Comparison of Laparoscopic Versus Abdominal Radical Hysterectomy for FIGO Stage IB and IIA Cervical Cancer With Tumor Diameter of 3 cm or Greater

2014 ◽  
Vol 24 (2) ◽  
pp. 280-288 ◽  
Author(s):  
Tae Wook Kong ◽  
Suk-Joon Chang ◽  
Jisun Lee ◽  
Jiheum Paek ◽  
Hee-Sug Ryu
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Operating Time ◽  
Figo Stage ◽  
Tumor Diameter ◽  
Pelvic Magnetic Resonance Imaging ◽  
Laparoscopic Radical Hysterectomy ◽  
Stage Ib ◽  
Estimated Blood Loss ◽  
The Mean

ObjectiveThere have been many comparative reports on laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. However, most of these studies included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 and small (tumor diameter ≤2 or 3 cm) IB1 disease. The purpose of this study was to compare the feasibility, morbidity, and recurrence rate of LRH and ARH for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater.Materials and MethodsWe conducted a retrospective analysis of 88 patients with FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. All patients had no evidence of parametrial invasion and lymph node metastasis in preoperative gynecologic examination, pelvic magnetic resonance imaging, and positron emission tomography–computed tomography, and they all underwent LRH or ARH between February 2006 and March 2013.ResultsAmong 88 patients, 40 patients received LRH whereas 48 underwent ARH. The mean estimated blood loss was 588.0 mL for the ARH group compared with 449.1 mL for the LRH group (P< 0.001). The mean operating time was similar in both groups (246.0 minutes in the ARH vs 254.5 minutes in the LRH group,P= 0.589). Return of bowel motility was observed earlier after LRH (1.8 vs 2.2 days,P= 0.042). The mean hospital stay was significantly shorter for the LRH group (14.8 vs 18.0 days,P= 0.044). There were no differences in histopathologic characteristics between the 2 groups. The mean tumor diameter was 44.4 mm in the LRH and 45.3 mm in the ARH group. Disease-free survival rates were 97.9% in the ARH and 97.5% in the LRH group (P= 0.818).ConclusionsLaparoscopic radical hysterectomy might be a feasible therapeutic procedure for the management of FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. Further randomized studies that could support this approach are necessary to evaluate long-term clinical outcome.

Robotic Versus Laparoscopic Radical Hysterectomy in Cervical Cancer Patients: A Matched-Case Comparative Study

2014 ◽  
Vol 24 (8) ◽  
pp. 1466-1473 ◽  
Author(s):  
Tae-Hyun Kim ◽  
Chel Hun Choi ◽  
June-Kuk Choi ◽  
Aera Yoon ◽  
Yoo-Young Lee ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Surgical Outcomes ◽  
Invasive Cervical Cancer ◽  
Operating Time ◽  
International Federation ◽  
Complication Rates ◽  
Laparoscopic Radical Hysterectomy ◽  
Gynecology And Obstetrics ◽  
Estimated Blood Loss

ObjectiveThis study aimed to compare initial surgical outcomes and complication rates of patients with early-stage cervical cancer who underwent robotic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH).MethodsPatients diagnosed with invasive cervical cancer (International Federation of Gynecology and Obstetrics stage I-IIA) who underwent RRH (n = 23) at Samsung Medical Center from January 2008 to May 2013 were compared with matched patients who underwent LRH (n = 69) during the same period. The 2 surgical groups were matched 3:1 for variables of age, body mass index, International Federation of Gynecology and Obstetrics stage, histological subtype, tumor size, and node positivity. All patient information and surgical and postoperative follow-up data were retrospectively collected.ResultsOperating time was significantly longer (317 vs 236 minutes; P < 0.001) in the RRH group compared with the LRH group but mean estimated blood loss was significantly reduced in the RRH group (200 vs 350 mL; P = 0.036). Intraoperative and postoperative complications were not significantly different between the 2 groups (4.3% for RRH vs 1.45% for LRH; P = 0.439). Recurrences were 2 (8.7%) in the RRH and 7 (10.1%) in the LRH group. The overall 3-year recurrence-free survival was 91.3% in RRH group and 89.9% in the LRH group (P = 0.778).ConclusionsAlthough operating time was longer in the RRH cases because of lesser experience on robotic platform, we showed that surgical outcomes and complication rate of RRH were comparable to those of LRH. In addition, surgical skills for LRH easily and safely translated to RRH in case of experienced laparoscopic surgeon.

Oncologic Results and Surgical Morbidity of Laparoscopic Nerve-Sparing Radical Hysterectomy in the Treatment of FIGO Stage IB Cervical Cancer: Long-Term Follow-Up

2011 ◽  
Vol 21 (2) ◽  
pp. 355-362 ◽  
Author(s):  
Nae Yoon Park ◽  
Gun Oh Chong ◽  
Dae Gy Hong ◽  
Young Lae Cho ◽  
Il Soo Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Survival Rates ◽  
Operating Time ◽  
Figo Stage ◽  
Nerve Sparing ◽  
Surgical Morbidity ◽  
Stage Ib ◽  
Urological Complications ◽  
Long Term Follow Up

Objectives:The aim of this study was to evaluate a long-term follow-up data for oncologic results and surgical morbidity of a laparoscopic nerve-sparing radical hysterectomy (NSRH) in the treatment of FIGO stage IB cervical cancer.Methods:This was a retrospective study that comprised consecutive 125 patients with cervical cancer stage IB1 (n = 105) and IB2 (n = 20) who underwent a laparoscopic NSRH (Piver type III) by a gynecologic oncologist without selecting patients from January 1999 to December 2007.Results:In regression analysis, the operating time (R2linear = 0.311,P< 0.001) and estimated blood loss (R2linear = 0.261,P< 0.001) were decreased, whereas the number of harvested pelvic lymph nodes (R2linear = 0.250,P< 0.001) was increased. Seventeen patients (13.6%, 17/125) were found to have pelvic node metastasis. Para-aortic node metastasis had occurred in 2 patients (5.1%, 2/39). There were high urological complications (13/125, 10.4%) related to radical surgery. Forty-one patients (33%) needed transfusions. Positive surgical margins did not exist. Patients were able to self-void at a mean of 10.3 days postoperatively. The return rates to normal voiding function at postoperative 14 and 21 days were 92.0% and 95.2%, respectively. Thirteen patients (IB1 n = 9, IB2 n = 4) experienced a recurrence postoperatively. Six patients (IB1 n = 3, IB2 n = 3) died of recurrent disease. Five-year disease-free survival rates of cervical cancer IB1 and IB2 were 92% and 78%, respectively (P= 0.1772). Five-year overall survival rates of cervical cancer IB1 and IB2 were 96% and 83%, respectively (P= 0.0437).Conclusions:A laparoscopic NSRH for FIGO stage IB cervical cancer was comparable to open NSRH in terms of early recovery of bladder function. It did not compromise surgical radicality, but revealed high urological complications, long operating time, and much blood loss, compared with conventional radical hysterectomy. However, these surgical morbidities were corrected with increase in experiences.

scholarly journals Laparoskopska radikalna histerektomija z limfadenektomijo: naše izkušnje

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.

scholarly journals Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared With the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

2017 ◽  
Vol 27 (9) ◽  
pp. 1990-1999 ◽  
Author(s):  
Ji-Chan Nie ◽  
An-Qi Yan ◽  
Xi-Shi Liu
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Surgical Outcomes ◽  
Operating Time ◽  
Bowel Function ◽  
Lymph Node Yield ◽  
Laparoscopic Radical Hysterectomy ◽  
Function Recovery ◽  
Node Yield

ObjectiveThe aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients.MethodsWe have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients.ResultsBoth groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups.ConclusionsThe results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.

scholarly journals The value of sentinel lymphadenectomy in radical operative treatment of cervical cancer

2009 ◽  
Vol 66 (7) ◽  
pp. 539-543 ◽  
Author(s):  
Vladimir Pazin ◽  
Svetlana Dragojevic ◽  
Zeljko Mikovic ◽  
Milan Djukic ◽  
Snezana Rakic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Predictive Value ◽  
Sentinel Nodes ◽  
Sentinel Lymphadenectomy ◽  
Stage Ib ◽  
The Mean

Background/Aim. Therapy of the early stages of cervical carcinoma is surgical or radiation therapy, and for advanced stages chemoradiotherapy. Pelvic and paraaortic lymphadenectomy in early stages offers the most important prognostic factor for survival. To evaluate the method and possible influence on surgical staging and therapy of the disease, we performed sentinel node (SN) identification and excision during open radical hysterectomy and lymphadenectomy in stage Ib-IIa cervical carcinoma. Methods. Fifty patients initially diagnosed with invasive squamous-cell cervical cancer stage Ib-IIa were included in the study. Only blue dye was used for sentinel node mapping. During the surgery sentinel nodes were identified and sent to histopathology separately from the other lymph nodes. After lymphadenectomy, radical hysterectomy was performed. Results. The mean age of our fifty patients was 49.10 years (SD = 5.92), and the mean number of extracted lymph nodes per patient was 25.78 (SD = 5.58). The number of sentinel nodes identified per patient was between 0 and 5, mean 2.60 (SD = 1.54). There were no inframesenteric paraaortic sentinel nodes found among the patients. The dominant tumor grades were 1 and 2, 40% and 50% respectively, and 37 out of 50 patients (74%) had tumor diameter less than 2 cm. In four patients (8%) SN were not identified. In the rest of 46 patients the presence of SN was bilateral (19 patients, 38%) or unilateral (27 patients, 54%). Positive SN were found in 17 patients (34%), and negative in 29 patients (58%). Out of the whole group of patients (50), 21 of them (42%) had positive lymph nodes (LN). In the crosstab statistics, no differences were noticed in the group without SN found, in comparison with tumor grade and diameter. Finally, our test showed sensitivity of 85% (SE = 8%), specificity 100%, positive predictive value of 100%, negative predictive value of 89.6% (SE = 5.6%), and effectiveness of 93% (SE = 3.6%) regarding sentinel lymphadenectomy. Conclusion. This method of sentinel lymph node identification is simple, but not reliable enough to support further laparoscopic SN excision in order to make the final decision about the treatment of cervical cancer.

Preoperative nomogram for prediction of microscopic parametrial infiltration in patients with FIGO stage IB cervical cancer treated with radical hysterectomy

2016 ◽  
Vol 142 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Tae-Wook Kong ◽  
Jayoun Kim ◽  
Joo-Hyuk Son ◽  
Seong Woo Kang ◽  
Jiheum Paek ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Figo Stage ◽  
Stage Ib

Surgical and Pathological Outcomes of Laparoscopic Versus Abdominal Radical Hysterectomy With Pelvic Lymphadenectomy and/or Para-aortic Lymph Node Sampling for Bulky Early-Stage Cervical Cancer

2017 ◽  
Vol 27 (6) ◽  
pp. 1222-1227 ◽  
Author(s):  
Tao Zhu ◽  
Xi Chen ◽  
Jianqing Zhu ◽  
Yaqing Chen ◽  
Aijun Yu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Tumor Diameter ◽  
Laparoscopic Radical Hysterectomy ◽  
Lymph Node Sampling ◽  
Aortic Lymph Node ◽  
Early Stage Cervical Cancer

Background and ObjectivesThe aim of this study was to compare the feasibility, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (LRH) with those of abdominal radical hysterectomy (ARH) for bulky early-stage cervical cancer.MethodsWe performed a retrospective cohort study of 112 patients with stage IB1 or IIA2 cervical cancer in which the tumor diameter was 3 cm or greater. All patients underwent LRH (n = 30) or ARH (n = 82) with pelvic lymphadenectomy and/or para-aortic lymph node sampling between May 2011 and November 2014. Perioperative outcomes were compared between the 2 surgical groups.ResultsThe laparoscopic approach consisted of 4 trocar insertions. Age, tumor diameter, and pelvic lymph nodes significantly differed between the 2 cohorts. Body mass index, International Federation of Gynecology and Obstetrics stage, histologic type and grade, deep stromal invasion, lymphovascular space invasion, positive margins, and adjuvant therapy were not significantly different between the 2 cohorts. Laparoscopic radical hysterectomy exhibited favorable results compared with ARH in terms of operating time, blood loss, intestinal exhaust time, and length of hospital stay. In addition, recurrence was observed in 5 LRH patients (16.7%) and 9 ARH patients (11.7%).ConclusionsThe surgical outcomes of LRH with pelvic lymphadenectomy and/or para-aortic lymph node sampling exhibited a similar therapeutic efficacy to those of the ARH approach.

Comparative study of chemoradiation and neoadjuvant chemotherapy effects before radical hysterectomy in stage IB–IIB bulky cervical cancer and with tumor diameter greater than 4 cm

2005 ◽  
Vol 15 (3) ◽  
pp. 483-488
Author(s):  
M. Modarress ◽  
F. Q. Maghami ◽  
M. Golnavaz ◽  
N. Behtash ◽  
A. Mousavi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Hysterectomy ◽  
Tumor Size ◽  
Pathologic Complete Response ◽  
Residual Tumor ◽  
Preoperative Treatment ◽  
Tumor Diameter ◽  
Stage Ib ◽  
Significant Difference

Tumor size seems to be a determinant in the prognosis of early cervical cancer. Patients with tumor greater than 4 cm (bulky) in diameter have worse outcome. The purpose of this study was to compare the efficacy of preoperative combined chemoradiation and neoadjuvant chemotherapy (NAIC) programs followed by radical hysterectomy in stage IB–IIB bulky cervical cancer. From September 1999 to April 2002, 60 patients with stage IB–IIB bulky cervical cancer were treated with preoperative external-beam radiotherapy to 45 Gy plus weekly cisplatin 50 mg/m2 or preoperative NAIC by cisplatin 50 mg/m2 and vincristin 1 mg/m2 every 7–10 days, for three courses. Surgery was performed 4–6 weeks after the completion of the preoperative treatment. There were no significant difference between age, stage, tumor size, and histopathologic type in two groups (P > 0.05). Toxicity associated with two treatment methods was usually mild. In chemoradiation group, two patients developed vesicovaginal fistula, and four patients developed long-term hydronephrosis that needed urethral stenting. Before surgery, complete and partial clinical response had no significant difference between two groups (P > 0.05). After surgery, lymph node and parametrial involvement had no significant difference between two groups (P > 0.05). In NAIC group, more patients had significantly residual tumor (P = 0.012), but residual tumor size had no significant difference between two groups (P > 0.05). Pathologic complete response was significantly higher in chemoradiation group (P = 0.004). According to the result of this study, it seems that NAIC and chemoradiation had similar effects in survival prognostic factors.

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