Objective.:To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. Methods.:We performed a retrospective review of all patients who underwent a total l...Objective.:To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. Methods.:We performed a retrospective review of all patients who underwent a total laparoscopic radical hysterectomy at our institution between May 2004 and August 2005. Data collected included age,body mass index,stage,histopathologic subtype,tumor grade,estimated blood loss,perioperative blood transfusions,number and status of lymph nodes obtained,status of surgical margins,length of hospital stay,time to resumption of normal bladder function,intraoperative and postoperative complications,and disease-free interval. Results.:Twenty patients underwent total laparoscopic radical hysterectomy during the study period. None of the surgeries required conversion to laparotomy. The median patient age was 41.5 years (range,25-76). Eighteen patients had cervix cancer (5 stage IA2 and 13 stage IB1),and 2 had endometrial cancer (1 stage IB and 1 stage IIIA). Among those with cervix cancer,12 had adenocarcinoma,4 squamous cell carcinoma,and 2 adenosquamous carcinoma. The median weight was 70 kg (range,49-112). The median number of resected pelvic lymph nodes was 13 (range,9-26). One patient had nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 200 ml (range,25-700 ml). Only 1 patient required an intraoperative blood transfusion (1 U packed red blood cells). The median length of hospital stay was 1 day (range,1-5). There were 3 short-term complications-unintentional cystotomy,pulmonary embolus,and pneumomediastinum with subcutaneous emphysema. There were 2 long-term complications-vaginal eviscerations and a lymphocyst. The median time to resumption of normal bladder function was 16 days (range,13-29). The median follow-up time was 8 months range (1-16). All patients remain free of disease at the time of this report. Conclusions.:Total laparoscopic radical hysterectomy can be performed safely with minimal blood loss and postoperative morbidity,and patients undergoing this proceduremay be discharged after an overnight stay in the hospital.展开更多
PURPOSE: If it were possible to identify the features of primary colorectal carcinoma that were associated with liver metastasis, these features could be used as predictors of liver metastasis. METHODS: From January 1...PURPOSE: If it were possible to identify the features of primary colorectal carcinoma that were associated with liver metastasis, these features could be used as predictors of liver metastasis. METHODS: From January 1995 to December 1997, 648 consecutive cases of colorectal carcinoma were recorded at the Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. We evaluated clinicopathologic and immunohistochemical factors (age, gender, tumor location, gross type, size, histologic type, dedifferentiation of invasive front, depth of invasion, lymphatic invasion, venous invasion, lymph-node metastasis, and expression of CD10, MUC2, and human gastric mucin) in 505 of these patients who had undergone resection of T2/T3/T4 colorectal carcinomas to clarify the correlation between these factors and liver metastasis. RESULTS: Liver metastases, including unresectable, were detected in 122 patients (24 percent), all of whom had been followed for at least five years. Univariate analysis revealed that liver metastasis was significantly associated with tumor size, histologic type, dedifferentiation of invasive front, depth of invasion, lymphatic invasion, venous invasion, lymph-node metastasis, and CD10 expression. Multivariate analysis revealed that invasion deeper than the subserosa, venous invasion, lymph-node metastasis, and CD10 expression were significantly associated with liver metastases. CONCLUSIONS: CD10 expression in colorectal carcinoma is a good predictor of liver metastasis.展开更多
Background.: Central nervous system(CNS) metastases from cervical carcinoma are uncommon events. Leptomeningeal involvement from cervical squamous cell carcinoma has not been extensively described. Case.: A 43-year-ol...Background.: Central nervous system(CNS) metastases from cervical carcinoma are uncommon events. Leptomeningeal involvement from cervical squamous cell carcinoma has not been extensively described. Case.: A 43-year-old woman with initial diagnosis of stage IB squamous cervical carcinoma at age 30 was treated with hysterectomy and left salpingo-oophorectomy. She recurred with nodal disease at age 39 and went into a clinical com-plete remission after chemotherapy and radiation treatment. Three years later, she presented with symptoms of optic neuropathy. Cerebral spinal fluid(CSF) was positive for squamous cells consistent with primary cervical squamous cell carcinoma. No measurable disease was evident outside of the CNS. Conclusion.: Meningeal carcinomatosis from cervical squamous cell carcinoma involving optic nerves has not been reported. Rapid progression of this patient’s CNS metastatic disease suggests this form of metastases may be more aggressive and carry extremely poor prognosis.展开更多
To describe our experience with the sentinel lymph node biopsy in cervical cancer patients, using a laparotomic approach and blue dye technique. Methods. Between January 2003 and January 2005, patients with histologic...To describe our experience with the sentinel lymph node biopsy in cervical cancer patients, using a laparotomic approach and blue dye technique. Methods. Between January 2003 and January 2005, patients with histologically proven FIGO stage IA2 to IIA carcinoma of the uterine cervix were submitted to SLN procedure if they were scheduled to have radical abdominal hysterectomy and pelvic lymphadenectomy. The SLN mapping was done after intracervical methylene blue (4 ml) injection. Final pathologic evaluation of SLNs included serial step sections and wide spectrum cytokeratin immunohistochemical analysis. Results. Fifty patients were accrued to this prospective observational double-center study. A total of 86 SLNs (mean 1.9) were identified in the 45 patients with fruitful quest for SLN detection. The SLN detection rate per patient was 90% , and for the side of dissection, 72% . Bilateral SLNs were detected in 60% of cases. SLNs were identified in the external iliac and obturator areas in 55% and 38% , respectively; 5 isolated SLNs were discovered in the common iliac region. Ten patients (20% ) had lymph node metastases; one of these had false-negative SLN. The false-negative rate and the negative predictive value, calculated by patient and by side of dissection, were 10% and 97.2% , and 8.3% and 98.4% , respectively. Conclusions. SLN detection with blue dye is a feasible procedure, particularly useful as a surgical staging procedure in young patients with small tumors. The true morbidity-sparing role of this technique in cervical cancer treatment is yet to be found.展开更多
文摘Objective.:To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. Methods.:We performed a retrospective review of all patients who underwent a total laparoscopic radical hysterectomy at our institution between May 2004 and August 2005. Data collected included age,body mass index,stage,histopathologic subtype,tumor grade,estimated blood loss,perioperative blood transfusions,number and status of lymph nodes obtained,status of surgical margins,length of hospital stay,time to resumption of normal bladder function,intraoperative and postoperative complications,and disease-free interval. Results.:Twenty patients underwent total laparoscopic radical hysterectomy during the study period. None of the surgeries required conversion to laparotomy. The median patient age was 41.5 years (range,25-76). Eighteen patients had cervix cancer (5 stage IA2 and 13 stage IB1),and 2 had endometrial cancer (1 stage IB and 1 stage IIIA). Among those with cervix cancer,12 had adenocarcinoma,4 squamous cell carcinoma,and 2 adenosquamous carcinoma. The median weight was 70 kg (range,49-112). The median number of resected pelvic lymph nodes was 13 (range,9-26). One patient had nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 200 ml (range,25-700 ml). Only 1 patient required an intraoperative blood transfusion (1 U packed red blood cells). The median length of hospital stay was 1 day (range,1-5). There were 3 short-term complications-unintentional cystotomy,pulmonary embolus,and pneumomediastinum with subcutaneous emphysema. There were 2 long-term complications-vaginal eviscerations and a lymphocyst. The median time to resumption of normal bladder function was 16 days (range,13-29). The median follow-up time was 8 months range (1-16). All patients remain free of disease at the time of this report. Conclusions.:Total laparoscopic radical hysterectomy can be performed safely with minimal blood loss and postoperative morbidity,and patients undergoing this proceduremay be discharged after an overnight stay in the hospital.
文摘PURPOSE: If it were possible to identify the features of primary colorectal carcinoma that were associated with liver metastasis, these features could be used as predictors of liver metastasis. METHODS: From January 1995 to December 1997, 648 consecutive cases of colorectal carcinoma were recorded at the Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. We evaluated clinicopathologic and immunohistochemical factors (age, gender, tumor location, gross type, size, histologic type, dedifferentiation of invasive front, depth of invasion, lymphatic invasion, venous invasion, lymph-node metastasis, and expression of CD10, MUC2, and human gastric mucin) in 505 of these patients who had undergone resection of T2/T3/T4 colorectal carcinomas to clarify the correlation between these factors and liver metastasis. RESULTS: Liver metastases, including unresectable, were detected in 122 patients (24 percent), all of whom had been followed for at least five years. Univariate analysis revealed that liver metastasis was significantly associated with tumor size, histologic type, dedifferentiation of invasive front, depth of invasion, lymphatic invasion, venous invasion, lymph-node metastasis, and CD10 expression. Multivariate analysis revealed that invasion deeper than the subserosa, venous invasion, lymph-node metastasis, and CD10 expression were significantly associated with liver metastases. CONCLUSIONS: CD10 expression in colorectal carcinoma is a good predictor of liver metastasis.
文摘Background.: Central nervous system(CNS) metastases from cervical carcinoma are uncommon events. Leptomeningeal involvement from cervical squamous cell carcinoma has not been extensively described. Case.: A 43-year-old woman with initial diagnosis of stage IB squamous cervical carcinoma at age 30 was treated with hysterectomy and left salpingo-oophorectomy. She recurred with nodal disease at age 39 and went into a clinical com-plete remission after chemotherapy and radiation treatment. Three years later, she presented with symptoms of optic neuropathy. Cerebral spinal fluid(CSF) was positive for squamous cells consistent with primary cervical squamous cell carcinoma. No measurable disease was evident outside of the CNS. Conclusion.: Meningeal carcinomatosis from cervical squamous cell carcinoma involving optic nerves has not been reported. Rapid progression of this patient’s CNS metastatic disease suggests this form of metastases may be more aggressive and carry extremely poor prognosis.
文摘To describe our experience with the sentinel lymph node biopsy in cervical cancer patients, using a laparotomic approach and blue dye technique. Methods. Between January 2003 and January 2005, patients with histologically proven FIGO stage IA2 to IIA carcinoma of the uterine cervix were submitted to SLN procedure if they were scheduled to have radical abdominal hysterectomy and pelvic lymphadenectomy. The SLN mapping was done after intracervical methylene blue (4 ml) injection. Final pathologic evaluation of SLNs included serial step sections and wide spectrum cytokeratin immunohistochemical analysis. Results. Fifty patients were accrued to this prospective observational double-center study. A total of 86 SLNs (mean 1.9) were identified in the 45 patients with fruitful quest for SLN detection. The SLN detection rate per patient was 90% , and for the side of dissection, 72% . Bilateral SLNs were detected in 60% of cases. SLNs were identified in the external iliac and obturator areas in 55% and 38% , respectively; 5 isolated SLNs were discovered in the common iliac region. Ten patients (20% ) had lymph node metastases; one of these had false-negative SLN. The false-negative rate and the negative predictive value, calculated by patient and by side of dissection, were 10% and 97.2% , and 8.3% and 98.4% , respectively. Conclusions. SLN detection with blue dye is a feasible procedure, particularly useful as a surgical staging procedure in young patients with small tumors. The true morbidity-sparing role of this technique in cervical cancer treatment is yet to be found.
