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Park JY. Is it time to change surgery for early-stage low-risk cervical cancer to simple hysterectomy? J Gynecol Oncol 2024; 35:e47. [PMID: 38425138 PMCID: PMC10948992 DOI: 10.3802/jgo.2024.35.e47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Wang L, Liu P, Duan H, Li P, Su G, Li W, Liang C, Chen C. Abdominal type B vs. type C radical hysterectomy in early-stage cervical cancer: A matched single center cohort report. Front Surg 2023; 10:1166084. [PMID: 37123543 PMCID: PMC10130524 DOI: 10.3389/fsurg.2023.1166084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To compare survival outcomes of type B radical hysterectomy (RH) and type C RH in patients with early-stage cervical cancer. Methods We retrospectively identified continuous cervical cancer patients with FIGO stage IA2-IB2 and IIA1 who underwent either type B RH (n = 278) or type C RH (n = 148) performed by the same group of surgeons between 2009 and 2018. Propensity score matching was carried out to minimize selection biases. Intraoperative photographs, immediate postoperative questionnaire and specimen measurements were used to accurately determine the extensive of surgery. We further narrowed the study population to patients with specific histological subtypes and patients with deep stromal invasion. Results The median follow-up period was 42.41 ± 24.60 months. After adjusting, no differences in the 5-year overall survival (OS) and disease-free survival (DFS) were found between the type B group and the type C group (OS: 87.8% vs. 89.4%, P = 0.814; DFS: 84.9% vs. 85.6%, P = 0.898). In further analysis of patients with squamous-cell carcinoma, adenocarcinoma, adenosquamous carcinoma, similar 5-year OS and DFS rates were found between two groups (OS: 88.7% vs. 97.1%, P = 0.250; DFS: 84.7% vs. 92.3%, P = 0.541). Consistent results were found in patients with deep stromal invasion (OS: 81.8% vs. 100%, P = 0.144; DFS: 82.8% vs. 100%, P = 0.128). Conclusions Type B RH could be used to treat FIGO stage IA2-IB2 and IIA1 cervical cancer to get equivalent 5-year OS and DFS. Further randomized controlled trials are warranted.
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Jeon J, Park BK, Lee JW, Choi CH, Lee YY, Kim TJ, Kim BG. Invisible cervical cancers on MRI: Can the type of histology (SCC versus non-SCC) influence surgical planning? Front Oncol 2022; 12:996516. [PMID: 36568188 PMCID: PMC9773832 DOI: 10.3389/fonc.2022.996516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Invisible cervical cancers on MRI can indicate less invasive surgery. Cervical cancers consist of squamous cell carcinoma (SCC) and non-SCC, each with different long-term outcomes. It is still unclear if surgical planning should be changed according to the histologic type of cervical cancer when it is not visible on MRI. Purpose The purpose of the study was to determine if surgical planning for cervical cancer that is not visible on MRI is influenced by the histologic type. Materials and methods Between January 2007 and December 2016, 155 women had Federation of Gynecology and Obstetrics (FIGO) stage 1B1 cervical cancer that was not visible on preoperative MRI. They underwent radical hysterectomies and pelvic lymph node dissections. Among them, 88 and 67 were histologically diagnosed with SCC and non-SCC, respectively. The size of the residual tumor, depth of stromal invasion, parametrial invasion, vaginal invasion, lymphovascular invasion, and lymph node metastasis were compared between these patients using the t-test, Mann-Whitney U test, Chi-squared test, or Fisher's exact test. The recurrence-free and overall 10-year survival rates were compared between the groups by Kaplan-Meier analysis. Results The mean sizes of residual tumors were 8.4 ± 10.4 mm in the SCC group and 12.5 ± 11.9 mm in the non-SCC group (p = 0.024). The mean depth of stromal invasion in the SCC group was 12.4 ± 21.2% (0%-100%), whereas that in the non-SCC group was 22.4 ± 24.4 (0%-93%) (p = 0.016). However, there was no difference in parametrial or vaginal invasion, lymphovascular invasion, or lymph node metastasis (p = 0.504-1.000). The recurrence-free and overall 10-year survival rates were 98.9% (87/88) and 95.5% (64/67) (p = 0.246), and 96.6% (85/88) and 95.5% (64/67) (p = 0.872), respectively. Conclusions The non-SCC group tends to have larger residual tumors and a greater depth of stromal invasion than the SCC group, even though neither is visible on MRI. Therefore, meticulous care is necessary for performing parametrectomy in patients with non-SCC cervical cancer.
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Affiliation(s)
- Jungeun Jeon
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byoungi-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Palaia I, Santangelo G, Caruso G, Perniola G, Tibaldi V, Muzii L, Benedetti Panici P, Di Donato V. Long-term Quality of Life and Sexual Function After Neoadjuvant Chemotherapy and Radical Surgery for Locally Advanced Cervical Cancer. J Sex Med 2022; 19:613-619. [PMID: 35227622 DOI: 10.1016/j.jsxm.2022.01.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/13/2022] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cervical cancer survivors report the worst quality of life (QoL) among all cancer survivors and this is mainly due to their younger age and the long-term treatment sequelae. AIM The purpose of this study is to assess the long-term QoL and sexual function of locally advanced cervical cancer (LACC) patients treated with neoadjuvant chemotherapy (NACT) and radical hysterectomy (RH) instead of the standard chemoradiotherapy. METHODS This is a retrospective case-control study including LACC patients (FIGO stage IIB-IVA) treated with the NACT-RH strategy and a control group of healthy women undergoing hysterectomy for uterine fibromatosis in the same period. OUTCOMES Main outcome measures were the EORTC QLQ-C30 and EORTC QLQ-CX24 for quality of life and Female Sexual Function Index (FSFI) for sexual function. RESULTS Overall, 96 patients were included: 48 LACC and 48 controls. The mean age at diagnosis was 45.5 ± 9.0 and 47.0 ± 7.8, respectively (P = .38). Compared to controls, LACC patients reported lower mean scores for the global health status (69.4 ± 22.6 vs 81.2 ± 24.3; Mean Difference (MD): -11.80 [95% CI: -21.19, -2.41]; P = .016), QLQ-C30 functional scale (80.1 ± 22.6 vs 92.4 ± 14.9; MD: -12.30 [95% CI: -19.96, -4.64]; P = .002), QLQ-Cx24 functional scale (55.5 ± 25.0 vs 80.4 ± 22.4; MD: -24.00 [95% CI: -34.40, -15.40]; P < .001), and the total FSFI (19.3 ± 9.6 vs 26.2 ± 9.9; MD: -6.90 [95% CI: -10.80, -3.00]; P < .001). On the other hand, LACC patients reported higher mean scores on the QLQ-C30 (16.9 ± 22.1 vs 8.4 ± 16.6; MD: 8.50 [95% CI: 0.68, 16.32]; P = .03) and QLQ-CX24 (26.0 ± 28.8 vs 15.0 ± 11.7; MD: 11.00 [95% CI: -2.21, 19.79]; P = .01) symptoms scales. CLINICAL IMPLICATIONS The confirmed poor quality of life even in surgically treated LACC survivors underlines the importance of tailoring parametrectomy based on lymph node status and developing personalized strategies. STRENGTHS AND LIMITATIONS The study assessed the long-term QoL and sexual function in the specific subpopulation of LACC patients treated with NACT-RH. Main limitations include the small sample size and the retrospective design. CONCLUSION LACC long-term survivors treated with NACT-RH experience poor QoL and sexual dysfunction. Palaia I, Santangelo G, Caruso G, et al. Long-term Quality of Life and Sexual Function After Neoadjuvant Chemotherapy and Radical Surgery for Locally Advanced Cervical Cancer. J Sex Med 2022;19:613-619.
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Affiliation(s)
- Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Valentina Tibaldi
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Utility of 3T MRI in Women with IB1 Cervical Cancer in Determining the Necessity of Less Invasive Surgery. Cancers (Basel) 2022; 14:cancers14010224. [PMID: 35008388 PMCID: PMC8750208 DOI: 10.3390/cancers14010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Cervical cancer that is invisible on magnetic resonance imaging (MRI) may suggest lower tumor burden than physical examination. Recently, 3 tesla (3T) MRI has been widely used prior to surgery because of its higher resolution than 1.5T MRI. The aim was to retrospectively evaluate the utility of 3T MRI in women with early cervical cancer in determining the necessity of less invasive surgery. MATERIALS AND METHODS Between January 2010 and December 2015, a total of 342 women with FIGO stage IB1 cervical cancer underwent 3T MRI prior to radical hysterectomy, vaginectomy, and lymph node dissection. These patients were classified into cancer-invisible (n = 105) and cancer-visible (n = 237) groups based on the 3T MRI findings. These groups were compared regarding pathologic parameters and long-term survival rates. RESULTS The cancer sizes of the cancer-invisible versus cancer-visible groups were 11.5 ± 12.2 mm versus 30.1 ± 16.2 mm, respectively (p < 0.001). The depths of stromal invasion in these groups were 20.5 ± 23.6% versus 63.5 ± 31.2%, respectively (p < 0.001). Parametrial invasion was 0% (0/105) in the cancer-invisible group and 21.5% (51/237) in the cancer-visible group (odds ratio = 58.3, p < 0.001). Lymph node metastasis and lymphovascular space invasion were 5.9% (6/105) versus 26.6% (63/237) (5.8, p < 0.001) and 11.7% (12/105) versus 40.1% (95/237) (5.1, p < 0.001), respectively. Recurrence-free and overall 5-year survival rates were 99.0% (104/105) versus 76.8% (182/237) (p < 0.001) and 98.1% (103/105) versus 87.8% (208/237) (p = 0.003), respectively. CONCLUSIONS 3T MRI can play a great role in determining the necessity of parametrectomy in women with IB1 cervical cancer. Therefore, invisible cervical cancer on 3T MRI will be a good indicator for less invasive surgery.
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Park BK, Kim TJ. Useful MRI Findings for Minimally Invasive Surgery for Early Cervical Cancer. Cancers (Basel) 2021; 13:cancers13164078. [PMID: 34439231 PMCID: PMC8391577 DOI: 10.3390/cancers13164078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary Radical hysterectomy and lymph node dissection are extensive procedures with severe post-operative morbidities and should be avoided on patients with low risk of recurrence. Still, due to lack of good prognostic tools, radical surgery is performed on most patients with early stage cervical cancer, leading to overtreatment and unnecessary morbidities. The recent International Federation of Gynecology and Obstetrics (FIGO) staging system accepts the use of magnetic resonance imaging (MRI) in addition to physical examination. Currently, 3 Tesla (3T) MRI is available widely and, due to its high soft tissue contrast, can provide more useful information on precise estimation of tumor size and metastasis than can physical examination in patients with cervical cancer. Therefore, this imaging modality can help gynecologic oncologists to determine whether minimally invasive surgery is necessary and can be used for early detection of small recurrent cancers. Abstract According to the recent International Federation of Gynecology and Obstetrics (FIGO) staging system, Stage III cervical cancer indicates pelvic or paraaortic lymph node metastasis. Accordingly, the new FIGO stage accepts imaging modalities, such as MRI, as part of the FIGO 2018 updated staging. Magnetic resonance imaging (MRI) is the best imaging modality to estimate the size or volume of uterine cancer because of its excellent soft tissue contrast. As a result, MRI is being used increasingly to determine treatment options and follow-up for cervical cancer patients. Increasing availability of cancer screening and vaccination have improved early detection of cervical cancer. However, the incidence of early cervical cancers has increased compared to that of advanced cervical cancer. A few studies have investigated if MRI findings are useful in management of early cervical cancer. MRI can precisely predict tumor burden, allowing conization, trachelectomy, and simple hysterectomy to be considered as minimally invasive treatment options for early cervical cancer. This imaging modality also can be used to determine whether there is recurrent cancer following minimally invasive treatments. The purpose of this review is to highlight useful MRI features for managing women with early cervical cancer.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Korea
- Correspondence: (B.K.P.); (T.-J.K.); Tel.: +82-2-3410-6457 (B.K.P.); +82-2-3410-0630 (T.-J.K.)
| | - Tae-Joong Kim
- Department of Obstetrics & Gynecology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Korea
- Correspondence: (B.K.P.); (T.-J.K.); Tel.: +82-2-3410-6457 (B.K.P.); +82-2-3410-0630 (T.-J.K.)
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Plotti F, Ficarola F, Messina G, Terranova C, Montera R, Guzzo F, DE Cicco Nardone C, Rossini G, Schirò T, Gatti A, Luvero D, Feole L, Angioli R. Tailoring parametrectomy for early cervical cancer (Stage IA-IIA FIGO): a review on surgical, oncologic outcome and sexual function. Minerva Obstet Gynecol 2020; 73:149-159. [PMID: 33249819 DOI: 10.23736/s2724-606x.20.04683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cervical cancer is currently one of the most common cancers afflicting the female population worldwide and in industrialized countries the presence of screening and a specific diagnostic and therapeutic process has favored early diagnosis of cervical cancer. In literature have found that reducing the radicality on the parametria in early cervical cancer (ECC), reduces complications without impacting oncological outcomes, but the data in the literature are not yet clear. EVIDENCE ACQUISITION Searching on PubMed, we included 1473 articles from January 1974 to 2020. We identified all the studies that compared different type of radical hysterectomy in the primary surgical treatment of ECC. 16 articles were elected for the review. EVIDENCE SYNTHESIS Modified radical hysterectomy (Piver II/Querleu-Morrow Type B) in ECC, if compared to CRH (Piver III/Querleu-Morrow Type C2), is not associated with worse cancer outcome and patient survival, but it is associated with a minor operating time, lower blood loss and minor bladder dysfunction. Nerve sparing radical hysterectomy approach (NSRH/Querleu-Morrow Type C1) compared to CRH (Piver III/Type C2) in the ECC, with our data we can confirm a non-inferiority regarding the oncological outcome. CONCLUSIONS Reduced radicality on the parametrium offers positive effects on the quality of life (sexual life and bladder function) of patients without impacting on survival, oncological outcome.
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Affiliation(s)
- Francesco Plotti
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Fernando Ficarola
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy -
| | - Giuseppe Messina
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Corrado Terranova
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Roberto Montera
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Federica Guzzo
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | | | - Gianmarco Rossini
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Teresa Schirò
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Gatti
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Daniela Luvero
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Laura Feole
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
| | - Roberto Angioli
- Unit of Obstetrics and Gynecology, Campus Bio-Medico University, Rome, Italy
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Chen C, Wang W, Liu P, Li P, Wang L, Jin S, Bin X, Lang J. Survival After Abdominal Q-M Type B versus C2 Radical Hysterectomy for Early-Stage Cervical Cancer. Cancer Manag Res 2019; 11:10909-10919. [PMID: 32021416 PMCID: PMC6955639 DOI: 10.2147/cmar.s220212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the survival outcomes of abdominal Q-M type B and type C2 radical hysterectomy (RH) for early-stage (IA1 (lymphovascular invasion)-IIA2) cervical cancer. Patients and methods Based on this multicenter, retrospective cohort study on the clinical diagnosis and treatment for cervical cancer in China (Four C), the survival outcomes of abdominal type B and type C2 RH for early-stage cervical cancer were compared under real-world and matched cohort study conditions. Results In total, 46,313 cases were included in the Four C database, among whom 20,018 underwent abdominal type B or type C2 RH. In the real-world study, no differences were found in the 5-year overall survival (OS) between the type B group (n=15,471) and type C2 group (n=4547), but the 5-year disease-free survival (DFS) was lower in the type C2 group (82.1 vs 84.8%, hazard ratio: 1.144). Based on the inclusion criteria, 9135 cases were included and the type C2 group (n=1818) was found to have a lower 5-year OS and DFS (OS: 89.5 vs 92.0%, hazard ratio: 1.393; DFS: 84.3 vs 87.4%, hazard ratio: 1.342). Subsequently, 1799 cases from each group were matched and the type C2 group had a lower 5-year DFS (84.6 vs 88.4%, hazard ratio: 1.332). Upon further analysis of the subgroups, the type C2 group had a lower 5-year OS and DFS (OS: 90.3 vs 93.8%, hazard ratio: 1.522; DFS: 85.2 vs 89.4%, hazard ratio: 1.439). Conclusion Q-M type B RH could be used for the treatment of stage IA1 (lymphovascular invasion)-IIA2 cervical cancer.
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Affiliation(s)
- Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Wuliang Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, People's Republic of China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Lu Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Shuangling Jin
- Department of Obstetrics and Gynecology, Peace Hospital Affiliated to Changzhi Medical College, Changzhi 046000, People's Republic of China
| | - Xiaonong Bin
- Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou 511436, People's Republic of China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, People's Republic of China
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The Effect of Major Pelvic Extirpative Surgery on Lower Urinary Tract Function. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Tseng JH, Aloisi A, Sonoda Y, Gardner GJ, Zivanovic O, Abu-Rustum NR, Leitao MM. Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival. Gynecol Oncol 2018; 150:44-49. [PMID: 29776598 DOI: 10.1016/j.ygyno.2018.04.571] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Standard surgical treatment for women with stage IB1 cervical cancer consists of radical hysterectomy. This study assesses survival outcomes of those treated with less radical surgery (LRS; conization, trachelectomy, simple hysterectomy) compared to more radical surgery (MRS; modified radical, radical hysterectomy). METHODS Using the Surveillance, Epidemiology and End Results database, we identified women <45 years with FIGO stage IB1 cervical cancer diagnosed from 1/1998 to 12/2012. Only those who underwent lymph node (LN) assessment were analyzed. Disease-specific survivals (DSSs) of LRS were compared with those of MRS. RESULTS Of 2571 patients, 807 underwent LRS and 1764 underwent MRS, all with LN assessment. For LRS vs. MRS, 28% vs. 23% were diagnosed with adenocarcinoma (p = 0.024), 31% vs. 39% had G3 disease (p < 0.001), 40% vs. 45% had tumor size >2 cm (p < 0.001), and 27% vs. 29% received adjuvant radiation therapy (p = 0.005). Median follow-up was 79 months (range, 0-179). Ten-year DSS for LRS vs. MRS was 93.5% vs. 92.3% (p = 0.511). There was no difference in 10-year DSS when stratified by tumor size ≤2 cm (LRS 95.1% vs. MRS 95.6%, p = 0.80) or > 2 cm (LRS 90.1% vs. MRS 88.2%, p = 0.48). Factors independently associated with increased risk of death included adenosquamous histology (HR 2.37), G3 disease (HR 2.86), tumors >2 cm (HR 1.82), and LN positivity (HR 2.42). Compared to MRS, LRS was not associated with a higher risk of death. CONCLUSIONS In a select group of young women with stage IB1 cervical cancer, LRS compared to MRS does not appear to compromise DSS.
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Affiliation(s)
- Jill H Tseng
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alessia Aloisi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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The safety of fertility preservation for microinvasive cervical adenocarcinoma: a meta-analysis and trial sequential analysis. Arch Gynecol Obstet 2018; 298:465-475. [PMID: 29876746 DOI: 10.1007/s00404-018-4799-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE This study sought to evaluate the safety of conservative treatment in the management of patients with microinvasive cervical adenocarcinoma. METHODS The PubMed, PMC, EMBASE, Web of Science and Cochrane databases were searched to collect correlational studies published in English between January 1949 and May 2018. Series reports that evaluating the oncological prognoses of patients with microinvasive cervical adenocarcinoma who were treated with fertility-sparing surgery versus hysterectomy were pooled for meta-analysis and trial sequential analysis. RESULTS A total of 8 articles with 1256 patients were collected, including 7 retrospective reviews and 1 prospective study. Only one (0.08%) patient had parametrial involvement. Positive margins of surgical specimens were identified in 6 patients (2.2%). Lymph node metastasis was found in 5 patients (0.4%). The progression-free survival and overall survival rates were 99.3 and 98.2%. Fertility-sparing surgery had no adverse impact on recurrence or survival (P = 0.524 and 0.485, respectively). Regarding potential selection bias, significantly more patients with stage IA2 tumors than those with stage IA1 disease were treated with hysterectomy (P < 0.001). The trial sequential analysis indicated that the cumulative number of patients failed to meet the required sample size (number of patients). CONCLUSIONS The prognosis for patients with microinvasive cervical adenocarcinoma is excellent. Fertility preservation is at least appropriate for young women with stage IA1 adenocarcinoma. Further studies are still warranted to evaluate the safety of this procedure in managing patients with microinvasive cervical adenocarcinoma.
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Factors associated with parametrial involvement in patients with stage IB1 cervical cancer: Who is suitable for less radical surgery? Obstet Gynecol Sci 2017; 61:88-94. [PMID: 29372154 PMCID: PMC5780326 DOI: 10.5468/ogs.2018.61.1.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/22/2017] [Accepted: 07/06/2017] [Indexed: 11/08/2022] Open
Abstract
Objective To detect the possible clinicopathologic factors associated with parametrial involvement in patients with stage IB1 cervical cancer and to identify a cohort of patients who may benefit from less radical surgery. Methods We retrospectively reviewed 120 patients who underwent radical hysterectomy and pelvic lymphadenectomy as treatment for stage IB1 cervical cancer. Results Overall, 18 (15.0%) patients had parametrial tumor involvement. Tumor size larger than 2 cm, invasion depth greater than 1 cm, presence of lymphovascular space involvement (LVSI), corpus involvement, and positive lymph nodes were statistically associated with parametrial involvement. Multivariate analysis for other factors showed invasion depth >1 cm (P=0.029), and corpus involvement (P=0.022) were significantly associated with parametrial involvement. A subgroup with tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Conclusion Tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Invasion depth >1 cm and corpus involvement were significantly associated with parametrial involvement in multivariate analysis. These finding may suggest that tumor size may a strong predictor of parametrial involvement in International Federation of Gynecology and Obstetrics stage IB1 cervical cancer, which can be used to select a subgroup population for less radical surgery.
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Willows K, Lennox G, Covens A. Fertility-sparing management in cervical cancer: balancing oncologic outcomes with reproductive success. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:9. [PMID: 27795832 PMCID: PMC5073939 DOI: 10.1186/s40661-016-0030-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/27/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, many of who are still within their reproductive lifespan. Advances in screening and treatment have increased the 5-year survival for early stage disease to over 90 % in developed countries. The focus is now shifting to reducing morbidity and improving fertility outcomes for cervical cancer patients. Radical trachelectomy with lymph node assessment became the standard of care for selected women with lesions <2 cm who desire fertility preservation. However, several questions still remain regarding the degree of surgical radicality required for tumors <2 cm, and fertility-sparing options for women with early-stage disesase ≥2 cm, and those with more advanced disease. Here, we compile a narrative review of the evidence for oncologic and pregnancy outcomes following radical trachelectomy, non-radical fertility-sparing surgery, and the use of neoadjuvant chemotherapy prior to surgery for larger lesions. We also review the literature for assisted reproductive technologies in women with more advanced disease. FINDINGS Available literature suggests that the crude recurrence and mortality rates after radical trachelectomy are <5 and <2 %, respectively (approx. 11 and 4 % for tumors ≥ 2 cm). Among 1238 patients who underwent fertility-sparing surgery for early cervical cancer there were 469 pregnancies with a 67 % live birth rate. Among 134 cases with lesions ≥ 2 cm, there were ten conceptions with a live birth rate of 70 %. Outcomes after non-radical surgery (simple trachelectomy or cervical conization) are similar, although only applicable among a highly selected patient population. For patients ineligible for fertility-preserving surgery or who require adjuvant radiation therapy, current options include ovarian transposition and cryopreservation of oocytes or embryos but other techniques are under investigation. CONCLUSION Today, many cervical cancer survivors have successful pregnancies. For those with early-stage disease, minimally invasive and fertility sparing techniques have resulted in improved obstetrical outcomes without compromising oncologic safety. Results from three ongoing trials on non-radical surgery for low-risk tumors <2 cm will further inform the need for radical surgery in such patients. For those in whom natural childbearing is unachievable, advances in assisted reproductive technologies provide reproductive options. Despite our advances, the effects of cervical cancer survivorship on quality of life are not fully elucidated.
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Affiliation(s)
- Karla Willows
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, M5G 2 M9 ON Canada
| | - Genevieve Lennox
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, M5G 2 M9 ON Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, M5G 2 M9 ON Canada
- Division of Gynecologic Oncology, T2051 Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3 M5 ON Canada
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Balaya V, Ngo C, Rossi L, Cornou C, Bensaid C, Douard R, Bats A, Lecuru F. Bases anatomiques et principe du nerve-sparing au cours de l’hystérectomie radicale pour cancer du col utérin. ACTA ACUST UNITED AC 2016; 44:517-25. [DOI: 10.1016/j.gyobfe.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
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Panici PB, Di Donato V, Palaia I, Visentin VS, Marchetti C, Perniola G, Musella A, Gasparri ML, Lecce F, Sabatucci I, Monti M, Muzii L. Type B versus Type C Radical Hysterectomy After Neoadjuvant Chemotherapy in Locally Advanced Cervical Carcinoma: A Propensity-Matched Analysis. Ann Surg Oncol 2016; 23:2176-2182. [DOI: 10.1245/s10434-015-4996-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Martinelli F, Bogani G, Ditto A, Carcangiu M, Papadia A, Lecce F, Chiappa V, Lorusso D, Raspagliesi F. How often parametrial involvement leads to post-operative adjuvant treatment in locally advanced cervical cancer after neoadjuvant chemotherapy and type C radical hysterectomy? Eur J Surg Oncol 2015; 41:1089-96. [DOI: 10.1016/j.ejso.2015.03.228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/04/2015] [Accepted: 03/18/2015] [Indexed: 01/22/2023] Open
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Postoperative outcomes of MR-invisible stage IB1 cervical cancer. Am J Obstet Gynecol 2014; 211:168.e1-7. [PMID: 24607752 DOI: 10.1016/j.ajog.2014.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/24/2014] [Accepted: 02/26/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Tumor volume is a significant prognostic factor of cervical cancer. It is still unknown about outcome of biopsy-proven IB1 cervical cancer, which is invisible on preoperative magnetic resonance imaging (MRI). The aim was to evaluate retrospectively the postoperative outcomes of MR-invisible stage IB1 cervical cancers. STUDY DESIGN Between January 2001 and December 2007, we reviewed the medical records of 86 patients with biopsy-proven IB1 cervical cancer that was invisible on MRI. During the same period, we also reviewed the medical records of 260 patients with biopsy-proven IB1 cervical cancer that was visible on MRI. Both of these cancer groups were treated with radical hysterectomy and lymph node dissection. MR-invisible and MR-visible IB1 cancers were compared in terms of pathologic parameters and long-term survival rate. RESULTS The median sizes and depths of stromal invasion of MR-invisible vs MR-visible IB1 cancers were 4.5 ± 7.1 mm and 33.3% ± 20.1% vs 30 ± 14 mm and 66.7% ± 26.6%, respectively (P = .000). The incidences of lymph node metastasis, parametrial invasion, and lymphovascular invasion were 1.1% (1/86 cases) and 18.8% (49/260 cases; P = .000; odds ratio, 19.7), 0% (0/86 cases) and 6.5% (17/260 cases; P = .009; odds ratio, 12.4), and 4.7% (4/86 cases) and 26.9% (70/260 cases; P = .000; odds ratio, 7.6) in the MR-invisible and MR-visible IB1 cancers, respectively. Recurrence-free and overall 5-year survival rates of MR-invisible vs MR-visible IB1 cancers were 98.8% (85/86 cases) vs 91.2% (237/260 cases) and 100% (86/86 cases) vs 95.8% (249/260 cases), respectively (P = .011 and .045). CONCLUSION MR-invisible IB1 cancer provides better postoperative outcomes than MR-visible IB1 cancer because of the much lower tumor burden.
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Ditto A, Martinelli F, Ramondino S, Vullo S, Carcangiu M, Haeusler E, Mariani L, Lorusso D, Raspagliesi F. Class II versus Class III radical hysterectomy in early cervical cancer: An observational study in a tertiary center. Eur J Surg Oncol 2014; 40:883-90. [DOI: 10.1016/j.ejso.2014.02.229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 12/31/2022] Open
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Vizza E, Corrado G, Zanagnolo V, Tomaselli T, Cutillo G, Mancini E, Maggioni A. Neoadjuvant chemotherapy followed by robotic radical hysterectomy in locally advanced cervical cancer: A multi-institution study. Gynecol Oncol 2014; 133:180-5. [DOI: 10.1016/j.ygyno.2014.02.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/18/2014] [Accepted: 02/23/2014] [Indexed: 11/16/2022]
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Ye S, Yang J, Cao D, Zhu L, Lang J, Chuang LT, Shen K. Quality of life and sexual function of patients following radical hysterectomy and vaginal extension. J Sex Med 2014; 11:1334-42. [PMID: 24628816 DOI: 10.1111/jsm.12498] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Radical hysterectomy (RH) has negative consequences on sexual function due to a shortened vagina, vaginal dryness, and dyspareunia. Peritoneovaginoplasty aims to extend vagina by vesical peritoneum and anterior rectal wall to improve postoperative sexual function. AIM The aim of this study was to investigate whether vaginal extension can improve sexual function and quality of life and the problem of sexual dysfunction in early-stage cervical cancer survivors (CCSs) in China. METHODS Case-control and questionnaire-based methods were employed. Thirty-one patients who had undergone vaginal extension following RH and 28 patients with matching factors after RH alone were enrolled in the study. MAIN OUTCOME MEASURES Both groups were assessed retrospectively by questionnaires at least 6 months after treatment. The European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module and the Sexual Function Vaginal Changes Questionnaire are validated measurements for disease- and treatment-specific issues. RESULTS Vaginal length was 10.03 ± 1.26 cm and 5.92 ± 1.05 cm in study and control group, respectively (P < 0.05). In the study group, 67.7% patients and 64.3% of control group resumed sexual activity at the time of interview, averaging 6 months between treatment and sexual activity. While difficulty emptying bladder, incomplete emptying, and constipation were the most commonly reported symptoms, no significant difference was observed regarding pelvic floor symptoms. Reduced vagina size and shortened vagina was significantly more prominent in the control group, whereas both group presented with hypoactive sexual desire (88.1%), orgasm dysfunction (71.8%), and low enjoyment or relaxation after sex (51.3%). CONCLUSION Shortened vagina was significantly less reported in study group, while no difference was observed in other sex-related dimensions. Vaginal extension does not worsen pelvic floor symptoms. Sexual rehabilitation interventions are of significance and should be paid more attention to the CCSs in China.
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Affiliation(s)
- Shuang Ye
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Science, Peking Union Medical College, Beijing, China
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Rob L, Lukas R, Robova H, Helena R, Halaska MJ, Jiri HM, Hruda M, Martin H, Skapa P, Petr S. Current status of sentinel lymph node mapping in the management of cervical cancer. Expert Rev Anticancer Ther 2014; 13:861-70. [PMID: 23875664 DOI: 10.1586/14737140.2013.811147] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The status of regional lymph nodes is the most important prognostic factor in early cervical cancer patients. Pelvic lymph node dissections are routinely performed as a part of standard surgical treatment. Systematic pelvic lymphadenectomy is associated with short- and long-term morbidities. This review discusses single components of the sentinel lymph node mapping (SLNM) technique and results of the detection of sentinel lymph nodes. SLNM biopsy performed by an experienced team for small volume tumors (<2 cm) has high specific side detection rate, excellent negative-predictive value and high sensitivity. Uncommon lymphatic drainage has been reported in 15% of cervical cancer patients. There is sufficient data now to suggest that SLNM with 99mTc plus blue dye in the hands of a surgeon with extensive experience should prove to be an important part of individualized cervical cancer surgery and increase the safety of less radical or fertility-sparing surgery.
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Affiliation(s)
| | - Rob Lukas
- Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University, V uvalu 84, 150 00 Prague 5.
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Laterza RM, Sievert KD, de Ridder D, Vierhout ME, Haab F, Cardozo L, van Kerrebroeck P, Cruz F, Kelleher C, Chapple C, Espuña-Pons M, Koelbl H. Bladder function after radical hysterectomy for cervical cancer. Neurourol Urodyn 2014; 34:309-15. [PMID: 24519734 DOI: 10.1002/nau.22570] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 01/08/2014] [Indexed: 11/06/2022]
Abstract
AIM To report the effects of radical hysterectomy and nerve-sparing techniques on lower urinary tract function in women. METHODS A literature search was performed in Pubmed and Medline using the keywords bladder after radical hysterectomy, nerve sparing radical hysterectomy, and urinary dysfunction following radical hysterectomy. Significant results and citations were reviewed manually by the authors. RESULTS The sympathetic and parasympathetic systems innervating the lower urinary tract may be disrupted due to resection of uterosacral and rectovaginal ligaments, the dorsal and lateral paracervix, the caudal part of the vesico-uterine ligaments, and the vagina. This supports the neurogenic etiology of early and late bladder dysfunction after radical surgery. Bladder disorders are also related to the extent of radical surgery. The neuropathopysiology of lower urinary tract symptoms after radical hysterectomy is not fully understood. Recent data have highlighted the role of urethral sphincter pressure in the etiology of postoperative incontinence. Various surgical approaches have been developed to preserve autonomic pelvic innervation. CONCLUSIONS Nerve-sparing techniques appear to improve bladder function without compromising overall survival. Studies comparing the effects of nerve-sparing radical hysterectomy with standard surgery yielded encouraging results in respect of postoperative lower urinary tract function. Clinical trials with a long period of follow-up are required for better comprehension of the complex pathophysiology of bladder dysfunction after radical hysterectomy.
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Affiliation(s)
- Rosa M Laterza
- Division of Gynecology and Gynecological Oncology, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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Benedetti Panici P, Perniola G, Tomao F, Fischetti M, Savone D, Di Donato V, Angioli R, Muzii L. An Update of Laparoscopy in Cervical Cancer Staging: Is It a Useful Procedure? Oncology 2013; 85:160-5. [DOI: 10.1159/000351995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/09/2013] [Indexed: 11/19/2022]
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Greggi S, Scaffa C. Surgical Management of Early Cervical Cancer: The Shape of Future Studies. Curr Oncol Rep 2012; 14:527-34. [DOI: 10.1007/s11912-012-0269-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Palaia I, Musella A, Bellati F, Marchetti C, Di Donato V, Perniola G, Benedetti Panici P. Simple extrafascial trachelectomy and pelvic bilateral lymphadenectomy in early stage cervical cancer. Gynecol Oncol 2012; 126:78-81. [DOI: 10.1016/j.ygyno.2012.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 03/27/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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Rob L, Robova H, Chmel R, Komar M, Halaska M, Skapa P. Surgical options in early cervical cancer. Int J Hyperthermia 2012; 28:489-500. [DOI: 10.3109/02656736.2012.675116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Plotti F, Nelaj E, Sansone M, Antonelli E, Altavilla T, Angioli R, Benedetti Panici P. Sexual Function after Modified Radical Hysterectomy (Piver II/Type B) vs. Classic Radical Hysterectomy (Piver III/Type C2) for Early Stage Cervical Cancer. A Prospective Study. J Sex Med 2012; 9:909-17. [DOI: 10.1111/j.1743-6109.2011.02581.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N. Re-consideration of lymphadenectomy for stage Ib1 cervical cancer. J Obstet Gynaecol Res 2012; 38:420-6. [DOI: 10.1111/j.1447-0756.2011.01727.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gaurilcikas A, Vaitkiene D, Cizauskas A, Inciura A, Svedas E, Maciuleviciene R, Di Legge A, Ferrandina G, Testa AC, Valentin L. Early-stage cervical cancer: agreement between ultrasound and histopathological findings with regard to tumor size and extent of local disease. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:707-715. [PMID: 21538643 DOI: 10.1002/uog.9037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To determine the agreement between ultrasound and histological examination of the cervix in patients with early stage cervical cancer with regard to tumor size and local extent of the disease. METHODS Eighteen patients with histologically proven cervical cancer Stage IB1-IIA according to traditional clinical staging (FIGO 1988) who were scheduled for radical surgery underwent a standardized transvaginal ultrasound examination. The maximum tumor length, anteroposterior tumor diameter, tumor width, tumor area, depth of cervical stroma invasion, and the minimal thickness of tumor-free cervical stroma on sagittal and transverse planes through the cervix were measured, and the local extent of the disease within the parametria and vagina were evaluated. The surgical specimens were examined using a specifically devised method of histopathological examination. The results of the ultrasound and histopathological examinations were compared. RESULTS Limits of agreement were wide and the intraclass correlation coefficient (ICC) was low (0.51-0.58) for three of the four measurements taken to represent the minimal depth of tumor-free cervical stroma, i.e. the results of the measurements taken posteriorly and laterally. However, the limits of agreement were narrower and the ICC values were higher (0.74-0.92) for the depth of cervical stroma invasion and for the tumor size measurements. Histological examination revealed parametrial cancer infiltration in four patients, which was detected during ultrasound examination, with no false-positive results. CONCLUSIONS Transvaginal sonography is acceptably accurate for evaluation of tumor size and depth of cervical stroma invasion in clinical practice.
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Affiliation(s)
- A Gaurilcikas
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Intra-operative detection of nodal metastasis in early stage cervical cancer: A survey of the practice patterns of SGO members. Gynecol Oncol 2011; 121:143-7. [DOI: 10.1016/j.ygyno.2010.12.337] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 12/13/2010] [Accepted: 12/15/2010] [Indexed: 11/22/2022]
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Panici PB, Di Donato V, Plotti F, Musella A, Sansone M, Angioli R, Perniola G, Bellati F. Feasibility and safety of type C2 total extraperitoneal abdominal radical hysterectomy (TEARH) for locally advanced cervical cancer. Gynecol Oncol 2011; 120:423-9. [DOI: 10.1016/j.ygyno.2010.12.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 12/19/2010] [Accepted: 12/21/2010] [Indexed: 12/01/2022]
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Diaz JP, Gemignani ML, Pandit-Taskar N, Park KJ, Murray MP, Chi DS, Sonoda Y, Barakat RR, Abu-Rustum NR. Sentinel lymph node biopsy in the management of early-stage cervical carcinoma. Gynecol Oncol 2011; 120:347-52. [PMID: 21216450 DOI: 10.1016/j.ygyno.2010.12.334] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/07/2010] [Accepted: 12/09/2010] [Indexed: 01/24/2023]
Abstract
OBJECTIVES We aimed to determine the sentinel lymph node detection rates, accuracy in predicting the status of lymph node metastasis, and if pathologic ultrastaging improves the detection of micrometastases and isolated tumor cells at the time of primary surgery for cervical cancer. METHODS A prospective, non-randomized study of women with early-stage (FIGO stage IA1 with lymphovascular space involvement--IIA) cervical carcinoma was conducted from June 2003 to August 2009. All patients underwent an intraoperative intracervical blue dye injection. Patients who underwent a preoperative lymphoscintigraphy received a 99m Tc sulfur colloid injection in addition. All patients underwent sentinel lymph node (SLN) identification followed by a complete pelvic node and parametrial dissection. SLN were evaluated using our institutional protocol that included pathologic ultrastaging. RESULTS SLN mapping was successful in 77 (95%) of 81 patients. A total of 316 SLN were identified, with a median of 3 SLN per patient (range, 0-10 SLN). The majority (85%) of SLN were located at three main sites: the external iliac (35%); internal iliac (30%); and obturator (20%). Positive lymph nodes (LN) were identified in 26 (32%) patients, including 21 patients with positive SLN. Fifteen of 21 patients (71%) had SLN metastasis detected on routine processing. SLN ultrastaging detected metastasis in an additional 6/21 patients (29%). Two patients had grossly positive LN at exploration, and mapping was abandoned. Three of 26 (12%) patients had successful SLN mapping; however, the SLN failed to identify the metastatic LN. Of these 3 false negative cases, 2 patients had a metastatic parametrial node as the only positive LN with multiple negative pelvic nodes including negative SLN. One patient with stage IA1 disease and lymphovascular invasion had unilateral SLN mapping and a metastatic common iliac LN identified on completion lymphadenectomy of the contralateral side that did not map. The 4 (5%) patients with unsuccessful mapping included 1 who had grossly positive nodes identified at the time of laparotomy; the remaining 3 occurred during each surgeon's initial SLN mapping learning phase. CONCLUSION SLN mapping in early-stage cervical carcinoma yields high detection rates. Ultrastaging improves micrometastasis detection. Parametrectomy and side-specific lymphadenectomy (in cases of failed mapping) remain important components of the surgical management of selected cases.
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Affiliation(s)
- John P Diaz
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Neoadjuvant Chemotherapy Plus Fertility-Sparing Surgery in Locally Advanced Cervical Cancer: Case Report. J Minim Invasive Gynecol 2011; 18:121-2. [DOI: 10.1016/j.jmig.2010.08.691] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 08/07/2010] [Accepted: 08/12/2010] [Indexed: 10/18/2022]
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Parametrial Involvement in FIGO Stage IB1 Cervical Carcinoma: Diagnostic Impact of Tumor Diameter in Preoperative Magnetic Resonance Imaging. Int J Gynecol Cancer 2011. [DOI: 10.1097/igc.0b013e3182072eea] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background:In the surgical treatment for early-stage cervical carcinoma, it is important to identify preoperatively a low-risk group of patients as candidates for less radical surgery to avoid the morbidity associated with radical hysterectomy. The aim of this study was to evaluate the correlation between tumor diameter measured preoperatively using magnetic resonance imaging (MRI) and pathological prognostic factors in International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma.Methods:A total of 125 patients with FIGO stage IB1 cervical cancer were included in this study. Clinical records, pathology reports, and MRI findings were retrospectively reviewed.Results:Histological diagnosis was squamous cell carcinoma in 57 patients and nonsquamous cell carcinoma in 68 patients. All patients underwent preoperative evaluation by MRI within a median period of 13.5 days before surgery. The tumor diameter measured by MRI ranged from zero (no tumor detected) to 42 mm, with a median of 23 mm. Pathological prognostic factors included parametrial involvement, lymph node metastasis, deep stromal invasion, and lymphovascular space invasion. All these factors were found less frequently in patients with a smaller tumor diameter. Most notably, parametrial involvement was seen in none of the patients with tumors 20 mm or less and was detected only in patients with tumors greater than 20 mm (P= 0.01).Conclusions:In the FIGO stage IB1 cervical carcinoma, the tumor diameter measured preoperatively by MRI correlates well with other pathological prognostic factors, especially with parametrial involvement. This finding suggests that the tumor diameter measured in preoperative MRI may serve as a strong predictor of parametrial involvement in FIGO stage IB1 cervical carcinoma, which can be used to select a candidate population for less radical surgery without the need for a cone biopsy before hysterectomy.
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Fagotti A, Gagliardi ML, Moruzzi C, Carone V, Scambia G, Fanfani F. Excisional cone as fertility-sparing treatment in early-stage cervical cancer. Fertil Steril 2010; 95:1109-12. [PMID: 21122837 DOI: 10.1016/j.fertnstert.2010.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/16/2010] [Accepted: 11/03/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1), age ≤ 45 years, tumor ≤ 20 mm. INTERVENTION(S) Cold-knife conization and laparoscopic pelvic lymphadenectomy. MAIN OUTCOME MEASURE(S) Recurrence and pregnancy rate. RESULT(S) There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13-51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8-101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery. CONCLUSION(S) In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.
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Affiliation(s)
- Anna Fagotti
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
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Kim MK, Kim JW, Kim MA, Kim HS, Chung HH, Park NH, Park IA, Song YS, Kang SB. Feasibility of less radical surgery for superficially invasive carcinoma of the cervix. Gynecol Oncol 2010; 119:187-91. [DOI: 10.1016/j.ygyno.2010.06.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 06/22/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
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Should Radical Hysterectomy Be Aborted on Intraoperative Detection of Nodal Tumor Metastasis in Early Stage Cervical Cancer? J Low Genit Tract Dis 2010; 14:374-81. [DOI: 10.1097/lgt.0b013e3181e31e5d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rob L, Halaska M, Robova H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol 2010; 11:292-301. [PMID: 20202614 DOI: 10.1016/s1470-2045(09)70191-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cancer of the cervix is the second most common cancer in women worldwide, with about 500,000 new cases and 273,000 deaths reported annually. Ideal surgical management of cervical cancer should reduce early and late morbidity without compromising oncological disease control. Type of surgical radicality in early cervical cancer should be a consequence of exact preoperative and intraoperative assessments of risk factors. During the past 15 years, substantial progress has been made in understanding the neuroanatomy of the autonomic pelvic plexus. This progress has resulted in individually tailored surgery for cervical cancer. The concept of preservation of autonomic nerves during radical hysterectomy has become standard in many oncogynaecological centres. Nerve-sparing radical hysterectomy and individually tailored surgery, in comparison with standard radical hysterectomy, have led to a much improved quality of life. Since 2008, there has been a new classification of radical hysterectomy, which includes nerve-sparing techniques. 5-year survival in early stage cervical cancer is 88-97% and more than 50% of women are younger than 50 years of age. Thus, we must take into consideration the quality of life of these patients. In this Review, we focus on the neuroanatomy of the pelvis and the possible damage of autonomic nerves, and suggest options for the sparing of these nerves during surgery for cervical cancer.
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Affiliation(s)
- Lukas Rob
- Department of Obstetrics Gynaecology, 2nd Medical Faculty, Charles University, Prague, Czech Republic.
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Ercoli A, Delmas V, Iannone V, Fagotti A, Fanfani F, Corrado G, Ferrandina G, Scambia G. The lymphatic drainage of the uterine cervix in adult fresh cadavers: Anatomy and surgical implications. Eur J Surg Oncol 2010; 36:298-303. [DOI: 10.1016/j.ejso.2009.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 06/18/2009] [Indexed: 10/20/2022] Open
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Place du ganglion sentinelle dans le cancer du col de l’utérus en 2009. ONCOLOGIE 2010. [DOI: 10.1007/s10269-009-1831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De Vincenzo R, Amadio G, Ricci C, Licameli A, Ferrandina G, Capelli G, Scambia G. Treatment of cervical cancer in Italy: strategies and their impact on the women. Vaccine 2009; 27 Suppl 1:A39-45. [PMID: 19480960 DOI: 10.1016/j.vaccine.2008.11.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 11/21/2008] [Accepted: 11/21/2008] [Indexed: 11/27/2022]
Abstract
Treatment of cervical cancer greatly varies according to the stage of the disease. Laparoscopic surgical staging is emerging as a valid approach, compared to clinical and imaging staging, to better identify the treatment plan. Minimally invasive surgery plays the greatest role in the treatment of early cervical carcinoma (ECC). Laparoscopically assisted radical vaginal hysterectomy (LARVH) is an alternative surgical strategy in this subset of patients. Interest has been increasing in using conservative fertility-sparing surgery such as laparoscopic vaginal radical trachelectomy (LVRT) or chemo-conization, options to be preferred in selected patients, with early-stage disease and asking for future fertility. Chemoradiotherapy currently represents the gold standard in the treatment of patient with locally advanced cervical cancer (LACC). In Italy, neoadjuvant chemotherapy (NACT) followed by radical surgery is today emerging as a valid alternative to the standard chemoradiation and the paclitaxel, ifosfamide and cisplatin (TIP) regimen is one of the most active neoadjuvant chemotherapeutic treatments. Moreover, the combination of different strategies to maximize local control should be considered. Among different approaches to this issue the use of a three-modality treatment, including radiotherapy, chemotherapy and surgery has been investigated. Our data on a large single-institutional series of LACC patients treated with chemoradiation followed by radical surgery confirm that this three-modality treatment can achieve overall survival (OS) and Disease Free Survival (DFS) rates at least comparable to chemoradiation alone, with an acceptable rate of complications. Tailoring of radical surgery, on the basis of intraoperative findings, such as lympho-nodes status, might play an important role in diminishing the overall rate of complications and eventually improve quality of life (QoL) of these patients. Cervical cancer generally has an aggressive impact on relatively young women and, as we experienced, the relevance of psychosocial aspects in gynaecologic oncology has become a main issue.
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Affiliation(s)
- Rosa De Vincenzo
- Gynaecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
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Lousquy R, Delpech Y, Barranger E. Place du ganglion sentinelle dans la stratégie thérapeutique du cancer du col de l’utérus aux stades précoces. ACTA ACUST UNITED AC 2009; 37:827-33. [DOI: 10.1016/j.gyobfe.2009.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Uzan C, Gouy S, Pautier P, Lhommé C, Duvillard P, Haie-Meder C, Morice P. La paramétrectomie est-elle nécessaire pour tous les cancers du col à un stade précoce ? ACTA ACUST UNITED AC 2009; 37:504-9. [DOI: 10.1016/j.gyobfe.2009.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
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Protopapas A, Jardon K, Bourdel N, Botchorishvili R, Rabischong B, Mage G, Canis M. Total Laparoscopic Radical Hysterectomy in the Treatment of Early Cervical Cancer. Int J Gynecol Cancer 2009; 19:712-22. [DOI: 10.1111/igc.0b013e3181a3e2be] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pluta M, Rob L, Charvat M, Chmel R, Halaska M, Skapa P, Robova H. Less radical surgery than radical hysterectomy in early stage cervical cancer: a pilot study. Gynecol Oncol 2009; 113:181-4. [PMID: 19264352 DOI: 10.1016/j.ygyno.2009.02.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 01/25/2009] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this pilot study was to evaluate the feasibility and safety of a less radical surgery; laparoscopic lymphadenectomy followed by a simple vaginal hysterectomy in sentinel lymph node (SLN) negative early cervical cancer patients. Treatment-associated morbidity and oncological outcome were evaluated. PATIENTS AND METHODS From December 2000 to September 2007, 60 patients (50 squamous and 10 adenocarcinoma patients) in stages 3-IA1, 11-IA2 and 46-IB1 with median age of 44.6 years (range 33-64 years) were enrolled. Patients were selected based on favorable cervical tumors (IA1 with lymph-vascular space invasion [LVSI], IA2 and IB1 with tumor size less than 20 mm and less than half of stromal invasion). All patients underwent laparoscopic SLN identification using frozen section (FS). Negative SLN patients underwent complete pelvic laparoscopic lymphadenectomy and vaginal hysterectomy. FS positive patients underwent radical hysterectomy with low paraaortic lymphadenectomy. RESULTS The average number of sentinel nodes per side was 1.4 with detection rate per side of 95%. The average number of removed nodes was 23.2. Five patients (8.3%) were SLN positive. There were two false negative FS results (both were micrometastases in SLN). Median follow-up was 47 months (range 12-92). There were no recurrences in 55 SLN negative patients and in 5 SLN positive patients. CONCLUSION Lymphatic mapping and SLN identification improved safety in less radical surgery in early stage cervical cancer. This preliminary study showed that it is both feasible and safe to reduce the radicality of parametrial resection for small tumor volume in SLN negative patients. Results also indicated that treatment-associated morbidity is low.
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Affiliation(s)
- Marek Pluta
- Department of Gynecology and Obstet, Division of Oncogynecology, Charles University Prague, 2nd Medical Faculty, Prague 5, Czech Republic
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Benedetti Panici P, Basile S, Angioli R. Pelvic and aortic lymphadenectomy in cervical cancer: the standardization of surgical procedure and its clinical impact. Gynecol Oncol 2009; 113:284-90. [PMID: 19157526 DOI: 10.1016/j.ygyno.2008.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/23/2008] [Accepted: 12/02/2008] [Indexed: 01/28/2023]
Abstract
Cervical cancer ranks as the second most frequent cancer in women in the world, and nodal metastasis seems to be the first step of tumor spread in most cases. Since lymph node involvement is a major prognostic factor in cervical carcinoma, lymphatic spread of cervical cancer has been one of the most studied surgical topics in gynecologic oncology. Traditionally, lymph nodes stations have been accurately analyzed, improving surgical techniques of nodal dissection, which have been more and more intensive during years with the aim of improving survival. Oppositely, on the basis of recent acquisitions in cancer immunology and new anti-cancer immunotherapies and vaccines, the importance of lymph nodes has been recently reconsidered. Unfortunately, lymph node status is still difficult to be assessed pre-operatively with a high level of accuracy, and intra-operatively by sentinel node techniques, which remain inadequate for many aspects according to several gynecologic oncologists. The absence of definitive evidence of survival advantage given by extensive lymphadenectomy in all cervical cancer cases indicates that nodal dissection should be performed on the objective risk of node metastasis in each case. To date, the mainstay of detecting lymph node metastasis is still the histologic evaluation, therefore a proper resection of mostly involved lymph nodes remains a crucial surgical step when treating cervical cancer.
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Abstract
Radical hysterectomy has been the standard surgical treatment for cervical cancer, achieving a good survival outcome. However, it is a major operation that has considerable potential long-term morbidity. With good prognosis achieved in most early cervical cancers, there is a trend towards more emphasis on maintaining good quality of life post-treatment. Many women diagnosed with cervical cancer are young, and fertility-sparing surgery such as trachelectomy would preserve their reproductive potential. Minimally invasive surgery, such as laparoscopic radical hysterectomy, can potentially improve post-operative recovery and cosmetic results while maintaining oncological safety. Sentinel lymph nodes assessment can minimize unnecessary systematic pelvic lymphadenectomy. Radicality of the hysterectomy may also be reduced in selected individuals with good prognostic factors, thus minimizing long-term pelvic floor dysfunction. This review aims to give a broad overview of the current status of these new trends in surgical management for cervical cancer.
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Affiliation(s)
- Karen KL Chan
- Queen Elizabeth Hospital, Northern Gynaecological Oncology Centre, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6XS, UK, Tel.: +44 191 445 2706; Fax: +44 191 445 6192
| | - Raj Naik
- Tel.: +44 191 445 2706; Fax: +44 191 445 6192
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A prospective study of sentinel lymph node status and parametrial involvement in patients with small tumour volume cervical cancer. Gynecol Oncol 2008; 109:280-4. [PMID: 18377965 DOI: 10.1016/j.ygyno.2008.02.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 02/05/2008] [Accepted: 02/06/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of prospective study is to determine incidence and distribution of pelvic lymph node (LN) involvement, sentinel lymph node (SLN) involvement and pathologic parametrial involvement (PI) in stage Ia2 and small Ib1 cervical cancer. PI is defined as positive parametrial LN or discontinuous malignant cells in parametrium. METHODS After radical abdominal hysterectomy, 158 women patients were stratified into two groups based on tumour size: In Group 1 (91 women) tumours were less than 20 mm and less than half of stromal invasion. In Group 2 (67 women) tumours were between 20 and 30 mm and infiltration was not more than 2/3 of cervical stroma. RESULTS In Group 1 positive SLN was detected in 11(12.1%) patients; of these, 3 (27.3%) had positive PI. In 80 women with negative SLN PI was not detected. In Group 2 positive SLN was detected in 14 (20.9%) patients: PI was found in four (28.6%) of these 14 patients. No PI was detected in 53 women with negative SLN. CONCLUSION No PI was observed in early cervical cancer if SLNs were negative. However, we found PI in 28.0% of women with positive SLN. Statistical analysis revealed that the results were highly significant. Based on our results, radical removal of parametrium in SLN negative patients is questionable.
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Panici PB, Palaia I, Bellati F. Reply. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2007.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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