To describe the feasibility and results of total laparoscopic radical hysterec tomy with intraoperative sentinel lymph node identification in patients with ear ly cervical cancer. Between March 2001 and October 2003, ...To describe the feasibility and results of total laparoscopic radical hysterec tomy with intraoperative sentinel lymph node identification in patients with ear ly cervical cancer. Between March 2001 and October 2003, 12 patients with FIGO s tage IA2 (n = 1)or IB1 (n = 11) cancer of the cervix underwent surgical treatmen t through the laparoscopic route. All patients underwent a laparoscopic sentinel node identification with preoperative lymphoscintigraphy (technetium-99 m coll oid albumin injection around the tumor) and intraoperative lymphatic mapping wit h isosulfan blue dye and a laparoscopic gamma probe followed by systematic bilat eral pelvic lymphadenectomy and laparoscopic type II (n = 5) or type III (n = 7) hysterectomy. A mean of 2.5 sentinel nodes per patient (range 1-4) was detecte d, with a mean of 2.33 nodes per patient by gamma probe and a mean of 2 per pati ent after blue injection (combined detection rate 100%). The most frequent loca lization of the nodes was the interiliac region. Histopathologic examination of sentinel nodes including cytokeratin immunohistochemical analysis did not show m etastasis. Microscopic nodal metastases were not found. The mean number of resec ted pelvic nodes was 18.6 per patient (range 10-28). The operation was performe d entirely by laparoscopy in all patients and no case of laparotomy conversion w as recorded. The mean duration of operation was 271 min (range 235-300), with a mean blood loss of 445 mL (range 240-800), and a mean length of stay of 5.25 d ays (range 3-10). No major intraoperative complications occurred. After a media n follow-up of 20 months (range 5-34), all patients are free of disease. This study shows the feasibility of the combination of laparoscopic intraoperative se ntinel node mapping and laparoscopic radical surgery in the context of minimally invasive surgery for the management of patients with early cervical cancer.展开更多
. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy.... In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995- 2004, 6 of our patients underwent LPUV including 5 patients with stage Ib1 cervical cancer and one patient with Ia1 cervical cancer. Prior procedures were TVH (n = 3), TAH (n = 2) or LAVH (n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38- 49) years and Quetelet index was 31.5 (25- 40) kg/m2. Average time from hysterectomy to LPUV was 54 (30- 84) days. Retrospective FIGO staging revealed stage Ib1 (n = 5) and stage Ia1 (n = 1) cervical cancer. Mean duration of surgery was 207 (151- 265) min, average blood loss 300 (100- 500)mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10- 36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs postoperative was 6.4 (0.2- 10.9) % . There were no further postoperative complications during the average hospital stay of 3.5 (2- 5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (350) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.展开更多
文摘To describe the feasibility and results of total laparoscopic radical hysterec tomy with intraoperative sentinel lymph node identification in patients with ear ly cervical cancer. Between March 2001 and October 2003, 12 patients with FIGO s tage IA2 (n = 1)or IB1 (n = 11) cancer of the cervix underwent surgical treatmen t through the laparoscopic route. All patients underwent a laparoscopic sentinel node identification with preoperative lymphoscintigraphy (technetium-99 m coll oid albumin injection around the tumor) and intraoperative lymphatic mapping wit h isosulfan blue dye and a laparoscopic gamma probe followed by systematic bilat eral pelvic lymphadenectomy and laparoscopic type II (n = 5) or type III (n = 7) hysterectomy. A mean of 2.5 sentinel nodes per patient (range 1-4) was detecte d, with a mean of 2.33 nodes per patient by gamma probe and a mean of 2 per pati ent after blue injection (combined detection rate 100%). The most frequent loca lization of the nodes was the interiliac region. Histopathologic examination of sentinel nodes including cytokeratin immunohistochemical analysis did not show m etastasis. Microscopic nodal metastases were not found. The mean number of resec ted pelvic nodes was 18.6 per patient (range 10-28). The operation was performe d entirely by laparoscopy in all patients and no case of laparotomy conversion w as recorded. The mean duration of operation was 271 min (range 235-300), with a mean blood loss of 445 mL (range 240-800), and a mean length of stay of 5.25 d ays (range 3-10). No major intraoperative complications occurred. After a media n follow-up of 20 months (range 5-34), all patients are free of disease. This study shows the feasibility of the combination of laparoscopic intraoperative se ntinel node mapping and laparoscopic radical surgery in the context of minimally invasive surgery for the management of patients with early cervical cancer.
文摘. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995- 2004, 6 of our patients underwent LPUV including 5 patients with stage Ib1 cervical cancer and one patient with Ia1 cervical cancer. Prior procedures were TVH (n = 3), TAH (n = 2) or LAVH (n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38- 49) years and Quetelet index was 31.5 (25- 40) kg/m2. Average time from hysterectomy to LPUV was 54 (30- 84) days. Retrospective FIGO staging revealed stage Ib1 (n = 5) and stage Ia1 (n = 1) cervical cancer. Mean duration of surgery was 207 (151- 265) min, average blood loss 300 (100- 500)mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10- 36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs postoperative was 6.4 (0.2- 10.9) % . There were no further postoperative complications during the average hospital stay of 3.5 (2- 5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (350) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.
