Objective. At present, cervical cancer remains the only gynecologic tumor, which is staged by clinical examination according to FIGO. This is associated with a high percentage of over-and understaging of tumor extent....Objective. At present, cervical cancer remains the only gynecologic tumor, which is staged by clinical examination according to FIGO. This is associated with a high percentage of over-and understaging of tumor extent. With the operative, especially laparoscopic staging, exact information about intraabdominal tumor spread, lymph node metastases, and involvement of adjacent organs is possible. However, the advantage of operative staging is still discussed controversially. The aim of this study is to describe the laparoscopic transperitoneal staging procedure in patients with cervical cancer and their oncologic outcome after primary chemoradiation. Methods. From November 1994 to October 2003, 456 consecutive patients with histologically confirmed primary cervical cancer were admitted to the Department of Gynecology of the Friedrich-Schiller-Univer-sity Jena, Germany. Out of these, 84 patients with locally advanced tumor (tumor size ≥4 cm) and/or lymph node involvement and/or tumor infiltration to bladder or rectum were selected by a standardized laparoscopic staging procedure for primary chemoradiation. Data of surgery, chemoradiation, and follow-up were analyzed retrospectively for these patients. Results. The mean age of the patients was 54 years (26-80), and the mean body-mass-index was 24.8 (17.9-42.2). Preoperative clinical evaluation showed a stage distribution according to FIGO with stage IB1 in 15.5%, IB2 in 15.5%, IIA in 8.3%, IIB in 23.8%, IIIA in 8.3%, IIIB in 21.4%, IVA in 6%, and IVB in 1.2%. In 15 out of 84 (17.8%) patients, intraabdominal tumor spread was diagnosed by laparascopy. In 24 out of 84 (28.5%) patients, invasion of bladder and/or rectum was proven histologically after biopsy. In 60 out of 84 (71%) patients, lymph node metastases were confirmed histologically. In 2 out of 13 patients with FIGO-stage Ib1, skip metastases in infrarenal para-aortic lymph nodes were seen. Removal of more than 5 pelvic and/or more than 5 positive para-aortic lymph nodes was associated with significant improvement of overall survival. According to the histological findings following laparoscopic staging in 36 out of 84 (43%) patients, a higher tumor stage was diagnosed. If tumor involvement of lymph nodes is also included, an upstaging in 73/84 (87%) of patients has to be noted down. Downstaging was not necessary in any patient following laparoscopic evaluation. Conclusion. Only operative staging gives exact information about tumor extension in patients with locally advanced and/or nodal positive cervical cancer and allows individual treatment planning. This can be done successfully by a transperitoneal laparoscopic approach without serious adverse effects delaying chemoradiation. Debulking of tumor-involved lymph nodes significantly improves overall survival and should be performed prior to primary chemoradiation. Laparoscopic staging should be the basis for all treatment studies in order to group patients according to true tumor extent.展开更多
Objective: Axis and support of the vagina can be restored by sacrocolporectopexy with preservation of coital function. We developed a new technique of transvaginal sacrocolporectopexy for patients with prolapse of ute...Objective: Axis and support of the vagina can be restored by sacrocolporectopexy with preservation of coital function. We developed a new technique of transvaginal sacrocolporectopexy for patients with prolapse of uterus and vagina or prolapse of the vaginal vault. Study design: During a 4-year period, 20 patients with vaginal vault prolapse and 83 patients with uterine and vaginal prolapse underwent transvaginal sacrocolporectopexy. Intra-and post-operative complications were recorded. After a mean follow-up period of 24 months (6-48), the result of surgery with respect to prolapse, incontinence, and sexuality was evaluated by patient interviews. Results: No serious perioperative complications occurred with the exception of one patient with bleeding from a presacral vein. Subjectively, 84 patients (82%) were cured of prolapse symptoms. One patient had recurrent grade II vault prolapse and four patients deve-loped a grade II rectocele. Five patients developed urge incontinence grade I. One patient developed fecal incontinence. No patient had coital problems as a sequelae of sacrocolporectopexy. Conclusion: Transvaginal sacrocolporectopexy is a safe procedure with a success rate comparable to sacrospinous fixation.展开更多
Radical trachelectomy in combination with pelvic and parametric lymphadenectomy is indicated in young patients with early cervical cancer and planned pregnancy. If pregnancy occurs, premature delivery is a known probl...Radical trachelectomy in combination with pelvic and parametric lymphadenectomy is indicated in young patients with early cervical cancer and planned pregnancy. If pregnancy occurs, premature delivery is a known problem in these patients. We evaluated if uterine blood supply is decreased after radical trachelectomy as one of various possible causes of preterm birth. Between October 2003 and April 2004, 14 consecutive patients with early cervical cancer underwent radical trachelectomy with pelvic and parametric lymphadenectomy. The uterine blood supply was measured as resistance index (RI) by Doppler sonography pre- and postoperatively. Doppler sonography of the uterine artery was also performed in 14 healthy students as a control cohort. Fourteen patients with histologically confirmed adenocarcinoma or squamous carcinoma of the cervix uteri stage Ia1 L1 to 1b1 underwent radical trachelectomy. Mean age of patients was 33.4 years (31- 37). On average, 11.5 mm (5- 23) of cervical length and 24.6 (14- 35) tumor- free lymph nodes were removed. Decrease of RI of the uterine artery was 0.06 on the right side (0.76- 0.70) and 0.07 (0.75- 0.68) on the left side. The absolute RI values after radical trachelectomy were not different compared to the values in the control group (0.76 versus 0.70 right side, 0.74 versus 0.68 left side). Uterine perfusion after radical trachelectomy with pelvic and parametric lymphadenectomy remains unchanged.展开更多
文摘Objective. At present, cervical cancer remains the only gynecologic tumor, which is staged by clinical examination according to FIGO. This is associated with a high percentage of over-and understaging of tumor extent. With the operative, especially laparoscopic staging, exact information about intraabdominal tumor spread, lymph node metastases, and involvement of adjacent organs is possible. However, the advantage of operative staging is still discussed controversially. The aim of this study is to describe the laparoscopic transperitoneal staging procedure in patients with cervical cancer and their oncologic outcome after primary chemoradiation. Methods. From November 1994 to October 2003, 456 consecutive patients with histologically confirmed primary cervical cancer were admitted to the Department of Gynecology of the Friedrich-Schiller-Univer-sity Jena, Germany. Out of these, 84 patients with locally advanced tumor (tumor size ≥4 cm) and/or lymph node involvement and/or tumor infiltration to bladder or rectum were selected by a standardized laparoscopic staging procedure for primary chemoradiation. Data of surgery, chemoradiation, and follow-up were analyzed retrospectively for these patients. Results. The mean age of the patients was 54 years (26-80), and the mean body-mass-index was 24.8 (17.9-42.2). Preoperative clinical evaluation showed a stage distribution according to FIGO with stage IB1 in 15.5%, IB2 in 15.5%, IIA in 8.3%, IIB in 23.8%, IIIA in 8.3%, IIIB in 21.4%, IVA in 6%, and IVB in 1.2%. In 15 out of 84 (17.8%) patients, intraabdominal tumor spread was diagnosed by laparascopy. In 24 out of 84 (28.5%) patients, invasion of bladder and/or rectum was proven histologically after biopsy. In 60 out of 84 (71%) patients, lymph node metastases were confirmed histologically. In 2 out of 13 patients with FIGO-stage Ib1, skip metastases in infrarenal para-aortic lymph nodes were seen. Removal of more than 5 pelvic and/or more than 5 positive para-aortic lymph nodes was associated with significant improvement of overall survival. According to the histological findings following laparoscopic staging in 36 out of 84 (43%) patients, a higher tumor stage was diagnosed. If tumor involvement of lymph nodes is also included, an upstaging in 73/84 (87%) of patients has to be noted down. Downstaging was not necessary in any patient following laparoscopic evaluation. Conclusion. Only operative staging gives exact information about tumor extension in patients with locally advanced and/or nodal positive cervical cancer and allows individual treatment planning. This can be done successfully by a transperitoneal laparoscopic approach without serious adverse effects delaying chemoradiation. Debulking of tumor-involved lymph nodes significantly improves overall survival and should be performed prior to primary chemoradiation. Laparoscopic staging should be the basis for all treatment studies in order to group patients according to true tumor extent.
文摘Objective: Axis and support of the vagina can be restored by sacrocolporectopexy with preservation of coital function. We developed a new technique of transvaginal sacrocolporectopexy for patients with prolapse of uterus and vagina or prolapse of the vaginal vault. Study design: During a 4-year period, 20 patients with vaginal vault prolapse and 83 patients with uterine and vaginal prolapse underwent transvaginal sacrocolporectopexy. Intra-and post-operative complications were recorded. After a mean follow-up period of 24 months (6-48), the result of surgery with respect to prolapse, incontinence, and sexuality was evaluated by patient interviews. Results: No serious perioperative complications occurred with the exception of one patient with bleeding from a presacral vein. Subjectively, 84 patients (82%) were cured of prolapse symptoms. One patient had recurrent grade II vault prolapse and four patients deve-loped a grade II rectocele. Five patients developed urge incontinence grade I. One patient developed fecal incontinence. No patient had coital problems as a sequelae of sacrocolporectopexy. Conclusion: Transvaginal sacrocolporectopexy is a safe procedure with a success rate comparable to sacrospinous fixation.
文摘Radical trachelectomy in combination with pelvic and parametric lymphadenectomy is indicated in young patients with early cervical cancer and planned pregnancy. If pregnancy occurs, premature delivery is a known problem in these patients. We evaluated if uterine blood supply is decreased after radical trachelectomy as one of various possible causes of preterm birth. Between October 2003 and April 2004, 14 consecutive patients with early cervical cancer underwent radical trachelectomy with pelvic and parametric lymphadenectomy. The uterine blood supply was measured as resistance index (RI) by Doppler sonography pre- and postoperatively. Doppler sonography of the uterine artery was also performed in 14 healthy students as a control cohort. Fourteen patients with histologically confirmed adenocarcinoma or squamous carcinoma of the cervix uteri stage Ia1 L1 to 1b1 underwent radical trachelectomy. Mean age of patients was 33.4 years (31- 37). On average, 11.5 mm (5- 23) of cervical length and 24.6 (14- 35) tumor- free lymph nodes were removed. Decrease of RI of the uterine artery was 0.06 on the right side (0.76- 0.70) and 0.07 (0.75- 0.68) on the left side. The absolute RI values after radical trachelectomy were not different compared to the values in the control group (0.76 versus 0.70 right side, 0.74 versus 0.68 left side). Uterine perfusion after radical trachelectomy with pelvic and parametric lymphadenectomy remains unchanged.
