Radical Hysterectomy in Cervical Cancer: Patients’ Epidemiological and Clinical Profiles and Perioperative Outcome in Two Referral Hospitals in Cameroon

Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.

Total Laparoscopic Radical Hysterectomy for Treatment of Uterine Malignant Tumors:Analysis of Short-term Therapeutic Efficacy

To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraoperative and postoperative complications.The procedure was completed laparoscopically in 108 patients.Two patients were converted to laparotomy due to common iliac vein injury.The mean overall operative time was 200.6±38.6 min;the mean operative blood loss was 280.5±128.3 mL;the mean number of pelvic lymph nodes that were resected was 26.0±5.8.The time for recovery of normal temperature and the normal bladder function after the operation was 5.8±2.9 d and 15.2±4.3 d.There were 2(1.8%) common iliac vein injuries during the operation and 10(9.1%) bladder retentions post operation.It was concluded that TLRH is feasible,minimally invasive and provides promise for the treatment of uterine malignancies.

Progress on the Prevention and Nursing of Urinary Tract Infection Associated with Radical Hysterectomy and Pelvic Lymphadenectomy

Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.

Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer

Background:After radical hysterectomy for cervical cancer,the most common complication is lower urinary tract symptoms.Post-operatively,bladder capacity can alter bladder function for a prolonged period.This study aimed to identify factors affecting bladder storage function.Methods:A multicenter,retrospective cohort study was conducted.Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria.Demographic,surgical,and oncological data were collected.The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively.Ninety-five(46.8%)patients were diagnosed with stress urinary incontinence(SUI).The incidence of low bladder compliance(LBC)was 23.2%.Twenty-seven(13.3%)patients showed detrusor overactivity(DO).Fifty-seven patients(28.1%)presented with a decreased maximum cystometric capacity(DMCC).The probability of composite bladder storage dysfunction was 68.0%.Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498(P=0.034).Patients who underwent a nerve-sparing procedure were less odds to experience SUI(P=0.014).A significant positive correlation between LBC and DO was observed(P<0.001).A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO,while radiotherapy exerted a stronger effect than chemotherapy.Additionally,patients who received chemoradiotherapy frequently developed a DMCC.The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.

Comparison of two methods for evaluating lower urinary tract symptoms in cervical cancer patients following radical hysterectomy

Objective:To compare the degree of agreement and consistency of urodynamic studies(UDS)with low urinary tract symptoms(LUTS)questionnaires for evaluating LUTS in cervical cancer patients following radical hysterectomy(RH)and pelvic lymphadenectomy.Methods:From January 2012 to March 2015,204 cervical cancer patients who underwent RH in 13 hospitals were evaluated using the Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS)and the Overactive Bladder Symptom Score(OABSS).Urodynamic tests were also performed on these patients during the same period.Results:Study participants’age ranged from 23 to 75 years,with a mean(standard deviation)of 48.0±9.3 years.Using questionnaires,the prevalence of patients with LUTS symptoms,including storage symptoms,voiding symptoms,stress urinary incontinence(SUI)and overactive bladder(OAB)was 86.3%,77.0%,62.7%,52.9%and 14.7%,respectively.For UDS,the corresponding prevalence was 89.7%,70.1%,66.7%,46.6%and 13.2%,respectively.The diagnostic concordance of questionnaires and UDS for storage symptoms,voiding symptoms,SUI and OAB was 79.9%,66.7%,66.7%,57.4%and 79.9%,respectively.For voiding symptoms,the correlation coefficient was 0.272,which was higher than that of storage symptoms,SUI and OAB.

Radical Vaginal Hysterectomy and Trachelectomy in Early-Stage Cervical Cancer

Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 5 years in both hospitals, are presented. Laparoscopic systemic pelvic lymphadenectomy with radical vaginal hysterectomy or radical vaginal trachelectomy was performed to patients, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: Between April 2008 and May 2013, 110 patients were submitted to this technique. 15 patients had their surgery aborted: 13 presented positive nodes for carcinoma in contemporary biopsy and 2 had extensive cervical compromise when performing radical vaginal hysterectomy or trachelectomy. Analysis of the remaining 95 cases shows an average age of 43.9 years (26 - 61), all of them had given birth before, 23 (21%) of them through C-section. BMI averaged 30.5 and 31 (28.2%) had cone surgery performed previously. Average duration of surgery was of 220 minutes. Postoperative hospitalization averaged 3.1 days. Bleeding volume was estimated at 125 cc and one patient required blood transfusion. En 25 patients’ uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 25.4 pelvic nodes were obtained. Complications 13.6% with eight patients suffered bladder injury, two had rectovaginal fistula, 3 patients requires surgical repair of ureteral obstruction, two patients present thromboembolic disease. The disease-free and overall survivals are consistent with reports in the literature. Conclusion: We believe that handling patients with this technique is possible and has the advantages of vaginal and laparoscopic surgery with minimal complications.

Different strategies of treatment for uterine cervical carcinoma stage ⅠB2-ⅡB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.

Separate lateral parametrial lymph node dissection improves detection rate of parametrial lymph node metastasis in early-stage cervical cancer: 10-year clinical evaluation in a single center in China

Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.

Locally advanced cervical rhabdomyosarcoma in adults:A case report

BACKGROUND Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin,occurring predominantly in children and adolescents,but extremely rare in adults and the data regarding its treatment are sparse.Here,we would like to share our experience in the treatment of a locally advanced primary embryonal rhabdomyosarcoma of cervix in a 39-year-old female.CASE SUMMARY The patient was admitted with symptoms of intermenstrual bleeding and postcoital bleeding for six months.Physical examination revealed a friable,polyplike mass(5 cm×5 cm)in her cervix protruding into the vagina,while the uterus was mobile and normal-sized.Colposcopy-directed biopsy was performed,and a pathological diagnosis of embryonal rhabdomyosarcoma was made.Magnetic resonance imaging of the pelvis showed that the cervical volume was significantly increased,with a hypointense and hyperintense soft tissue mass on the right side,invading the cervical stroma;the mass was 5 cm×5 cm with a clear boundary and confined to the cervix;there were no obvious findings indicating tumor invasion in the vaginal wall,parametrium,or pelvic wall;no enlarged lymph nodes were observed in the pelvic cavity.Based on our findings,the tumor was classified as stage IA according to the intergroup rhabdomyosarcoma studies criteria and IB3stage according to The International Federation of Gynecology and Obstetrics 2018.The patient underwent two courses of neoadjuvant chemotherapy and a partial remission was achieved.Subsequently,she underwent laparoscopic radical hysterectomy,bilateral salpingo-oophrectomy and pelvic lymph node dissection and there were no risk factors revealed by postoperative pathological examination.Adjuvant chemotherapy was performed after surgery.The patient was disease-free until the last follow-up,49 mo after completing the entire treatment.CONCLUSION Our experience suggests that neoadjuvant vincristine,dactinomycin,and cyclophosphamide chemotherapy followed by radical surgery and adjuvant chemotherapy might be reasonable therapeutic option for bulky cervical rhabdomyosarcoma in adults without fertility desire.Since large-scale studies on such rare conditions are rather impossible,further case reports and systematic reviews could help optimize the treatment of primary,bulky cervical rhabdomyosarcoma in adults.

针刺对360例子宫全切术后患者膀胱功能影响分析

Objective:To analysis the clinical curative effect on bladder function recovery after radical hysterectomy with acupuncture and acu-physiotherapy.Methods:A total of 564 cervical cancer patients in the gynecology department who received radical hysterectomy from January 2011 to December 2017 in Qilu Hospital of Shandong University were collected.According to the inclusion and exclusion criteria,we studied 360 case records at last,with 120 cases respectively.Patients got treatment of acupuncture[acupuncture at Zhongwan(中脘CV12),Tianshu(天枢ST25),Shuidao(水道ST28),TAichong(太冲LI3),Sanyinjiao(三阴交SP6),Zusanli(足三里ST36)and Yinlingquan(阴陵泉SP9)],or acu-physiotherapy with two large-size electrodes placed on the bladder area above the pubic symphysis besides acupuncture,from the 3 rd day after operation once a day till the14 th day that removing the indwelling catheter.And the blank group got no other auxiliary treatment except scrubbed the meatus orifice with iodophor twice a day.We tested the residual urine volume 6 h later after removement of indwelling catheter.Residual urine volume more than 100 mL was defined as urinary retention,and the volume less than 50 mL was defined as adequate bladder emptying.Results:We analyzed patients’age,the International Federation of Gynecology and Obstetrics(FIGO)stage,operation duration,amount of hemorrhage,depth of myometrium infiltration,cancer embolus,parametrium invasion,lymphatic metastasis,treating methods and residual urine volume recorded in case records,and there was no significant difference between every two groups(P>0.05).The incidences of urinary retention of the acupuncture group,the acu-physiotherapy group and the blank group were 24.17%,21.67%,and 44.17%,indicating that both treating methods have significant effects(P<0.05),and acupuncture group was a little better than acu-physiotherapy group.The bladder function recovery rates of the 3 groups were 44.17%,56.67%,and 40.83%correspondingly,which had significant difference between acu-physiotherapy group and blank group(P<0.05).Both acupuncture and acu-physiotherapy could reduce the incidence of urinary retention for the patients of Ibl and IIal stages(P<0.01),whilst for patients of Ib2 and IIa2 stages,neither of the two methods was effective(P>0.05).Conclusion:Both acupuncture and acu-physiotherapy could prevent urinary retention after radical hysterectomy for local early cervical cancer(Ibl and IIal stages)effectively,and acupuncture was a little more effective than acu-physiotherapy group.Acupuncture together with modulated medium frequency eletro-therapy could improve the cure rate of bladder function and minimize the residual urine volume.

Surgical route and pathological risk factors in early cervical cancer-Node Zero(SURPEC-N0)

Aim:The aim of this study is to compare disease-free survival(DFS)and overall survival(OS)in patients with stage I cervical cancer(≤4cms,lymph node-negative)undergoing open radical hysterectomy(ORH)vs.minimally invasive radical hysterectomy(MIRH).Methods:All patients undergoing radical hysterectomy between January 2012-December 2018 from the largest tertiary referral cancer centre were included.A 1:1 propensity matching was done based on four independent prognostic factors to compare DFS and OS with the route of surgery.Results:One hundred and ninety-nine patients were included during the study period.The median age of the cohort was 50 years.The median follow-up of patients was 47 months.Following 1:1 propensity matching,a total of 174 patients were analysed for DFS and OS in ORH(n=87)and MIRH(n=87)groups.Protective measure was used in two-thirds of the patients during MIRH.Twenty-nine patients(16.7%)had recurrences.For the matched cohort(n=174),the DFS at 36 and 60 months was 84.8%(78.1%-89.6%)and 81%(73.4%-86.6%)respectively and the OS was 96.5%(91.7%-98.5%)and 95.6%(90.3%-98%)respectively.There was no statistically significant difference in DFS or OS between ORH and MIRH.Conclusion:The present study showed no difference in oncological outcomes in MIRH compared to ORH.Retrospective audits on patient characteristics such as screening/vaccination history along with surgical technique/load and matching for crucial risk factors should be factored in future studies to eliminate the possible methodological errors.

Cancer field surgery for locoregional tumor control of cervical carcinoma

As the current standard,surgery is applied to treat early-stage cervical cancer and selected post-irradiation pelvic relapses.Surgical therapy for local disease is based on a model of unlimited isotropic cancer cell propagation and dissection artifacts such as subperitoneal“ligaments”and“spaces”.For regional disease,the role of traditional surgery is diagnostic and eventually cytoreductive.However,the isotropic local tumor propagation model has to be rejected due to numerous inconsistencies with clinical facts.Likewise,the“ligament and space”approach to the subperitoneum is too crude and variable to accurately cover both local spread and intercalated lymph node metastases of cervical cancer.The ontogenetic cancer field model is fully in line with the locoregional spread patterns of carcinoma of the female genital tract.Developmentally derived(ontogenetic)anatomy enables unbiased and accurate dissection of the complex tissue structures within the subperitoneum.Cancer field surgery founded on these insights has a high potential to improve the treatment outcome of cervical carcinoma.