scholarly journals Managing Anterior Communicating Artery Aneurysms—Are We Doing It Right?

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lauren Harris ◽  
Ciaran S Hill ◽  
Matthew Elliot ◽  
Teresa Fitzpatrick ◽  
Alejandro Feria ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Open Surgery ◽  
Group Analysis ◽  
Mass Effect ◽  
Anterior Communicating Artery ◽  
Single Centre ◽  
Increased Risk ◽  
Aneurysm Morphology ◽  
Csf Diversion

Abstract INTRODUCTION The natural history and optimal treatment—of previously ruptured anterior communicating artery (ACOM) aneurysms that recur is unclear. This study determines whether our management decisions of endovascular treatment vs open surgery is correct with respect to recurrence and rebleeding rates. METHODS A retrospective observational study. All patients presenting to a single centre with a subarachnoid haemorrhage (SAH) secondary to an ACOM aneurysm were included. Data was collected from November 2012 to September 2018. Data collected included baseline demographics, aneurysm characteristics, management, complications, follow-up imaging, and outcomes. RESULTS A total of 137 patients were included in the study. A total of 113 aneurysms were coiled and 19 were clipped. The indication for clipping was due to aneurysm morphology or the presence of a haematoma exerting mass effect. Rates of vasospasm, infarction, cerebrospinal fluid (CSF) diversion, rebleed, length of stay, and functional outcome were not significantly different in the 2 cohorts. Residual and recurrence was higher in the coiled cohort n = 46 vs clipping n = 2 (P = .0140) with over a quarter of these patients requiring further treatment at a median time of 16 mo. In a subgroup group analysis of coiled aneurysms, there was no statistical differences in rates of rebleed or functional outcome in those that recurred/had a residual and those that did not. CONCLUSION Patients treated with coiling have an increased risk of recurrence vs those treated with clipping. However, the risk of rebleed was not statistically significant. The prevention and impact of recurrence and residual aneurysms remain incompletely understood. Hence, treatment decisions should be considered carefully in a multidisciplinary setting.

scholarly journals Cerebellar hemangioblastoma during pregnancy: Management options and review of literature

2020 ◽  
Vol 11 ◽  
pp. 123
Author(s):  
Nitish Nayak ◽  
Anil Kumar
Keyword(s):  
Obstructive Hydrocephalus ◽  
Mass Effect ◽  
Lateral Position ◽  
Management Options ◽  
Cerebellar Hemangioblastoma ◽  
Suboccipital Craniotomy ◽  
History Of ◽  
Nerve Paresis ◽  
Csf Diversion

Background: Symptomatic cerebellar hemangioblastomas are extremely rare in pregnant women and the ideal management is not well established. In the present article, we aimed to report a case of large cerebellar hemangioblastoma complicated by pregnancy and managed successfully by surgical resection. In addition, we also discuss management options and review of the current literature pertaining to this pathology. Case Description: A 22-year-old female presented with a history of headache and vomiting for 4 weeks. She was carrying 28 weeks of pregnancy. She had left cerebellar signs, gait ataxia, and bilateral six nerve paresis. Fundus examination revealed bilateral papilledema. She was diagnosed to have large cerebellar hemangioblastoma with mass effect and obstructive hydrocephalus. She underwent suboccipital craniotomy and excision of lesion in lateral position. She recovered well postoperatively and delivered a healthy baby in the full term. Imaging at10- month follow-up demonstrates no residual lesion or another hemangioblastoma. Conclusion: Early diagnosis and direct surgery for excision of hemangioblastoma is a good option during pregnancy while avoiding CSF diversion procedures. The symptomatic hemangioblastoma during pregnancy can be safely operated during early pregnancy.

scholarly journals Modified Orbitozygomatic Craniotomy for a Previously Coiled Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Clip Occlusion

Abstract Clip occlusion of previously coiled aneurysms poses unique technical challenges. The coil mass can complicate aneurysm neck access and clip tine approximation. This patient had a previously ruptured anterior communicating artery (ACOM) aneurysm that had been treated with coil embolization. On follow-up evaluation, the patient was found to have a recurrence of the aneurysm, which prompted an orbitozygomatic craniotomy for clip occlusion. The approach provided a favorable view of the aneurysm neck with the coil mass protruding outside the aneurysm dome. Indocyanine green fluoroscopy was used to assist with ideal permanent clip placement along the aneurysm neck. The segment of coils present outside the aneurysm neck was removed to reduce mass effect on the optic chiasm. Postoperative imaging demonstrated aneurysm obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Six-month follow-up of functional status in discharged patients with coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hou-wei Du ◽  
Shuang-fang Fang ◽  
Sang-ru Wu ◽  
Xiao-ling Chen ◽  
Jun-nian Chen ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcome ◽  
Increased Risk ◽  
Tumor Center ◽  
Union Hospital ◽  
Limited Function ◽  
Discharged Patients ◽  
Grade 3

Abstract Background The long-term functional outcome of discharged patients with coronavirus disease 2019 (COVID-19) remains unresolved. We aimed to describe a 6-month follow-up of functional status of COVID-19 survivors. Methods We reviewed the data of COVID-19 patients who had been consecutively admitted to the Tumor Center of Union Hospital (Wuhan, China) between 15 February and 14 March 2020. We quantified a 6-month functional outcome reflecting symptoms and disability in COVID-19 survivors using a post-COVID-19 functional status scale ranging from 0 to 4 (PCFS). We examined the risk factors for the incomplete functional status defined as a PCFS > 0 at a 6-month follow-up after discharge. Results We included a total of 95 COVID-19 survivors with a median age of 62 (IQR 53–69) who had a complete functional status (PCFS grade 0) at baseline in this retrospective observational study. At 6-month follow-up, 67 (70.5%) patients had a complete functional outcome (grade 0), 9 (9.5%) had a negligible limited function (grade 1), 12 (12.6%) had a mild limited function (grade 2), 7 (7.4%) had moderate limited function (grade 3). Univariable logistic regression analysis showed a significant association between the onset symptoms of muscle or joint pain and an increased risk of incomplete function (unadjusted OR 4.06, 95% CI 1.33–12.37). This association remained after adjustment for age and admission delay (adjusted OR 3.39, 95% CI 1.06–10.81, p = 0.039). Conclusions A small proportion of discharged COVID-19 patients may have an incomplete functional outcome at a 6-month follow-up; intervention strategies are required.

Advanced Age at Transplant Increases the Risk of Second Solid Malignancy (SSM) after Haematopoetic Stem Cell Transplantation (HSCT)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3952-3952
Author(s):  
John Murray ◽  
John Chadwick ◽  
Adrian Bloor ◽  
Jim Cavet ◽  
Mike Dennis ◽  
...  
Keyword(s):  
Stem Cell ◽  
Research Funding ◽  
Second Malignancy ◽  
Single Centre ◽  
Solid Malignancy ◽  
Increased Risk ◽  
Cell Transplants ◽  
Long Term Survivors

Abstract Introduction: It is increasingly important to understand the long term risk associated with transplantation because the number of long term survivors is steadily growing. In comparison to other long term risks following transplantation like infertility, cataracts, endocrine dysfunction, etc. the risk of second malignancy is likely to be associated with increased risk of mortality and hence significant impact on survival outcomes. This retrospective, single centre analysis was undertaken to evaluate the risk of second solid malignancy in patients undergoing HSCT. Methods: From February 1973 to November 2013, 1983 patients (median age: 45yr., range: 14-76 yr.; M: 1259, F: 724) received stem cell transplants for haematological malignancies (Ac. Leuk: 507, Chr. Leuk: 97, lymphoma:645, myeloma:621, solid tumours:113). Donor was allogeneic (n=528) or autologous (n=1455) and conditioning was with (n=556) or without TBI (n=1427). Donor was sibling (n=302), matched unrelated (n=220) or cord blood (n=6). Source of stem cell was marrow (n=322), PBSC (n=1627), both (n=28) or cord blood (n=6). GVH prophylaxis included Campath in 203 cases. Of all the patients 1774 received single transplant but 209 received more than one transplant. Data was analysed as of 01/12/2013 using competing risk models with death as the competing event. Patients who developed second haematological malignacy were not included in this analysis. Results: Patient follow-up was more than 10 years in 382 cases (19%), between 5 to 10 years in 328 (17%), 1 to 5 years in 667 (34%) and less than 1 year in 606 cases (31%). Second solid malignancy developed in 70 patients with the incidence of 1% at 5yr (95% CI: 0.5-1.6), 2.2% at 10 yr (95% CI: 1.6-3.3), 4.8% at 15yr (95% CI: 3.6-6.8) and 8% (95% CI: 5.9-10.5) at 20 years. Site of second malignancy was brain (n=2), breast (n=15), cervix (n=3), GIT (n=11), genitourinary (n=9), lung (n=3), skin (n=17), head & neck (n=7), thyroid (n=3) and non EBV related lymphoma (n=3). In univariate analysis 10 yr. probability of developing SSM was not influenced by gender, stage of disease, primary diagnosis, type of HSCT, use of TBI, cranial top-up radiation, type of donor or year of transplant. It was significantly higher with use of PBSC (1.4% vs. 2.6%, p=0.02) and age above 65yr. (1.5% vs. 11%, p=0.001). In multi-variate analysis age above 65yr. (RR: 1.8, 95% CI: 1.1-2.9, p=0.02) and PBSC (RR: 9.4, 95% CI: 1-99, p=0.05) were independently associated with increased risk of SMN. 19 patients have died due to SSM (27%) and survival was significantly shorter with gastrointestinal, genitourinary and lung cancers. Conclusion: This single centre analysis shows that the risk of developing SSM increases with advancing age, longer follow-up and the survival is poor. Long term survivors of stem cell transplants need follow-up probably for life in speciality clinics. Continued vigilance, avoidance of known carcinogens and life style changes are strongly recommended. Disclosures Bloor: GSK: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Cavet:Novartis: Research Funding; BMS: Research Funding.

scholarly journals Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome

2016 ◽  
Vol 41 (2) ◽  
pp. E6 ◽  
Author(s):  
Tanmoy K. Maiti ◽  
Shyamal C. Bir ◽  
Devi Prasad Patra ◽  
Piyush Kalakoti ◽  
Bharat Guthikonda ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Wide Spectrum ◽  
Neurofibromatosis Type ◽  
Spinal Tumors ◽  
Benign Tumors ◽  
Increased Risk ◽  
Dural Tail ◽  
Spinal Meningiomas ◽  
Signal Changes

OBJECTIVE Spinal meningiomas are benign tumors with a wide spectrum of clinical and radiological features at presentation. The authors analyzed multiple clinicoradiological factors to predict recurrence and functional outcome in a cohort with a mean follow-up of more than 4 years. The authors also discuss the results of clinical studies regarding spinal meningiomas in the last 15 years. METHODS The authors retrospectively reviewed the clinical and radiological details of patients who underwent surgery for spinal tumors between 2001 and 2015 that were histopathologically confirmed as meningiomas. Demographic parameters, such as age, sex, race, and association with neurofibromatosis Type 2, were considered. Radiological parameters, such as tumor size, signal changes of spinal cord, spinal level, number of levels, location of tumor attachment, shape of tumor, and presence of dural tail/calcification, were noted. These factors were analyzed to predict recurrence and functional outcome. Furthermore, a pooled analysis was performed from 13 reports of spinal meningiomas in the last 15 years. RESULTS A total of 38 patients were included in this study. Male sex and tumors with radiological evidence of a dural tail were associated with an increased risk of recurrence at a mean follow-up of 51.2 months. Ventral or ventrolateral location, large tumors, T2 cord signal changes, and poor preoperative functional status were associated with poor functional outcome at 1-year follow-up. CONCLUSIONS Spine surgeons must be aware of the natural history and risk factors of spinal meningiomas to establish a prognosis for their patients.

scholarly journals The Medina Embolic Device: Karolinska experience

2017 ◽  
Vol 24 (1) ◽  
pp. 4-13 ◽  
Author(s):  
P Bhogal ◽  
PA Brouwer ◽  
L Yeo ◽  
M Svensson ◽  
M Söderman
Keyword(s):  
Internal Carotid ◽  
Clinical Status ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Single Centre ◽  
Complete Occlusion ◽  
Neck Size ◽  
Cerebellar Artery ◽  
Single Centre Experience

Background The aim of this study was to report our single centre experience with the Medina Embolic Device (MED). Methods We performed a retrospective analysis of prospectively collected data to identify all patients treated with the MED. A total of 14 aneurysms (non-consecutive), in 13 patients, were treated including one ruptured and one partially thrombosed aneurysm. Fundus diameter was ≥5 mm in all cases. We evaluated the angiographic appearances, the clinical status, complications, and the need for adjunctive devices or repeat treatments. Results Aneurysm location was cavernous internal carotid artery (ICA; n = 1), supraclinoid ICA ( n = 1), terminal ICA ( n = 2), anterior communicating artery (AComA; n = 4), A2–3 ( n = 1), M1–2 junction ( n = 1), posterior communicating artery (PComA; n = 1), superior cerebellar artery (SCA; n = 1), and basilar tip ( n = 2). The average aneurysm fundus size was 8.6 mm (range 7–10 mm) and average neck size 3.75 mm (range 1.9–6.9 mm). Immediate angiographic results were modified Raymond–Roy occlusion classification (mRRC) I n = 2, mRRC II n = 1, mRRC IIIa n = 2, mRRC IIIb n = 2, the remaining 7 aneurysms showed complete opacification. At follow-up angiography (mean 5 months) mRRC I n = 5, mRRC II n = 5, mRRC IIIa n = 3, and persistent filling was seen in 1 aneurysm. Overall, four patients had repeat treatment and one is pending further treatment. Of the aneurysms treated with more than one MED, 75% showed complete occlusion at 6-month follow up whereas only one aneurysm treated with a single device showed complete occlusion. Overall, three patients had temporary complications and there were no deaths. Conclusions The MED is an intra-saccular flow-diverting device with satisfactory angiographic results and an acceptable safety profile. Use of a single MED cannot be recommended and further longer term studies are needed prior to widespread clinical use.

scholarly journals Six-month follow-up of functional status in discharged patients with coronavirus disease 2019

2020 ◽  
Author(s):  
Houwei Du ◽  
Shuang-fang Fang ◽  
Sang-ru Wu ◽  
Xiao-ling Chen ◽  
Jun-nian Chen ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcome ◽  
Increased Risk ◽  
Tumor Center ◽  
Union Hospital ◽  
Limited Function ◽  
Discharged Patients ◽  
Grade 3

Abstract Background The long-term functional outcome of discharged patients with coronavirus disease 2019 (COVID-19) remains unresolved. We aimed to describe a six-month follow-up of functional status of COVID-19 survivors.Methods We reviewed the data of COVID-19 patients who had been consecutively admitted to the Tumor Center of Union Hospital (Wuhan, China) between 15 February and 14 March 2020. We quantified a six-month functional outcome reflecting symptoms and disability in COVID-19 survivors using a post-COVID-19 functional status scale ranging from 0 to 5 (PCFS). We examined the risk factors for the incomplete functional status defined as a PCFS > 0 at a six-month follow-up after discharge.Results We included a total of 95 COVID-19 survivors with a median age of 62 (IQR 53-69) who had a complete functional status (PCFS grade 0) at baseline in this retrospective observational study. At six-month follow-up, 67 (70.5%) patients had a complete functional outcome (grade 0), 9 (9.5%) had a negligible limited function (grade 1), 12 (12.6%) had a mild limited function (grade 2), 7 (7.4%) had moderate limited function (grade 3). Univariable logistic regression analysis showed a significant association between the onset symptoms of muscle or joint pain and an increased risk of incomplete function (unadjusted OR 4.06, 95%CI 1.33 - 12.37). This association remained after adjustment for age and admission delay (adjusted OR 3.39, 95%CI 1.06 - 10.81, p = 0.039).Conclusions A small proportion of discharged COVID-19 patients may have an incomplete functional outcome at a six-month follow-up; intervention strategies are required.

scholarly journals How good is operator opinion at predicting high ventricular pacing burden among patients receiving device therapy for bradycardia?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Chattopadhyay ◽  
P Chousou ◽  
R Thomas ◽  
J Hayes ◽  
J O"brien ◽  
...  
Keyword(s):  
Complete Heart Block ◽  
Sinus Node ◽  
Group Analysis ◽  
Conduction System ◽  
Ventricular Pacing ◽  
Single Centre ◽  
System Disease ◽  
Node Disease ◽  
Conduction System Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Current guidelines indicate that pacing methods that maintain physiologic ventricular activation (biventricular pacing or His-bundle pacing) should be chosen over right ventricular pacing (Vp) among patients with EF 36-50% who are expected to Vp >40% of the time. There are no guidelines to help predict which patients will receive a high burden of Vp and this is left to operator opinion. We sought to ascertain whether operator opinion is an accurate predictor of high burden of Vp. Methods This was a single-centre single-blinded observational study of patients who received pacemaker implant for treatment of bradycardia between April 2015 and 2019 and had at least 12 month follow-up data on record. Patients’ demographic, clinical, electrocardiographic and echocardiographic data were reviewed in a blinded fashion by a senior implanting physician, who estimated whether the Vp at 12 months would exceed 40%. The Vp at approximately 12 months was obtained from the pacing records and compared with the prediction. Results Some 982 patients underwent pacemaker implantation during the study period, 698 for conduction system disease (CSD), 267 for sinus node disease (SND) and 17 for other conditions. Overall, 856 had valid follow-up data. Of these, 543 (63.4%) were predicted to Vp >40% , and 527(61.6%) were documented as having Vp >40%. The sensitivity and specificity of operator prediction were 93.2% and 84.2%, with positive and negative predictive values of 90.4% and 88.5%. Table 1 illustrates analyses of different populations by clinical parameter. In sub-group analysis, complete heart block and PR > 300ms were significant factors for accurate prediction of Vp > 40%, however clinical features, such as syncope, were poor discriminators. Conclusion In this single-centre study, among patients receiving pacemaker implant for treatment of bradycardia, operator prediction of the burden of Vp >40% has an acceptable degree of accuracy. Sub-group analysis suggests that certain clinical parameters could make this prediction easier. Table 1. Comparison of operator opinion SND CSD CHB SND+PR < 160 PR > 300 Syncope Non-syncope n 698 267 216 84 60 409 344 Sensitivity 44.4% 97.7% 100% 6.3% 100% 86.4% 87.9% Specificity 98.3% 62.0% 45.2% 97.1% 0%* 89.9% 79.6% PPV 87.0% 90.6% 91.6% 33.3% 98.3% 94.2% 92.2% NPV 87.9% 87.9% 100% 81.5% - 77.6% 70.5% * only 1 patient did not RV pace >40% - this was not predicted. SND – sinus node disease; CSD – conduction system disease; CHB – complete heart block, PPV – positive predictive value; NPV – negative predictive value

Abstract TMP88: Blood Pressure Variability Within 24 Hours After Recanalization Worsens Functional Outcome Among Patients Who Underwent Endovascular Treatment

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Campos ◽  
Manuel Requena ◽  
Mariana Carvalho ◽  
Marlene Saraiva ◽  
Alvaro Garcia-Tornel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Systemic Blood Pressure ◽  
Hemorrhagic Transformation ◽  
Poor Functional Outcome ◽  
Ischemic Tissue ◽  
Increased Risk ◽  
Potential Risks

Introduction: Systemic blood pressure (BP) should be strictly monitored and adjusted during the initial stages of stroke. Due to the impairment of cerebral autoregulation, cerebral blood flow is directly affected by systemic BP and some degree of permissive hypertension might be beneficial prior to reperfusion treatments to ensure an adequate perfusion in the ischemic tissue. However, after generalization of endovascular treatment (EVT) the rate of successful recanalization has skyrocketed and it is not well established if, once achieved, BP control should be stricter given its potential risks. We aim to explore the relation between BP and outcome among patients who underwent EVT. Methods: This is a retrospective study of a prospectively acquired unicentric database that includes patients who underwent EVT with successful recanalization measured by a mTICI ≥2b. Hourly measuring of systolic and diastolic BP was conducted during the first 24 hours post-procedure. BP variation was measured using standard deviation (SD) and range. We explored the effects of BP on functional outcome at 3 months and safety variables. Results: The study included 351 subjects with a mean age of 72.7+/-13.1 and 51.6% were men. The 3-months mRS was ≤2 in 50.4% of patients, 66 subjects (19.2%) presented hemorrhagic transformation and 67 (19.1%) were dead in the 3-months follow-up period. Both systolic BP SD (15.6+/-9.9 vs. 12.9+/-4.3; p<0.01) and range (55.6+/-18.4 vs. 48.7+/-16.4; p<0.01) were higher among patients with bad functional outcome (mRS>2). Subjects with hemorrhagic transformation presented higher range of DBP (35.7+/-12.4 vs. 32.0+/-11.9; p=0.03) and SBP (56.8+/-17.0 vs. 51.4+/-18.1; p=0.03) and higher diastolic DBP SD (9.3+/-4.1 vs. 8.2+/-2.7; p<0.01). In a logistic regression analysis DBP SD predicted ICH (OR 1.11, CI 1.02-1.22, p=0.01) and SBP range emerged as a predictor of poor functional outcome (OR 0.97, CI 0.96-0.99, p<0.01). No differences were detected in regard to admission BP, maximal and minimal BP or mean arterial pressure. Conclusions: Major fluctuations in systolic and diastolic BP predict increased risk of hemorrhagic complications and poor functional outcome. Minimizing BP fluctuations may improve outcome of EVT patients after recanalization.

scholarly journals Association of Preoperative Cone Biopsy With Recurrences After Radical Hysterectomy

2021 ◽  
Author(s):  
Rüdiger Klapdor ◽  
Hermann Hertel ◽  
Laura Delebinski ◽  
Peter Hillemanns
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Open Surgery ◽  
Recurrent Disease ◽  
Tumor Diameter ◽  
Free Survival ◽  
Increased Risk ◽  
Single Center Study ◽  
Cone Biopsy

Abstract ObjectiveTo evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer.MethodsThis is a retrospective single-center study. Patients with cervical cancer stage IA1 with LVSI to IIA2 and squamous, adenosquamous and adenocarcinoma subtype were included. Patients were analyzed for general characteristics and recurrence-free survival (RFS). ResultsIn total, of 480 patients with cervical cancer 183 patients met the inclusion criteria (117 with laparoscopic and 66 with open surgery). The median tumor diameter was 25.0 mm (range 4.6-70.0 mm) with 66 (36.2%) patients having tumors smaller than 2 cm. During median follow-up of 54.0 months (range 0-166.0 months) the RFS for the laparoscopic cohort was 93.2% and 87.5% at 3 and 4.5 years, and 79.3% for the open cohort after 3 and 4.5 years, respectively. In total, 17 (9.3%) patients developed recurrent disease, 9 (7.3%) after laparoscopic, and 8 (12.1%) after open surgery. No preoperative cone biopsy (OR 9.60, 95%CI 2.14-43.09) as well as tumor diameter >2cm (OR 5.39, 95%CI 1.20-24.25) were significantly associated with increased risk for recurrence. In multivariate analysis only missing preoperative cone biopsy was significantly associated with increased risk for recurrence (OR 5.90, 95% CI 1.11-31.29)ConclusionThere appears to be a subgroup of patients (preoperative cone biopsy, tumor diameter <2cm) with excellent survival and low risk for recurrence after radical hysterectomy which might benefit from the advantages of laparoscopic surgery.

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