Step-by-Step Radical Hysterectomy with Pelvic Lymphadenectomy (Without Nerve-Sparing)

e17007 Background: The aim of this study was to assess the early and late post-operative morbidity of patients who have undergone a radical hysterectomy (RH) for early-stage cervical cancer. Methods: We retrospectively analyzed the data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II). Patients underwent a radical hysterectomy for early-stage cervical cancer between January 2005 and March 2012 in 23 French oncologic centers. Results: A total of 412 patients were enrolled and 284 had a radical hysterectomy. Data were complete for 232 patients: 115 by laparoscopic-assisted vaginal way, 80 patients by total laparoscopic way, 9 patients by total vaginal way, 22 patients by laparotomy and 6 patients by robot-assisted way. The median age was 44 years (range = 25-85 years). 89.6 % of patients had a stage IB1 disease. 72.4% were epidermoid carcinoma and 24.6% adenocarcinoma. Eighty-one patients (35%) had only a sentinel lymph node biopsy and 151 patients (65%) had an additional pelvic lymphadenectomy. There were 45 cases of urinary infections (19.4%), 17 cases of dysuria (7.3%), 10 cases of urinary incontinence (4.3%), and 6 cases of ureteral or vesical fistula (2.6%). The genito-femoral nerve was injured in 25 cases (10.7%) and the obturator nerve was injured in 22 cases (9.5%). There were 38 cases of limb lymphedema (16.3%) and 14 cases of pelvic lymphocyst (6%). Conclusions: These complications rates are similar with those found in the current literature. Urinary infections and limb lymphedema are the main complications of RH. The functional outcomes could be improved by applying nerve-sparing techniques. [Table: see text]

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Nerve Sparing in Radical Surgery for Early-Stage Cervical Cancer: Yes We Should!

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181f6381f ◽

2010 ◽

Vol 20 (Suppl 2) ◽

pp. S39-S41 ◽

Cited By ~ 18

Author(s):

Cornelis D. de Kroon ◽

Katja N. Gaarenstroom ◽

Mariette I. E. van Poelgeest ◽

Alexander A. Peters ◽

J. Baptist Trimbos

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Radical Surgery ◽

Early Stage ◽

Surgical Techniques ◽

Pelvic Lymphadenectomy ◽

Nerve Sparing ◽

Autonomic Nerves ◽

Early Stage Cervical Cancer

Radical hysterectomy with pelvic lymphadenectomy is considered to be the cornerstone in the treatment of early-stage cervical cancer. Although survival in early-stage cervical cancer is up to 95%, long-term morbidity with regard to bladder, bowel, and sexual function is considerable. Damage to the pelvic autonomic nerves may be the cause of these long-term complications following radical hysterectomy. Some authors have presented surgical techniques to preserve the autonomic nerves (ie, the hypogastric nerves and the splanchnic nerves) without compromising radicality. Safety, efficacy, and the surgical techniques of nerve-sparing radical hysterectomy are presented, and data confirm that whenever the decision is made to perform a radical hysterectomy, nerve-sparing techniques should be considered.

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Nerve-sparing surgery in current gynecologic oncology

Current Gynecologic Oncology ◽

10.15557/cgo.2021.0005 ◽

2021 ◽

Vol 19 (1) ◽

pp. e27-e32

Author(s):

Paweł Gruszecki ◽

◽

Kazimierz Pityński ◽

Keyword(s):

Quality Of Life ◽

Surgical Procedures ◽

Radical Hysterectomy ◽

Gynecologic Oncology ◽

Pelvic Lymphadenectomy ◽

Autonomic Nerve ◽

Operation Technique ◽

Nerve Sparing ◽

Modern Approach

Nerve-sparing surgery is currently a very important topic in gynecologic oncology. In this review, it is shown that radical hysterectomy is not the only operation where the nerve-sparing technique can be used. Most surgical procedures in modern gynecologic oncology should spare the autonomic nerve structures. The review includes recently published articles precisely describing the nerve-sparing techniques in paraaortic and pelvic lymphadenectomy, and the modern approach to radical nerve-sparing hysterectomy. It has been shown in the literature that the quality of life of patients is directly dependent on the operation technique and its extension. As mentioned above, the nerve-sparing technique needs to be used not only in surgical procedures for cervical cancer, but more extensively also for endometrial and ovarian cancers. Modern techniques demonstrate that such an operation can be suitable both for the radicality and improved quality of life. Results of such operations are comparable to the old – not nerve-sparing techniques – both in terms of progression-free survival and overall survival. Nerve-sparing surgery in gynecologic oncology is our future. Better quality of life and greater patient satisfaction should be our goals. Studies are needed for better examination and comparison of the presented systematic nerve-sparing operations of lymphadenectomy in ovarian and endometrial cancers, and also combined with nerve-sparing radical hysterectomy.

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Laparoskopska radikalna histerektomija z limfadenektomijo: naše izkušnje

Slovenian Medical Journal ◽

10.6016/zdravvestn.1623 ◽

2016 ◽

Vol 85 (9) ◽

Author(s):

Leon Meglič

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Standard Procedure ◽

Operating Time ◽

Figo Stage ◽

Pelvic Lymphadenectomy ◽

Nerve Sparing ◽

Laparoscopic Radical Hysterectomy ◽

Paraaortic Lymphadenectomy ◽

Lymph Nodes Dissection

BackgroundThe second most common cancer in women up to 65 years of age is cervical cancer. Same cancer is the leading cause of death from gynaecological deseases worldwide.The standard procedure for cervical cancer treatment with FIGO stage including IB2 is radical hysterectomy sec. Wertheim-Meigs-Novak with or without adnexa with radical pelvic lymphadenectomy and/or para-aortic lymphadenectomy. In the last two decades has with the development of laparoscopy also developed laparoscopic radical hysterectomy .Laparoscopic radical hysterectomy with pelvic and para-aortic lymph nodes dissection was performed for the first time by Nezhat with coworkers in 1989.Laparoscopic radical hysterectomy with pelvic and/or paraaortic lymphnode dissection in treatement of cervical cancer including FIGO stage IB1 is performed at Dep Ob/Gyn UKC Ljubljana since 2013. The purpose of this article is to evaluate the morbidity and safety of the procedure. MethodsWe retrospectively reviewed the medical records of patients with cervical cancer who underwent laparoscopic radical histerectomy with pelvic and/or paraaortic lymphadenectomy from April 2013 to May 2016. Results34 patient were included, 32 patients with CC FIGO stage IB1, 1 patient with CC FIGO stage IB2, 1 patient with CC FIGO stage IIB.There were four (11,8%) bladder lesions, all of them were corrected during the surgery, but no ureteral lesion! There was one (2,9%) surgical revision right after the surgery due to assumption of bleeding (though there was no active bleeding found).Three patients (8,8%) had permanent urinary dysfunction – retention. One patient (2,9%) had dehiscence of vaginal vault after 4 months (after sexual intercourse)There was no ureterovaginal/vesicovaginl fistula after surgery! The mean operating time was 2 hours 55 min, mean admission time after surgery was 8,7 days, mean blood loss during operation was 291 ml. ConclusionsLaparoscopic radical hysterectomy is the method of choice in cervical tumors including FIGO stage IB1.Percentage of bladder lesions is part of learning curve.Our goal in future is to decrease the percentage of bladder lesions and to decrease the percentage of patients suffering from bladder dysfunction by using „nerve sparing“ technic.We expect, the same results for 5 year survival rate as with patients treated with classical radical hysterectomy.

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Nerve-Sparing Radical Hysterectomy Using the Okabayashi–Kobayashi Method

The Surgery Journal ◽

10.1055/s-0041-1739119 ◽

2021 ◽

Author(s):

Noriaki Sakuragi ◽

Masanori Kaneuchi

Keyword(s):

Radical Hysterectomy ◽

Early Stage ◽

Three Dimensional ◽

Pelvic Lymphadenectomy ◽

Dimensional Structure ◽

Nerve Sparing ◽

Autonomic Nerves ◽

Clear Understanding ◽

Intraoperative Bleeding ◽

Early Stage Cervical Cancer

AbstractRadical hysterectomy (RH) is a standard treatment for early-stage cervical cancer. This surgery extirpates the uterus along with the paracervical tissues, vagina, and the paracolpium to achieve local control. Pelvic lymphadenectomy is a critical component of RH performed for regional control. A clear understanding of pelvic anatomy is critical to safely performing a RH and achieving optimal oncological and functional outcomes. The various surgical steps can damage the pelvic autonomic nerves, and a systematic nerve-sparing technique is used for the preservation of autonomic nerves. There is an intricate vascular network in the lateral paracervix (cardinal ligament) and the pelvic sidewall. We need to comprehend the three-dimensional structure of the vascular and nerve anatomy in the pelvis to perform RH effectively and safely. We can create six spaces around the uterine cervix, including the paravesical spaces, pararectal spaces, a vesicovaginal space, and a rectovaginal space to reveal the target of extirpation. It is critical to find the proper tissue plane separated by the layers of membranous connective tissue (fascia), in order to minimize intraoperative bleeding.

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Nerve sparing radical hysterectomy: Short-term oncologic, surgical, and functional outcome

10.1055/s-0040-1718213 ◽

2020 ◽

Author(s):

Muallem MZ ◽

A Miranda ◽

R Armbrust ◽

J Neymeyer ◽

J Sehouli ◽

...

Keyword(s):

Functional Outcome ◽

Radical Hysterectomy ◽

Nerve Sparing ◽

Short Term

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Nerve-sparing radical hysterectomy in patients with infiltrative cervical cancer

HEALTH OF WOMAN ◽

10.15574/hw.2016.112.46 ◽

2016 ◽

pp. 46-51

Author(s):

T. Dermenzhy ◽

◽

V. Svintitskiy ◽

S. Nespryadko ◽

L. Legerda ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Contractile Function ◽

Major Elements ◽

Control Group ◽

Nerve Sparing ◽

Group I ◽

Hypogastric Plexus ◽

Prognostic Indexes

The objective: to improve an effectiveness of therapy and quality of life of patients with infiltrative cervical cancer using radical hysterectomy accomplished with nerve-sparing methodology. Patients and Methods: Ninety patients with histologically verified infiltrative cervical cancer were cured with radical hysterectomy (RHE) in the Department of Oncogynecology of National Cancer Institute (Kyiv, Ukraine) in 2012-2016. The age of the patients was from 26 to 65 years (an average age of 42.61±1.06). The patients were distributed in 2 groups: group I treated with nerve-sparing radical hysterectomy (NSRHE), 45 patients, the main group; group II treated with radical hysterectomy (RHE III), the control group, 45 patients. The prognostic indexes in the groups were similar. Results. NSRHE that included the dissection of cardinal ligament, separation of dorsal and anterior layers of uterovesical ligament allowed separate uterine branch of inferior hypogastric plexus, preserve an innervation of urinary bladder and prevent the malfunction of its contractile function at postoperative period. Conclusion. The data of the urodynamic study using cystomanometry performed at pre- and early operative periods have shown that surgical treatment of patients with infiltrative cervical cancer with preservation of the major elements of pelvic autonomic plexuses allows significantly decrease the rate of postoperative urogenical malfunctions. Key words: nerve-sparing radical hysterectomy, cervical cancer, cystomanometry.

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