological risk factors for recurrence after neoadjuvant chemotherapy and radical hysterectomy in cervical cancer

BackgroundCervical cancer is one of the common gynecological malignancies with a high recurrence rate after surgery. This study aimed to analyze the clinicopathological risk factors for recurrence after the surgical treatment of cervical cancer and provide the basis for the prevention of recurrence and an improvement of prognosis.MethodsA total of 424 cervical cancer cases between 1 January 1998 and 31 December 2011 undergoing surgical treatment were studied retrospectively, of which 23 cases had recurrences. Relevant recurrence risk factors were evaluated by univariate and multivariate analyses between recurrence group and non-recurrence group.ResultsUsing univariate analysis, tumor differentiation, clinical stage, pelvic lymph node metastasis, postoperative radiotherapy and postoperative chemotherapy were related to recurrence of cervical cancer. Multivariate COX model analysis revealed that pelvic lymph node metastasis and postoperative chemotherapy had an impact on recurrence rate. Moderately and highly differentiated tumor, advanced clinical stage, and positive pelvic lymph nodes indicated a high recurrence rate of cervical cancer. Postoperative chemotherapy and radiotherapy can effectively reduce the recurrence rate.ConclusionsIn conclusion, cervical lymph node metastasis and postoperative chemotherapy are two independent factors for recurrence of cervical cancer after radical surgery.

Colpohystérectomie élargie par voie cœlioscopique dans les cancers du col utérin : étude de qualité de vie. À propos de 22 cas

ObjectiveLaparoscopic radical hysterectomy is currently the surgical treatment of cervical cancer. The objective of this study was to evaluate the quality of life of patients with cervical cancer treated by radical hysterectomy by laparoscopy. Patients and methodsQuality of life was evaluated in 22 patients with cervical cancer (FIGO stade IB1-IIB) treated by laparoscopic radical hysterectomy. The study employed two types of survey questionnaires: EORTC QLQ-C 30 and QLQ-OV 28. ResultsAfter a median follow-up of 25 months (range: 12-48 months), the average global health scores and quality of life after the surgery was high, indicating a good overall quality of life. The symptoms most commonly implicated were fatigue and insomnia. The average symptom scores (abdominal, peripheral neuropathy, side effects of chemotherapy) was low, meaning little inconvenience. It noted, however, an exception for the symptoms of menopause that generate significant discomfort in several patients. Among patients with a regular sexual activity, most described a change in frequency and quality of reporting. Discussion and conclusionsPatients with cervical cancer treated by laparoscopy have good overall quality of life. The function that is most affected by the treatment in the majority of patients is sexual function. A comparative prospective study with laparotomy would be necessary.

Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review

BACKGROUND:Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome.OBJECTIVE:Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH) and comparing the results with abdominal radical hysterectomy (ARH).SEARCH STRATEGY:Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31st 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy.SELECTION CRITERIA:Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. Data collection and analysis: Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes.RESULTS:Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH.CONCLUSIONS:Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may reduce the complications rate.

Total Laparoscopic Radical Hysterectomy (Piver Type II and III) in the Management of Early Stage of Cervical Cancer. Our Experience and First Reported Case Series from Turkey

Study Objective: To describe feasibility and our experience of total laparoscopic radical hysterectomy with pelvic lymphadenectomy.Design: Prospective collected data evaluated retrospectively.Setting: University Hospital.Patients: Totally 20 cases with stage IA2 and IBI cervical cancer.Intervention: : Laparoscopic type II (n=8) or type III(n=12) radical hysterectomy with pelvic lymphadenectomy including common iliac and/or paraaortic lymphadenectomy.Monopolar, Bipolar coagulation, vascular clips and liga-sure vascular sailing system were used.Measurements and Main Results: Median age was 42. All patients had pelvic lymphadenectomy including common iliac and 4 cases paraaortic lymphadenectomy, respectively. Median pelvic lymph node number was 29 and 16 for paraaortic lymphadenectomy. Two(10%) cases had parametrial involvement, one of them with pelvic lymph node metastasis. Adjuvant radiation therapy was given to these cases. There were no recurrences median follow up 36 months. Two unit blood transfusion was given in one case. There were no intraoperative serious complications. Three cases need postoperative self catheterisation.Conclusion: According to this case series, laparoscopic radical total abdominal hysterectomy can be applied to surgical treatment of cervical cancer with low morbidity. Study Objective: To describe feasibility and our experience of total laparoscopic radical hysterectomy with pelvic lymphadenectomy. Design: Prospective collected data evaluated retrospectively. Setting: University Hospital. Patients: Totally 20 cases with stage IA2 and IBI cervical cancer. Intervention: : Laparoscopic type II (n=8) or type III(n=12) radical hysterectomy with pelvic lymphadenectomy including common iliac and/or paraaortic lymphadenectomy.Monopolar, Bipolar coagulation, vascular clips and liga-sure vascular sailing system were used. Measurements and Main Results: Median age was 42. All patients had pelvic lymphadenectomy including common iliac and 4 cases paraaortic lymphadenectomy, respectively. Median pelvic lymph node number was 29 and 16 for paraaortic lymphadenectomy. Two(10%) cases had parametrial involvement, one of them with pelvic lymph node metastasis. Adjuvant radiation therapy was given to these cases. There were no recurrences median follow up 36 months. Two unit blood transfusion was given in one case. There were no intraoperative serious complications. Three cases need postoperative self catheterisation. Conclusion: According to this case series, laparoscopic radical total abdominal hysterectomy can be applied to surgical treatment of cervical cancer with low morbidity.

I333 New advances in surgical treatment of cervical cancer

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S82-S82 Invited presentations I333 New advances in surgical treatment of cervical cancer P. Suprasert, P. SuprasertSearch for more papers by this author P. Suprasert, P. SuprasertSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60333-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S82-S82 RelatedInformation

Sexual Function after Radical Hysterectomy for Early-Stage Cervical Cancer: Is There a Difference between Laparoscopy and Laparotomy?

Surgical treatment for cervical cancer is associated with a high rate of late postoperative complications, and in particular with sexual dysfunction. To evaluate sexual function in women who underwent radical hysterectomy (RH), in comparison with a control group of healthy women, using a validated questionnaire (Female Sexual Function Index [FSFI]). Then we tried to evaluate the possible differences between laparoscopic RH and abdominal RH in terms of their impact on sexuality. Consecutive sexually active women, who underwent RH for the treatment of early-stage cervical cancer between 2003 and 2007, were enrolled in this study (cases) and divided into two groups, according to the surgical approach. All women were administered the FSFI. The results of this questionnaire were compared between patients who underwent laparoscopic RH (LPS group) vs. women who underwent laparotomic RH (LPT group). The cases of RH were also compared with a control group of healthy women, who were referred to our outpatient clinic for a routine gynecologic evaluation. FSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, pain). A total of 38 patients were included. We also enrolled 35 women as healthy controls. FSFI score was significantly higher in the healthy controls vs. the cases of RH. In the LPS group, the total score and all the domains of the FSFI were lower in comparison with the healthy controls, whereas three of the six domains (arousal, lubrication, orgasm) and the total score of FSFI were lower in the LPT group if compared with the controls. There were no significant differences between LPS and LPT group. RH worsens sexual function, regardless of the type of surgical approach. In our experience, laparoscopy did not show any benefit on women's sexuality over the abdominal surgery for cervical cancer.

Principles and Practice of Surgical Treatment for Cervical Cancer: It's Time for a Change

Principles and Practice of Surgical Treatment for Cervical Cancer: It's Time for a Change

Preoperative pelvic lymphoscintigraphy is of limited usefulness for sentinel lymph node detection in cervical cancer

Objectives To analyze concordance between preoperative lymphoscintigraphy and intraoperative lymphatic mapping (ILM) for sentinel lymph node identification using technetium 99m-labeled-dextran 500 (99m-Tc) and patent blue dye in patients with early cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy, as well as to evaluate sentinel lymph node (SLN) detection. Study design Forty-seven patients underwent surgical treatment for cervical cancer. For SLN identification, 99m-Tc and blue patent were injected into the cervix on the eve and day of surgery, respectively. Preoperative pelvic lymphoscintigraphy was performed in all patients after 99m-Tc injection. Concordance between preoperative lymphoscintigraphy and ILM was evaluated. Results Of the 56 patients who underwent preoperative lymphoscintigraphy, 43 (81.13%) had at least one lymph node identified. Bilateral lymph nodes were identified in 21 (37.5%) patients. Sentinel lymph nodes detected on ILM had been previously found on preoperative lymphoscintigraphy in 66.7%, 67.2% and 0% in the right, left and central locations, respectively. In 14 patients (25%), only one lymph node was identified on preoperative lymphoscintigraphy, but more than one sentinel lymph node was detected on intraoperative mapping. In nine (16.1%) patients, lymphoscintigraphy showed only unilateral lymph nodes, but ILM identified bilateral sentinel lymph nodes. Conclusion The combination of patent blue and radionuclide techniques produced excellent results for SLN detection in cervical cancer. Preoperative lymphoscintigraphy does not offer any advantage over ILM for SLN identification.

The innovations of surgical treatment for cervical cancer

In recent years, many surgical innovations have been made from cervical cancer, such as trachelectomy, laparoscopic radical hysterectomy and surgery for advanced or recurrent cervical cancer, etc. The surgical innovations improve treatment effects, as well as postoperative quality of life. Key words: Uterine cervical neoplasms; Gynecologic surgical procedures; Trachelectomy; Hysterectomy

Advances in Surgical Treatment of Cervical Cancer

Radical hysterectomy has been the standard surgical treatment for cervical cancer, achieving a good survival outcome. However, it is a major operation that has considerable potential long-term morbidity. With good prognosis achieved in most early cervical cancers, there is a trend towards more emphasis on maintaining good quality of life post-treatment. Many women diagnosed with cervical cancer are young, and fertility-sparing surgery such as trachelectomy would preserve their reproductive potential. Minimally invasive surgery, such as laparoscopic radical hysterectomy, can potentially improve post-operative recovery and cosmetic results while maintaining oncological safety. Sentinel lymph nodes assessment can minimize unnecessary systematic pelvic lymphadenectomy. Radicality of the hysterectomy may also be reduced in selected individuals with good prognostic factors, thus minimizing long-term pelvic floor dysfunction. This review aims to give a broad overview of the current status of these new trends in surgical management for cervical cancer.

Do we need a new classification for radical hysterectomy? Insights in surgical anatomy and local tumor spread from human embryology

Objective. Current surgical treatment of cervical carcinoma is based on the assumption of undirected intra- and transcervical local tumor propagation and is executed by tailored excision of the paracervical tissues. We have recently demonstrated that cervical carcinoma spreads for extended phases during its malignant progression within the permissive compartment of the Müllerian morphogenetic unit (Lancet Oncol 2005;6:751–56) and proposed Müllerian compartment resection as the new principle for surgical treatment of cervical cancer. Do we need a new classification of radical hysterectomy? Methods. The therapeutic index of the surgical treatment of cervical carcinoma FIGO stages IB1–IIB by extirpation of the Müllerian compartment through total mesometrial resection (TMMR) without adjuvant radiation is evaluated by an ongoing controlled prospective trial at the University of Leipzig. Results. From 7/1998 to 12/2006, 163 patients with cervical carcinoma, FIGO stages IB1 ( n = 94), IB2 ( n = 21), IIA ( n = 14) and IIB ( n = 34) have been treated with TMMR and nerve-sparing therapeutic lymph node dissection. Twenty-five patients received (neo)adjuvant chemotherapy. No patient underwent adjuvant radiotherapy although 95 patients (58%) would have needed this additional modality in case of conventional radical hysterectomy because of their high-risk histopathological tumor features. At a median follow-up time of 45 months (3–104 months), recurrence-free and disease-specific overall survival is 93% and 96%. Maximum treatment-related morbidity according to the Franco-Italian score has been grade 2 in 12 patients (8%). Conclusions. The developmental view of local tumor spread and surgical anatomy holds a great promise for improving the therapeutic index of surgical cervical cancer therapy and challenges both the classification of radical hysterectomy based on tailored paracervical resection and the indication for adjuvant radiation.