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Song C, Jang TK, Kong S, Kang H, Kwon SH, Cho CH. Robotic Single-Site Radical Hysterectomy for Early Cervical Cancer: A Single Center Experience of 5 Years. J Pers Med 2023; 13:jpm13050733. [PMID: 37240903 DOI: 10.3390/jpm13050733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The mainstay of treatment for early-stage cervical cancer is surgery; we present a 5-year experience of robotic single-site radical hysterectomy (RSRH) focused on surgical and oncologic outcomes. METHODS This retrospective study included 44 cases of RSRH performed in patients with early-stage cervical cancer. RESULTS The median follow-up period for the 44 patients was 34 months. The mean total operation time was 156.07 ± 31.77 min, while mean console time was 95.81 ± 24.95 min. Two cases had complications, which required surgical management, while four cases (9.1%) exhibited recurrence. The disease-free survival rate at 5 years was 90.9%. The sub-division analysis showed that Stage Ia2 and stage Ib1 patient sub-group showed better DFS than that of the stage Ib2 patient sub-group. The learning curve analysis showed that the CUSUM-T initially peaks at the sixth case then gradually decreases before rising and peaking at the 24th case. After 24th case, the CUSUM-T gradually decreases and reaches zero. CONCLUSION The surgical outcomes of RSRH for early-stage cervical cancer treatment were safe and acceptable. However, RSRH could be considered carefully only in well-selected patient groups. Large-scale prospective studies are necessary in the future to validate the results.
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Affiliation(s)
- Changho Song
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Tae-Kyu Jang
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Soomin Kong
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Heeju Kang
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Sang-Hoon Kwon
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
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Zapardiel I, Ceccaroni M, Minig L, Halaska MJ, Fujii S. Avascular spaces in radical hysterectomy. Int J Gynecol Cancer 2023; 33:285-292. [PMID: 36581489 DOI: 10.1136/ijgc-2022-004071] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The most common cancer in women worldwide is cervical cancer. For early-stage disease the standard treatment is radical hysterectomy. One of the main issues faced by surgeons performing a radical hysterectomy is the wide variation in the terminology used to define the procedure and the nomenclature used to describe the anatomical spaces critical to the success of the surgery. The aim of this review was to synthesize currently used anatomical landmarks with relation to surgical avascular spaces for the performance of radical hysterectomy.A computer-based comprehensive review of the MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and SciSearch databases, as well as National Comprehensive Cancer Network and European Society of Gynaecological Oncology guidelines, was performed. With all relevant data collected, and previous anatomical studies during surgeries and on cadavers performed by authors, a manuscript of the definition of avascular spaces, methods of dissection, and anatomical limits was prepared.Avascular pelvic spaces developed during radical hysterectomy, such as the paravesical, pararectal, ureter tunnel, and paravaginal, were considered and included in the manuscript. A clear definition of avascular spaces may aid a better understanding of the anatomical aspects of the radical hysterectomy. It could improve surgeon knowledge of the structures that need to be preserved and those that need to be resected during a radical hysterectomy. Additionally, the detailed exposure of anatomical boundaries will facilitate the appropriate tailored radicality depending on the risk factors of the disease. Moreover, knowledge of these spaces could make pelvic surgery safer and easier for other types of gynecological and non-gynecological procedures.
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Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Marcello Ceccaroni
- Department of Obstetrics & Gynecology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (Verona), Italy
| | - Lucas Minig
- Gynecologic Oncology Unit, IMED Hospitales, Valencia, Spain
| | - Michael J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Shingo Fujii
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Chou MH, Meng E, Wu ST, Cha TL, Sun GH, Yu DS, Chung CH, Chien WC. Increased incidence of neurogenic bladder after radical hysterectomy for cervical cancer: A nationwide population-based cohort study. J Chin Med Assoc 2021; 84:942-950. [PMID: 34613942 DOI: 10.1097/jcma.0000000000000613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The effect of radical hysterectomy for patients with cervical cancer on voiding function remains controversial. The purpose of this study was to examine the association between radical hysterectomy for patients with cervical cancer and the odds of developing neurogenic bladder by using data from the National Health Insurance Research Database (NHIRD) in Taiwan. METHODS We identified 17 936 patients who underwent radical hysterectomy for cervical cancer between 2000 and 2013 among inpatients registered in the Longitudinal Health Insurance Database in Taiwan. Of the patients, those diagnosed as having cervical cancer without radical hysterectomy were selected and compared as a matched control group. Patients diagnosed as having cervical cancer before the index date, those with neurogenic bladder dysfunction before tracking, and those aged <20 years were excluded. The hazard ratios (HRs) of neurogenic bladder and other variants of interest were further calculated using a multivariate Cox regression analysis. The cutoff p value of <0.05 was regarded as statistically significant. RESULTS The adjusted HR (aHR) of subsequent neurogenic bladder was higher in the hysterectomy group (aHR = 1.205; 95% CI, 1.086-1.440; p = 0.029) than in the control group during the follow-up period. As to the age subgroups, the patients aged 20 to 44 years (aHR = 3.321, p = 0.001) had a significantly increased risk of developing neurogenic bladder after radical hysterectomy as compared with those aged 45 to 64 years (aHR = 1.193, p = 0.012). CONCLUSION Patients with cervical cancer undergoing radical hysterectomy have an increased risk of neurogenic bladder, which may result from nerve denervation caused by the operation. These patients should be informed of the potential risk of voiding dysfunction during discussion of the subsequent management for cervical cancer.
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Affiliation(s)
- Meng-Han Chou
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Guang-Huan Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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Aue-Aungkul A, Kietpeerakool C, Rattanakanokchai S, Galaal K, Temtanakitpaisan T, Ngamjarus C, Lumbiganon P. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer. Cochrane Database Syst Rev 2021; 1:CD012863. [PMID: 33491176 PMCID: PMC8092645 DOI: 10.1002/14651858.cd012863.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bladder dysfunction is a common complication following radical hysterectomy, caused by the damage to pelvic autonomic nerves that innervate the muscles of the bladder, urethral sphincter, and pelvic floor fasciae. Bladder dysfunction increases the rates of urinary tract infection, hospital visits or admission, and patient dissatisfaction. In addition, bladder dysfunction can also negatively impact patient quality of life (QoL). Several postoperative interventions have been proposed to prevent bladder dysfunction following radical hysterectomy. To our knowledge, there has been no systematic review evaluating the effectiveness and safety of these interventions for preventing bladder dysfunction following radical hysterectomy in women with cervical cancer. OBJECTIVES To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms. MAIN RESULTS We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms. AUTHORS' CONCLUSIONS None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.
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Affiliation(s)
- Apiwat Aue-Aungkul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chumnan Kietpeerakool
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Khadra Galaal
- Gynaecological Oncology, Princess Alexandra Wing, Royal Cornwall Hospital, Truro, UK
| | - Teerayut Temtanakitpaisan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chetta Ngamjarus
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Mengatto MF, Castro BGR, Nobrega L, Vieira MA, Andrade CEMC, Tsunoda AT, de Andrade DAP, Dos Reis R. Early removal of indwelling urinary catheter after radical surgery for early-stage cervical cancer-A cohort study. J Surg Oncol 2020; 122:1498-1505. [PMID: 32779228 DOI: 10.1002/jso.26167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the difference between early and delayed removal of indwelling urinary catheter after radical hysterectomy (RH) or radical trachelectomy (RT). METHODS An ambispective study was conducted in early-stage cervical cancer patients who underwent RH or RT. Delayed indwelling urinary catheter removal occurred on a postoperative day (POD) 7 in the retrospective group (January 2012-November 2013), and early removal occurred on POD 1 in the prospective group (May 2014-June 2017). The postvoid residual (PVR) test was performed after indwelling catheter removal in both groups. RESULTS Our sample included 47 patients in the delayed group and 48 in the early one. There was no difference in age, body mass index, tumor size, histology, stage, surgical approach, and intraoperative and postoperative complications. Indwelling urinary catheter reinsertion was needed in 16 (34%) patients in the delayed group and 12 (25%) in the early group (P = .37), with no statistical difference between the median PVR volumes -82.5 and 45 mL (P = .06), respectively. Seven (14.9%) patients in the delayed group presented with 30-day urinary tract infection vs two (4.2%) in the early group (P = .09). CONCLUSIONS Early indwelling urinary catheter removal, in regard to the rate of catheter reinsertion and PVR volume, does not differ from delayed removal.
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Affiliation(s)
- Mariana F Mengatto
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Beatriz G R Castro
- Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, Barretos, Brazil
| | - Leandro Nobrega
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marcelo A Vieira
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Carlos E M C Andrade
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Audrey T Tsunoda
- Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
| | | | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Togami S, Kubo R, Kawamura T, Yanazume S, Kamio M, Kobayashi H. Comparison of lymphatic complications between sentinel node navigation surgery and pelvic lymphadenectomy in patients with cervical cancer. Jpn J Clin Oncol 2020; 50:543-547. [PMID: 32104889 DOI: 10.1093/jjco/hyaa001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sentinel node navigation surgery (SNNS) has been frequently used in early cervical cancer. However, the incidence and potential reduction of lymphatic complications following the removal of the sentinel lymph node remain unknown. Thus, this study aimed to evaluate the occurrence of lymphatic complications post sentinel node navigation surgery in patients with early cervical cancer. METHODS A total of 167 patients, including 70 and 97 patients who had undergone SNNS and pelvic lymphadenectomy (PLA), respectively, were enrolled in this study. We compared the lymphatic complications (lower extremity lymphedema and pelvic lymphocele) between the SNNS and PLA groups. RESULTS The median number of sentinel lymph nodes removed was 2 (range: 1-14). Among the 70 patients in the SNNS group, there were 0 (0%) and 3 (4.3%) occurrences of lower extremity lymphedema and pelvic lymphocele, respectively. The occurrences of lower extremity lymphedema and pelvic lymphocele were significantly lower in the SNNS group than in the PLA group, despite circumflex iliac node removal. CONCLUSIONS The occurrence of lymphatic complications (lower extremity lymphedema and pelvic lymphocele) was significantly lower in the SNNS group than in the PLA group. We found that SNNS, and not PLA, was the best treatment option for preventing the development of lower extremity lymphedema and pelvic lymphocele, despite circumflex iliac node preservation.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Rintaro Kubo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Toshihiko Kawamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Lee S, Bae J, Han M, Cho Y, Park J, Oh S, Kim S, Choe S, Yun J, Lee Y. Efficacy of nerve‑sparing radical hysterectomy vs. conventional radical hysterectomy in early‑stage cervical cancer: A systematic review and meta‑analysis. Mol Clin Oncol 2019; 12:160-168. [PMID: 31929888 PMCID: PMC6951115 DOI: 10.3892/mco.2019.1959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Abstract
The aim of the present study was to compare the oncological outcome of nerve-sparing radical hysterectomy (NSRH) and conventional radical hysterectomy (CRH) for early-stage cervical cancer using a meta-analysis. A systematic review and meta-analysis was conducted, including 4 randomized controlled trials (RCT), 8 case-control and 11 comparative cohort studies comparing the morbidity, pelvic dysfunctions and oncological outcome between the two surgical methods. A total of 23 studies were included in this meta-analysis. The studies reported data of patients affected by cervical cancer; were written in English; included ≥20 patients; and reported data of patients with a comparison of clinical outcomes between NSRH and CRH. Data were extracted and risk of bias was assessed by four independent reviewers. A total of 1,796 patients were included: 884 patients (49.2%) undergoing NSRH and 912 (50.8%) undergoing CRH. The meta-analyses were conducted using Review Manager version 5.3 software, which is designed for conducting Cochrane reviews. As regards perioperative parameters, NSRH was found to be associated with a lower intraoperative blood loss and a shorter length of hospital stay in comparison with CRH. Patients undergoing NSRH experienced lower incidence of urinary, colorectal and sexual dysfunction compared with patients undergoing CRH. However, the resected parametrial width was favorable in patients with CRH, suggesting that NSRH was inferior to CRH in terms of radicality. The 5-year disease-free and overall survival rates were similar between the two groups. In this systematic review and meta-analysis, the collected data to date demonstrated that the nerve-sparing approach guarantees minimized surgical-related pelvic dysfunction, with similar oncological outcomes as CRH. However, further RCTs should be conducted to confirm the superiority and safety of NSRH.
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Affiliation(s)
- Seung Lee
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Jong Bae
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Myoungseok Han
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Yeon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Jung‑Woo Park
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - So Oh
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Su Kim
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Sun Choe
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Jeong Yun
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
| | - Yongmin Lee
- Department of Obstetrics and Gynecology, College of Medicine, Dong‑A University, Seo‑gu, Busan 49201, Republic of Korea
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Song J, Hu Q, Ma Z, Zhang J, Chen T. Value of diffusion-weighted and dynamic contrast-enhanced MR in predicting parametrial invasion in cervical stromal ring focally disrupted stage IB-IIA cervical cancers. Abdom Radiol (NY) 2019; 44:3166-3174. [PMID: 31377834 DOI: 10.1007/s00261-019-02107-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To compare the effectiveness of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging in detecting parametrial invasion (PMI) in cervical stromal ring focally disrupted stage IB-IIA cervical cancers. METHODS Eighty-one patients with cervical stromal ring focally disrupted stage IB-IIA cervical cancers (PMI positive, n = 35; PMI negative, n = 46) who underwent preoperative MRI and radical hysterectomy were included in this study. Preoperative clinical variables and MRI variables were analyzed and compared. RESULTS The Ktrans (min, mean, 10%, 25%, 50%, 75%, 90%), Kep (min, 10%, 25%, 50%, 75%, 90%), and Ve (min, 10%, 25%, 50%, 75%, 90%) values of patients with PMI were significantly higher than patients without PMI. The apparent diffusion coefficient (ADC) value did not show statistical difference between the two groups (1.01 ± 0.21 vs. 0.97 ± 0.20 10-3 mm2/s, p = 0.360). Tumor craniocaudal planes were higher in PMI-positive group than PMI-negative group (35.84 ± 15.39 vs. 29.70 ± 11.78 mm, p = 0.048). Tumor craniocaudal planes combined with Kepmin value showed the highest area under the curve (AUCs) of 0.775, with a sensitivity of 72.7% and a specificity of 71.1% (p = 0.000). CONCLUSIONS DCE parameters combined tumor craniocaudal planes may represent a prognostic indicator for PMI in cervical stromal ring focally disrupted IB-IIA cervical cancers.
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Affiliation(s)
- Jiacheng Song
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Qiming Hu
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zhanlong Ma
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China.
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China.
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9
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Nevo A, Haidar AM, Navaratnam A, Humphreys M. Urinary Retention Following Non-urologic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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10
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Kietpeerakool C, Aue‐aungkul A, Galaal K, Ngamjarus C, Lumbiganon P. Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). Cochrane Database Syst Rev 2019; 2:CD012828. [PMID: 30746689 PMCID: PMC6370917 DOI: 10.1002/14651858.cd012828.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radical hysterectomy is one of the standard treatments for stage Ia2 to IIa cervical cancer. Bladder dysfunction caused by disruption of the pelvic autonomic nerves is a common complication following standard radical hysterectomy and can affect quality of life significantly. Nerve-sparing radical hysterectomy is a modified radical hysterectomy, developed to permit resection of oncologically relevant tissues surrounding the cervical lesion, while preserving the pelvic autonomic nerves. OBJECTIVES To evaluate the benefits and harms of nerve-sparing radical hysterectomy in women with stage Ia2 to IIa cervical cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid (1946 to May week 2, 2018), and Embase via Ovid (1980 to 2018, week 21). We also checked registers of clinical trials, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the efficacy and safety of nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). DATA COLLECTION AND ANALYSIS We applied standard Cochrane methodology for data collection and analysis. Two review authors independently selected potentially relevant RCTs, extracted data, evaluated risk of bias of the included studies, compared results and resolved disagreements by discussion or consultation with a third review author, and assessed the certainty of evidence. MAIN RESULTS We identified 1332 records as a result of the search (excluding duplicates). Of the 26 studies that potentially met the review criteria, we included four studies involving 205 women; most of the trials had unclear risks of bias. We identified one ongoing trial.The analysis of overall survival was not feasible, as there were no deaths reported among women allocated to standard radical hysterectomy. However, there were two deaths in among women allocated to the nerve-sparing technique. None of the included studies reported rates of intermittent self-catheterisation over one month following surgery. We could not analyse the relative effect of the two surgical techniques on quality of life due to inconsistent data reported. Nerve-sparing radical hysterectomy reduced postoperative bladder dysfunctions in terms of a shorter time to postvoid residual volume of urine ≤ 50 mL (mean difference (MD) -13.21 days; 95% confidence interval (CI) -24.02 to -2.41; 111 women; 2 studies; low-certainty evidence) and lower volume of postvoid residual urine measured one month following operation (MD -9.59 days; 95% CI -16.28 to -2.90; 58 women; 2 study; low-certainty evidence). There were no clear differences in terms of perioperative complications (RR 0.55; 95% CI 0.24 to 1.26; 180 women; 3 studies; low-certainty evidence) and disease-free survival (HR 0.63; 95% CI 0.00 to 106.95; 86 women; one study; very low-certainty evidence) between the comparison groups. AUTHORS' CONCLUSIONS Nerve-sparing radical hysterectomy may lessen the risk of postoperative bladder dysfunction compared to the standard technique, but the certainty of this evidence is low. The very low-certainty evidence for disease-free survival and lack of information for overall survival indicate that the oncological safety of nerve-sparing radical hysterectomy for women with early stage cervical cancer remains unclear. Further large, high-quality RCTs are required to determine, if clinically meaningful differences of survival exist between these two surgical treatments.
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Affiliation(s)
- Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Apiwat Aue‐aungkul
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Chetta Ngamjarus
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Faculty of Public Health123 Miltraparp RoadKhon KaenKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Togami S, Kawamura T, Fukuda M, Yanazume S, Kamio M, Kobayashi H. Risk factors for lymphatic complications following lymphadenectomy in patients with cervical cancer. Jpn J Clin Oncol 2019; 48:1036-1040. [PMID: 30329065 DOI: 10.1093/jjco/hyy151] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/05/2018] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study was to evaluate the occurrence of lymphatic complications following pelvic lymphadenectomy (PLA) in patients with cervical cancer. Methods A retrospective study of 169 cervical cancer patients was conducted. Lower extremity lymphedema (LEL) was diagnosed using the International Society of Lymphology guidelines, and pelvic lymphocele (PL) was evaluated using trans-vaginal ultrasonography and computed tomography. Results The median patient age was 46 years (range: 22-74) and median body mass index was 21.7 kg/m2 (range: 15.7-37.1). The median number of lymph nodes (LNs) removed was 27 (range: 22-74); 94 (55.6%) patients underwent circumflex iliac node (CIN) dissection; 39 (23.1%) patients received adjuvant chemotherapy; and 81 (47.9%) patients received adjuvant postoperative radiotherapy. There were 28 (16.6%) and 32 (18.9%) occurrences of LEL and PL, respectively. In multivariate logistic regression analysis, the number of LNs removed (odds ratio [OR]: 3.37; 95% CI: 1.43-8.54; P = 0.0053) and CIN removal (OR: 3.92; 95% CI: 1.55-11.4; P = 0.0033) were independent risk factors for LEL; however, no risk factors were significantly associated with PL. Conclusions Our results demonstrated that CIN removal and the number of LNs removed were significant risk factors for LEL in patients with cervical cancer. However, we did not identify any significant risk factors for PL in this study. We instead speculate that LN dissection itself causes PL. We suggest that establishment of comprehensive PLA without CIN dissection, or use of the sentinel lymph node concept, will prevent the occurrence of lymphatic complications in cervical cancer patients.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan
| | - Toshihiko Kawamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan
| | - Mika Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan
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Yin S, Ma SN, Zhang YQ, Shi TY, Xiang LB, Ren YL, Zang RY. Surgical and oncological outcomes of an improved nerve-sparing radical hysterectomy technique: 6 years of experience at two centres. Surg Oncol 2018; 27:380-386. [DOI: 10.1016/j.suronc.2018.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 11/16/2022]
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Predicting Parametrial Invasion in Cervical Carcinoma (Stages IB1, IB2, and IIA): Diagnostic Accuracy of T2-Weighted Imaging Combined With DWI at 3 T. AJR Am J Roentgenol 2018; 210:677-684. [PMID: 29323549 DOI: 10.2214/ajr.17.18104] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to retrospectively evaluate the efficacy of combined analysis of T2-weighted imaging and DWI in the diagnosis of parametrial invasion (PMI) in cervical carcinoma. MATERIALS AND METHODS The clinical records of 192 patients with cervical carcinoma who met the study requirements were reviewed for this retrospective study. The signal intensities of suspicious PMI tissue were assessed on T2-weighted images, DW images, and apparent diffusion coefficient maps independently by two experienced radiologists. The radiologist observers predicted the presence of PMI by scoring T2-weighted imaging alone and then by scoring T2-weighted imaging and DWI combined. The results were compared with histopathologic findings. RESULTS Histopathologic findings revealed PMI in 24 of 192 study subjects. In positively predicting the presence of PMI, T2-weighted imaging and DWI combined scored significantly better than T2-weighted imaging alone, as proven by high sensitivity (T2-weighted imaging alone vs T2-weighted imaging and DWI combined: observer 1, 75.0% vs 83.3% [p = 0.477]; observer 2, 66.7% vs 91.7% [p < 0.05]), high specificity (T2-weighted imaging alone vs T2-weighted imaging and DWI combined: observer 1, 84.5% vs 98.8% [p < 0.001]; observer 2, 85.7% vs 98.8% [p < 0.001]), and high accuracy (T2-weighted imaging alone vs T2-weighted imaging and DWI combined: observer 1, 83.3% vs 96.9% [p < 0.001]; observer 2, 83.3% vs 97.9% [p < 0.001]). The area under the ROC curve was also significantly higher for T2-weighted imaging and DWI combined (observer 1, 0.911; observer 2, 0.952) than for T2-weighted imaging alone (observer 1, 0.798; observer 2, 0.762). Although the interobserver agreement was good for T2-weighted imaging (κ = 0.695) and excellent for T2-weighted imaging and DWI combined (κ = 0.753), the improvement failed to achieve statistical significance (p = 0.28). CONCLUSION Combined analysis of T2-weighted imaging and DWI enhances the accuracy of diagnosing PMI in patients with cervical cancer compared with T2-weighted imaging alone.
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Togami S, Kawamura T, Fukuda M, Yanazume S, Kamio M, Kobayashi H. Initial Report of Sentinel Lymph Node Identification During Laparoscopic Radical Hysterectomy Using a New Gamma Probe Technology. J Laparoendosc Adv Surg Tech A 2018; 28:864-866. [PMID: 29319395 DOI: 10.1089/lap.2017.0550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The standard surgical procedure for early-stage cervical cancer is abdominal radical hysterectomy, including pelvic lymphadenectomy. Currently, minimally invasive surgical techniques for early cervical cancer are progressing; total laparoscopic radical hysterectomy (TLRH) is a possible alternative to abdominal surgery. In addition, sentinel node navigation surgery (SNNS), which can prevent lower limb edema, has been widely used for radical hysterectomy. MATERIALS AND METHODS A radioisotope is injected into the uterine cervix 1 day preoperatively and surgeons carefully identify the correct sentinel lymph nodes (SLNs) to prevent picking up the cervical gamma rays during surgery. RESULTS It is difficult to identify SLNs in laparoscopic surgery compared to abdominal surgery using the traditional gamma probe, which has the sensor on the tip, since this probe picks up the gamma rays from the uterine cervix. We described 11 cases in which TLRH was combined with SNNS using a new device that accurately detects correct SLNs. CONCLUSIONS The SLNs were detected using a gamma probe that has a sensor built onto the side, without picking up the cervical gamma rays. We believe that the Neoprobe plays a crucial role in SNNS for accurately detecting SLNs and helping determine whether the patient needs to undergo SNNS.
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Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University , Kagoshima, Japan
| | - Toshihiko Kawamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University , Kagoshima, Japan
| | - Mika Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University , Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University , Kagoshima, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University , Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University , Kagoshima, Japan
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Aue-aungkul A, Kietpeerakool C, Galaal K, Temtanakitpaisan T, Ngamjarus C, Lumbiganon P. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Apiwat Aue-aungkul
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Chumnan Kietpeerakool
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall Hospital; Gynaecological Oncology; Truro UK TR1 3LJ
| | - Teerayut Temtanakitpaisan
- Faculty of Medicine, Khon Kaen University; Department of Obstetrics and Gynaecology; Mittraprap Road Khon Kaen Thailand
| | - Chetta Ngamjarus
- Khon Kaen University; Department of Epidemiology and Biostatistics, Faculty of Public Health; 123 Miltraparp Road Khon Kaen Khon Kaen Thailand 40002
| | - Pisake Lumbiganon
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
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Kim HS, Kim M, Luo Y, Lee M, Song YS. Favorable factors for preserving bladder function after nerve-sparing radical hysterectomy: A protocol-based validation study. J Surg Oncol 2017; 116:492-499. [PMID: 28695641 DOI: 10.1002/jso.24696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/02/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate favorable factors of nerve-sparing radical hysterectomy (NSRH) for preserving the pelvic autonomic nerves and subsequent bladder function and to compare the safety between NSRH and conventional radical hysterectomy (CRH) for cervical cancer. METHODS We recruited 87 consecutive patients with IB1-IIA cervical cancer who underwent NSRH, and reviewed the information of 81 patients who received CRH for historical comparisons. One gynaecologic oncologist performed all operations. RESULTS IB1 disease was the only favorable factor for unilateral or bilateral preservation (adjusted OR, 0.245; 95% CI, 0.077-0.774), whereas IB1 disease and squamous cell carcinoma (SqCC) were favorable for bilateral preservation (adjusted ORs, 0.336 and 0.116; 95% CIs, 0.162-0.982 and 0.023-0.581). The median duration of postoperative catheterization (DPC) was different among bilateral, unilateral and failed preservation (median 6 vs 18 vs 90 days; P < 0.001). The median DPC was shorter in NSRH patients with stage IB1 disease or SqCC (7 vs 14 days; P < 0.05) despite no difference between NSRH and CRH in those with IB2-IIA disease or non-SqCC. Survival was not different between NSRH and CRH patients. CONCLUSIONS IB1 disease and SqCC are favorable for preserving the pelvic autonomic nerves and subsequent bladder function without compromising survival outcomes in patients treated with NSRH.
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Affiliation(s)
- Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yanlin Luo
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Gong Y, Zhao L, Wang L, Wang F. The effect of clamping the indwelling urinary catheter before removal in cervical cancer patients after radical hysterectomy. J Clin Nurs 2017; 26:1131-1136. [PMID: 27627789 DOI: 10.1111/jocn.13579] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine the effect of clamping the indwelling urinary catheter before its removal on bladder reconditioning in patients with cervical cancer after radical hysterectomy. BACKGROUND It is suggested that indwelling urinary catheters should be clamped intermittently to fill the bladder and restore bladder function before removal. However, indwelling urinary catheter clamping showed no effect on bladder reconditioning according to some clinical studies. DESIGN Randomised controlled study. METHODS A total of 210 patients with cervical cancer after type C radical hysterectomy were randomised on 1:2 into two groups. In the clamping group, indwelling urinary catheters were clamped intermittently for 48 hours before removal based on a bladder-training sheet, while in the control group, the indwelling urinary catheters were removed without clamping. The primary outcome of the study was the rate of recatheterisation. The secondary outcomes included residual urine volume 24 hours after removal, incidence of urinary tract infection and duration of recatheterisation. RESULTS Seventy patients were assigned to the clamping group and 128 to the control group with paralleled baseline characteristics. The days of the primary catheterisation (13·20 ± 0·79 vs. 13·38 ± 1·04) and the incidence of urinary tract infection (22·9% vs. 20·3%) had no significant differences between the two groups. Ten patients in the clamping group and 19 in the control group underwent recatheterisation, the incidence of which showed no significant difference (14·3% vs. 14·8%). The days of recatheterisation were not statistically different between the two groups (11·40 ± 6·75 vs. 9·42 ± 5·23). However, the residual urine volume 24 hours after removal was higher in the clamping group than that in the control group. CONCLUSIONS Bladder recondition through indwelling urinary catheter clamping may not restore bladder function in patients after radical hysterectomy. RELEVANCE TO CLINICAL PRACTICE As indwelling urinary catheter clamping may increase the residual urine volume after indwelling urinary catheter removal and lead to an increased nursing workload, it should not be recommended in patients with cervical cancer postoperatively.
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Affiliation(s)
- Yao Gong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Zhao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fulan Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Recurrence of Early Stage Cervical Cancer After Laparoscopic Versus Open Radical Surgery. Int J Gynecol Cancer 2016; 26:547-52. [PMID: 26807638 DOI: 10.1097/igc.0000000000000627] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare site and time to recurrence in patients affected by early stage cervical cancer (CC) treated with laparoscopy radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH). METHODS This retrospective study was conducted in a university teaching, tertiary referral center hospital. We included patients undergoing either LRH or open ARH to treat CC. RESULTS One hundred fifty patients were included, 82 submitted to LRH and 68 submitted to ARH. Baseline characteristics of the 2 groups were comparable, except for body mass index higher in ARH group. Patients undergoing LRH experienced less blood loss (100 vs 400 mL, P < 0.0001), less lymph nodes removed (20 vs 31, P = 0.001), and shorter recovery (4 vs 8 days, P = 0.0005) in comparison with the ARH group. No significant differences were found regarding recurrence rate (9 vs 13, P = 0.17) and time to recurrence (8 vs 17 months, P = 0.066) between LRH and ARH group.Sites of recurrence were also comparable between the 2 groups: 2/9 versus 2/13 (P = 1) local recurrence, 4/9 versus 8/13 (P = 0.66) pelvic recurrence, 4/9 versus 7/13 (P = 1) distant recurrence in LRH and ARH groups, respectively. The most frequent sites of recurrence were pelvic and distant (44.4%) in LRH group and pelvic (61.5%) in ARH group. CONCLUSIONS Our data demonstrate that early stage CC can be treated with LRH with similar recurrence rates and patterns in comparison with ARH, reassuring its continuing clinical use.
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The Value of Diffusion-Weighted Imaging in Predicting the Prognosis of Stage IB-IIA Cervical Squamous Cell Carcinoma After Radical Hysterectomy. Int J Gynecol Cancer 2016; 26:361-6. [PMID: 26807567 DOI: 10.1097/igc.0000000000000613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate the value of mean apparent diffusion coefficient (ADC(mean)) value in predicting the prognosis of stage IB-IIA cervical squamous cell carcinoma (SCC) patients after radical hysterectomy. MATERIALS AND METHODS A total of 126 patients who were with stage IB-IIA cervical SCC and underwent magnetic resonance imaging examination and radical hysterectomy were retrospectively investigated. Receiver operating characteristic curve was used to determine the cutoff values of ADC(mean) for predicting earlier recurrence (2 consecutive increases in the SCC antigen value of more than 1 ng/mL or elevation of greater than 1.5 ng/mL). Disease-free survival and overall survival were analyzed using the Kaplan-Meier method, and differences between the survival curves were examined using the log-rank test. RESULTS Earlier recurrence was observed in 46 patients (36.2%) during a median follow-up of 22 months. The ADC(mean) value (P = 0.005), parametrial invasion (P = 0.049), and lymphovascular space invasion (P = 0.037) were significantly associated with earlier recurrence. Receiver operating characteristic curve identified that the cutoff value of ADC(mean) for predicting earlier recurrence was 0.785 × 10(-3)mm(2)/s. The ADC(mean) value, parametrial invasion, and lymphovascular space invasion were significantly associated with earlier recurrence. The hazard ratios were 7.33 (95% confidence interval [95% CI], 1.854-28.99), 4.88 (95% CI, 1.00-23.73), and 2.53 (95% CI, 1.058-6.052), respectively. Disease-free survival and overall survival rates of patients with the ADC(mean) less than 0.785 × 10(-3)mm(2)//s were significantly worse than those of patients with the ADC(mean) greater than or equal to 0.785 × 10(-3)mm(2)/s. CONCLUSIONS Mean ADC was a good biomarker in predicting the prognosis of stage IB-IIA cervical SCC after radical hysterectomy.
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Abstract
Although a rare cancer in the developed world due to the success of cervical screening programmes, cervical cancer remains one of the most common cancers diagnosed in women under the age of 35 years old. Radical hysterectomy and more recently radical trachelectomy have been highly effective in curing the majority of women with early stage disease. Many, however, are left with long-term 'survivorship' issues including bowel, bladder and sexual dysfunction. In view of these chronic co-morbidities, many clinicians now consider whether a less radical approach to surgery may be an option for some women. This review focuses on the current evidence for the safety of conservative surgery for early stage cervical cancer with regard to cure rates in comparison to standard management, as well as any improvement in short and long-term morbidity associated with a more conservative approach.
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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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Kim HS, Kim K, Ryoo SB, Seo JH, Kim SY, Park JW, Kim MA, Hong KS, Jeong CW, Song YS. Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis. J Gynecol Oncol 2016; 26:100-10. [PMID: 25872891 PMCID: PMC4397225 DOI: 10.3802/jgo.2015.26.2.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. Methods After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. Results Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. Conclusion NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
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Affiliation(s)
- Hee Seung Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Joung Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min A Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Sup Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Sang Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Major in Biomodulation, World Class University, Seoul National University, Seoul, Korea.
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Aoun F, Roumeguère T. Les conséquences neuro-urologiques de la colpohystérectomie totale pour le traitement du cancer du col utérin. Prog Urol 2015; 25:1184-90. [DOI: 10.1016/j.purol.2015.08.311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/20/2015] [Accepted: 08/13/2015] [Indexed: 12/17/2022]
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Bladder Dysfunction After Radical Hysterectomy Preventive Modalities: Limitations. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Aoun F, Albisinni S, Peltier A, Maoula A, van Velthoven R, Roumeguère T. [Lower urinary tract dysfunction following nerve sparing radical hysterectomy: A systematic review]. Prog Urol 2015; 26:S1166-7087(15)00690-9. [PMID: 26776826 DOI: 10.1016/j.purol.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Radical hysterectomy represents the cornerstone in the management of localized cervical cancer. Despite its oncologic efficacy, radical hysterectomy is associated with a significant amount of complications and a negative impact on quality of life. Surgical technique seems to influence the functional outcomes. AIM OF THE STUDY A systematic review to provide an update on the lower urinary tract dysfunction following nerve sparing radical hysterectomy. METHODS An initial search was carried out to identify articles for further review, using Cochrane reviews and PubMed and Embase databases. The search terms used were: "nerve sparing" and "cervical cancer" or "radical hysterectomy". The Preferred Reporting Items for Systematic Reviews and Meta-Analyses process for reporting included and excluded studies was followed, with the recommended flowchart showing the numbers of papers identified and included or excluded at each stage. RESULTS Twenty-nine clinical studies were included. The absence of a standardized surgical technique for nerve sparing radical hysterectomy and the poor methodological quality of the studies assessing lower urinary tract dysfunction after such intervention limited clear conclusions. However, all studies reported lower incidence of urinary tract dysfunction, urodynamic abnormalities and clean intermittent catheterization following nerve sparing radical hysterectomy compared to conventional technique. CONCLUSION Nerve sparing radical hysterectomy is associated with reduced lower urinary tract dysfunction. A standardization of the surgical technique for nerve sparing radical hysterectomy, tailored to each individual is necessary to allow its wide spread diffusion.
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Affiliation(s)
- F Aoun
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique.
| | - S Albisinni
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - A Peltier
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - A Maoula
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - R van Velthoven
- Service d'urologie, institut Jules Bordet, université Libre de Bruxelles, 1, rue Héger-Bordet, 1000 Bruxelles, Belgique
| | - T Roumeguère
- Service d'urologie, université Libre de Bruxelles, hôpital Erasme, cliniques universitaires de Bruxelles, Bruxelles, Belgique
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Kim HS, Kim TH, Suh DH, Kim SY, Kim MA, Jeong CW, Hong KS, Song YS. Success Factors of Laparoscopic Nerve-sparing Radical Hysterectomy for Preserving Bladder Function in Patients with Cervical Cancer: A Protocol-Based Prospective Cohort Study. Ann Surg Oncol 2015; 22:1987-1995. [DOI: 10.1245/s10434-014-4197-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
IMPORTANCE Surgery has evolved into the standard therapy for nonbulky carcinoma of the cervix. The mainstay of surgical management is radical hysterectomy; however, less radical procedures have a small but important role in the management of cervical tumors. OBJECTIVE Our objective was to discuss the literature behind the different procedures utilized in the management of cervical cancer, emphasizing the radical hysterectomy. In addition, we aimed to discuss ongoing trials looking at the utility of less radical surgeries as well as emerging technologies in the management of this disease. EVIDENCE ACQUISITION We performed a PubMed literature search for articles in the English language that pertained to the topic of surgical techniques and their outcomes in the treatment of cervical cancer. RESULTS The minimally invasive approaches to radical hysterectomy appear to reduce morbidity without affecting oncological outcomes, although further data are needed looking at long-term outcomes with the robotic platform. Trials are currently ongoing looking at the role of less radical surgery for patients with low-risk disease and the feasibility of sentinel lymph node mapping. CONCLUSIONS AND RELEVANCE Radical hysterectomy with pelvic lymphadenectomy has evolved into the standard therapy for nonbulky disease, and there is a clear advantage in the use of minimally invasive techniques to perform these procedures. However, pending ongoing trials, less radical surgery in patients with low-risk invasive disease as well as sentinel lymph node mapping may emerge as standards of care in selected patients with cervical carcinoma.
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Li H, Jia J, Xiao Y, Kang L, Cui H. Anatomical basis of female pelvic cavity for nerve sparing radical hysterectomy. Surg Radiol Anat 2014; 37:657-65. [PMID: 25533026 DOI: 10.1007/s00276-014-1405-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The separation and sparing of the vesical branch of the inferior hypogastric plexus (IHP), to preserve the pelvic autonomic nerve, is critical and difficult in nerve sparing radical hysterectomy. Pelvic local anatomy was performed to provide the necessary anatomical information. METHODS Precise pelvic anatomy was performed in 15 adult corpses, and immunohistochemical analysis was carried out on the parametrial tissues of three fresh cadavers to analyze the nerve fiber type and content of the vesical branch of the IHP. RESULTS The deep uterine vein is located in the upper region of the cardinal ligament (CL), with three to six multiple branches and anatomical variation, including one or two cervical branches, and two to four vesical branches. Three branches were found to be most common (63.3 %). The major distribution of the vesical branch of the IHP is dorsomedial to the middle and inferior vesical veins, with less ventral and lateral distribution. There are more sympathetic fibers than parasympathetic fibers in the vesical branch. There is a region rare of vasculature and nerve between the vaginal lateral margin and the vesical branch. CONCLUSION The deep uterine vein is suggested as an anatomical landmark during surgery, to process the CL and preserve the pelvic splanchnic nerves. The middle and inferior vesical veins can be used as the landmark to preserve the vesical branch of the IHP.
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Affiliation(s)
- Haili Li
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
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Aoun F, van Velthoven R. Lower urinary tract dysfunction after nerve-sparing radical hysterectomy. Int Urogynecol J 2014; 26:947-57. [PMID: 25432634 DOI: 10.1007/s00192-014-2574-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/04/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this review is to provide a comprehensive overview of the current role of nerve-sparing radical hysterectomy (NSRH) in reducing the incidence of postoperative lower urinary tract dysfunction (LUTD) and in improving quality of life. METHODS A detailed online search was performed using the following keywords: nerve sparing, radical hysterectomy, cervical cancer, and all these terms in combination with urinary dysfunction or bladder dysfunction in order to analyze the effect of NSRH on urinary functional outcomes. Articles retrieved were analyzed and assigned a level of evidence (LE) according to the criteria of the Centre for Evidence-Based Medicine in Oxford, UK. RESULTS Our review highlights the heterogeneity of conducting and reporting studies in the literature. Autonomic pelvic nerve injuries during the procedure are thought to be the major cause of LUTD. The amount of LUTD depends upon the extent and type of nerve injury. Anatomically based surgical techniques are developed to avoid nerve injury without compromising oncological control. All studies comparing NSRH to standard RH yielded promising results with respect to postoperative LUTD. A recent meta-analysis showed similar cancer control rates between the two techniques. However, controversies remain about the ideal surgical approach for nerve sparing and there is no consensus as to the level and landmarks of dissection to preserve the maximal amount of nerves without compromising oncological outcomes. CONCLUSIONS Available evidence suggests that NSRH is safe and associated with lower incidence of LUTD. However, there is no standardized technique for NSRH and controversies remain about its oncological safety. Long-term oncological data from multicenter surgical trials are needed as well as a universally accepted standard to report studies on NSRH.
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Affiliation(s)
- Fouad Aoun
- Urology Department, Jules Bordet Institute, 1 Héger Bordet Street, 1000, Brussels, Belgium,
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Implementation of laparoscopic approach for type B radical hysterectomy: a comparison with open surgical operations. Eur J Surg Oncol 2014; 41:34-9. [PMID: 25468458 DOI: 10.1016/j.ejso.2014.10.058] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/09/2014] [Accepted: 10/26/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the safety, feasibility and effectiveness of laparoscopic approach in the management patients undergoing modified radical hysterectomy for early stage cervical cancer. METHODS Consecutive data of 157 women who had class II radical hysterectomy, for stage IA2 and stage IB1 <2 cm cervical cancer, were prospectively collected. Data of patients undergoing surgery via laparoscopy (LRH) were compared with those undergoing open surgical operations (RAH). A propensity-matched comparison (1:1) was carried out to minimize as possible selection biases. Post-operative complications were graded per the Clavien-Dindo classification. Five-year survival outcomes were assessed using Kaplan-Meier model. RESULTS After the exclusion of 37 (23.5%) patients on the basis of propensity-matching, 60 patients undergoing LRH were compared with 60 patients undergoing RAH. No between-group differences in baseline, disease and pathological variables were observed (p > 0.05). Patients undergoing surgery via laparoscopy experienced longer operative time than patients undergoing RAH; while LRH correlated whit shorter length of hospitalization and lower blood loss in comparison to RAH. Intra- and post-operative complication rate was similar between groups (p = 1.00). The execution of LRH or RAH did not influence site of recurrence (p > 0.2) as well as survival outcomes, in term of 5-year disease-free (p = 0.29, log-rank test) and overall survivals (p = 0.50, log-rank test). CONCLUSION Laparoscopic approach is a safe procedure, upholds the results of RAH, reducing invasiveness of open surgical operations. Further large prospective investigations are warranted.
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Fanfani F, Costantini B, Mascilini F, Vizzielli G, Gallotta V, Vigliotta M, Piccione E, Scambia G, Fagotti A. Early postoperative bladder training in patients submitted to radical hysterectomy: is it still necessary? A randomized trial. Arch Gynecol Obstet 2014; 291:883-8. [PMID: 25273982 DOI: 10.1007/s00404-014-3500-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 09/25/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the role of bladder training during postoperative hospital stay in patients submitted to nerve-sparing radical hysterectomy, and to identify any clinical or surgical factor associated with postoperative bladder dysfunction. DESIGN, SETTING, AND PARTICIPANTS Parallel group randomized single institution trial, on gynaecologic malignancies patients conducted in Catholic University of Sacred Heart Rome, between April 2009 and November 2011. Randomization was on 1:1, using a block randomized computer-generated list. INTERVENTIONS Patients underwent Querleu-Morrow type B2 or C1 radical hysterectomy. After 2 days from surgery, patients were randomized to perform or not bladder training (scheduled clamping and unclamping of the trans-urethral catheter every three hours). Main outcome measures Necessity and duration of clean intermittent self catheterization. RESULTS Randomized participants were 111 women (bladder training arm n = 55; control arm n = 56). A total of 22 women (19.8%) required clean intermittent self catheterization, equally distributed in the two arms. At univariate analysis, only the type of radical hysterectomy was significantly associated with need of clean intermittent self catheterization (type C1 vs. type B2; p = 0.013). At univariate analysis, duration of clean intermittent self-catheterization was not associated with age, BMI, type of hysterectomy and of neo-adjuvant treatment. CONCLUSIONS Functional bladder disfunctions are the most common long-term complications following radical hysterectomy. Systematic postoperative bladder training following nerve-sparing radical hysterectomy does not influence the rate of urinary retention or re-admission for bladder catheterization.
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Affiliation(s)
- Francesco Fanfani
- Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy,
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Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis. PLoS One 2014; 9:e94116. [PMID: 24748015 PMCID: PMC3991621 DOI: 10.1371/journal.pone.0094116] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/13/2014] [Indexed: 11/21/2022] Open
Abstract
Backgroud and Objective Nerve-sparing radical hysterectomy (NSRH) may be associated with lower postoperative morbidity than radical hysterectomy (RH). We aimed to compare the clinical efficacy and safety of abdominal or laparoscopic NSRH and RH for treating cervical cancer through systematic review and meta-analysis. Methods PubMed, EMBASE, The Cochrane Library and the Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to compare intra- and postoperative outcomes for the two techniques. Results A total of 17 clinical trials were identified. Meta-analysis showed that although operating time was significantly longer for abdominal or laparoscopic NSRH than for RH, NSRH based on laparotomy or laparoscopy proved more effective for postoperative recovery of bladder function. NSRH was also associated with lower bladder dysfunction morbidity and fewer postoperative complications. Two abdominal trials and one laparoscopic study further suggested that NSRH was associated with shorter time to recovery of anal/rectal function. In contrast, RH and NSRH based on laparotomy or laparoscopy were similar in terms of extent of resection, recurrence rate, survival rate, blood loss and frequency of intraoperative complications. The meta-analysis showed that abdominal NSRH was not significantly different from RH in length of hospital stay, while one trial suggested that length of hospital stay was shorter after laparoscopic NSRH than after the corresponding RH. Conclusion NSRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than RH for postoperative recovery of pelvic organ function and postoperative morbidity, while the two techniques involve similar clinical safety and extent of resection. These results should be considered preliminary since they are based on a relatively small number of controlled trials, most of which were non-randomized. The findings should be verified in larger, well-designed studies.
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Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2–IIA cervical cancer. Eur Radiol 2014; 24:1081-8. [DOI: 10.1007/s00330-014-3109-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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Abstract
Several urological complications can occur after treatment of cervical cancer. Stage IB and IIA cervical tumours are mainly treated by radical hysterectomy; advanced-stage tumours are treated by chemoradiotherapy. In the past two decades, a decrease in complications has been seen due to improvements in therapy, although the exact incidence of lower urinary tract dysfunction is unknown. The main urological complications after radical surgery are hypocontractility of the bladder, detrusor overactivity, incontinence, low-compliance bladder, fistula and hydronephrosis. As a result of improved neuroanatomical knowledge, and consequently nerve-sparing surgery, bladder morbidity has been decreasing. Late radiation-induced urological complications include haemorrhagic cystitis, ureteric stenosis, low-compliance bladder and fistulas. Owing to technological improvements, such as dose reduction and decreased radiation fields, a decrease in radiation morbidity has been observed since 1990.
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Affiliation(s)
- Esther M K Wit
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
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Lanowska M, Brink-Spalink V, Mangler M, Grittner U, von Tucher E, Schneider A, Köhler C. Vaginal-assisted laparoscopic radical hysterectomy (VALRH) versus laparoscopic-assisted radical vaginal hysterectomy (LARVH) in the treatment of cervical cancer: surgical results and oncologic outcome. Arch Gynecol Obstet 2013; 289:1293-300. [PMID: 24362556 DOI: 10.1007/s00404-013-3121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the morbidity and survival rates of patients with early-stage cervical cancer treated by vaginal-assisted laparoscopic radical hysterectomy (VALRH) with pair-matched laparoscopic-assisted vaginal radical hysterectomy (LARVH) controls. METHODS One hundred nine patients who underwent VALRH for cervical cancer stage FIGO Ia1, L1 to IIb between 2007 and 2009 and 200 patients who underwent LARVH between 1994 and 2002 were analysed in their entirety and in a group of matched pairs. RESULTS In both groups, there was no conversion to laparotomy due to an intraoperative complication. Prevalence of blood transfusions was significantly lower in the VALRH group (2 vs. 39 patients; P < 0.001). Bladder function resumed sooner (P < 0.001), and patients were discharged earlier after VALRH (P < 0.001). There were no intraoperative injuries in the VALRH group. In the LARVH group, the most common intraoperative injury occurred to the bladder (7.0 %). Postoperatively, the most common complication in the VALRH group was ureterovaginal fistula (2.7 %) and fever (2.7 %) and in the LARVH ureterostenosis (3.5 %), uretero/bladder fistula (1 %), and fever (7 %). For patients with tumour stage Ib1 the 5-year recurrence-free survival was 92.8 % and 5-year overall survival 95.2 % following VALRH and 88.2 and 90.5 %, respectively, following LARVH. No significant difference in the survival rate was found (log rank, P = 0.740). CONCLUSION VALRH is a feasible and oncologically safe surgical option for patients with early-stage cervical cancer. We believe the complication rate is lowered in VALRH by the combination of the laparoscopic and vaginal approach.
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Affiliation(s)
- Malgorzata Lanowska
- Department of Gynecology, Charité-University Medicine Berlin, Campus Mitte and Benjamin Franklin, Charitéplatz 1, 10117, Berlin, Germany,
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Self-Reported Sexual, Bowel and Bladder Function in Cervical Cancer Patients Following Different Treatment Modalities: Longitudinal Prospective Cohort Study. Int J Gynecol Cancer 2013; 23:1717-25. [DOI: 10.1097/igc.0b013e3182a80a65] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveConventional radical hysterectomy with pelvic lymphadenectomy (RHL) for early-stage cervical cancer is associated with significant bladder, anorectal, and sexual dysfunction. Nerve-sparing modification of RHL (NS-RHL) has been developed with the aim to reduce surgical treatment-related morbidity. Postoperative radiation therapy (RT) is offered to patients with unfavorable prognostic features to improve local control. The aim of the study was to assess self-reported morbidity of various types of treatment in cervical cancer patients.MethodsSelf-reported symptoms were prospectively assessed before and 1 and 2 years after treatment by the Dutch Gynaecologic Leiden Questionnaire.ResultsIncluded were 229 women (123 NS-RHL and 106 conventional RHL). Ninety-four (41%) received RT. Up to 2 years (response rate, 81%), women reported significantly more bowel, bladder, and sexual symptoms compared with the pretreatment situation. No significant difference was found between the conventional RHL and NS-RHL with the exception of the unexpected finding that a smaller percentage in the NS-RHL group (34% vs 68%) complained about numbness of the labia and/ or thigh. Radiation therapy had a negative impact on diarrhea, urine incontinence, lymphedema, and sexual symptoms (especially a narrow/short vagina).ConclusionsIn the current longitudinal cohort study, treatment for early-stage cervical cancer was associated with worse subjective bladder, anorectal, and sexual functioning, irrespective of the surgical procedure used. Postoperative RT resulted in a significant deterioration of these functions. The results have to be interpreted with caution in view of the study design and method used.
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Jarruwale P, Huang KG, Benavides DR, Su H, Lee CL. Nerve-sparing radical hysterectomy in cervical cancer. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Gemer O, Eitan R, Gdalevich M, Mamanov A, Piura B, Rabinovich A, Levavi H, Saar-Ryss B, Halperin R, Finci S, Beller U, Bruchim I, Levy T, Ben Shachar I, Ben Arie A, Lavie O. Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement. Eur J Surg Oncol 2013; 39:76-80. [DOI: 10.1016/j.ejso.2012.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/07/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022] Open
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Klat J, Sevcik L, Simetka O, Graf P, Dvorackova J, Kraft O. What is the risk for parametrial involvement in women with early-stage cervical cancer with tumour <20 mm and with negative sentinel lymph nodes? Aust N Z J Obstet Gynaecol 2012; 52:540-4. [DOI: 10.1111/ajo.12015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/20/2012] [Indexed: 11/28/2022]
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Gottschalk E, Lanowska M, Chiantera V, Marnitz S, Schneider A, Brink-Spalink V, Hasenbein K, Koehler C. Vaginal-assisted laparoscopic radical hysterectomy: rationale, technique, results. JSLS 2012; 15:451-9. [PMID: 22643498 PMCID: PMC3340952 DOI: 10.4293/108680811x13176785203879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors conclude that vaginal-assisted laparoscopic radical hysterectomy is an oncologic viable alternative to abdominal radical hysterectomy, laparoscopic-assisted radical vaginal hysterectomy, totally laparoscopic radical hysterectomy, and robotic radical hysterectomy. Objective: Total laparoscopic radical hysterectomy (TLRH) makes it difficult to resect adequate vaginal cuff according to tumor size and to avoid tumor spread after opening the vagina. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is associated with higher risk for urologic complications. Methods: The vaginal-assisted laparoscopic radical hysterectomy (VALRH) technique comprises 3 steps: (1) comprehensive laparoscopic staging, (2) creation of a tumor-adapted vaginal cuff, and (3) laparoscopic transsection of parametria. We retrospectively analyzed data of 122 patients who underwent VALRH for early stage cervical cancer (n=110) or stage II endometrial cancer (n=12) between January 2007 and December 2009 at Charité University Berlin. Results: All patients underwent VALRH without conversion. Mean operating time was 300 minutes, and mean blood loss was 123cc. On average, 36 lymph nodes were harvested. Intra- and postoperative complication rates were 0% and 13.1%, respectively. Resection was in sound margins in all patients. After median follow-up of 19 months, disease-free survival and overall survival for all 110 cervical cancer patients was 94% and 98%, and for the subgroup of patients (n=90) with tumors ≤pT1b1 N0 V0 L0/1 R0, 97% and 98%, respectively. Conclusion: VALRH is a valid alternative to abdominal radical hysterectomy and LARVH in patients with early-stage cervical cancer and endometrial cancer stage II with minimal intraoperative complications and identical oncologic outcomes.
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A model for prediction of parametrial involvement and feasibility of less radical resection of parametrium in patients with FIGO stage IB1 cervical cancer. Gynecol Oncol 2012; 126:82-6. [DOI: 10.1016/j.ygyno.2012.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 11/20/2022]
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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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Cibula D, Abu-Rustum N, Benedetti-Panici P, Köhler C, Raspagliesi F, Querleu D, Morrow C. New classification system of radical hysterectomy: Emphasis on a three-dimensional anatomic template for parametrial resection. Gynecol Oncol 2011; 122:264-8. [PMID: 21592548 DOI: 10.1016/j.ygyno.2011.04.029] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 04/17/2011] [Accepted: 04/19/2011] [Indexed: 11/25/2022]
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Espino-Strebel EE, Luna JTP, Domingo EJ. A comparison of the feasibility and safety of nerve-sparing radical hysterectomy with the conventional radical hysterectomy. Int J Gynecol Cancer 2011; 20:1274-83. [PMID: 21495251 DOI: 10.1111/igc.0b013e3181f165f2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Radical hysterectomy has been the treatment of choice for early-stage cervical cancer. Since its introduction in oncology, modifications to the original technique were made to enhance feasibility, improve cure rate, and decrease postoperative complications. Among these are the identification and preservation of pelvic autonomic nerves, known as the nerve-sparing radical hysterectomy (RH). This retrospective study was conducted to compare the nerve-sparing with the conventional RH in terms of feasibility and safety, including bladder dysfunction and perioperative and postoperative complications and morbidities. METHODS Patients with biopsy-proven early-stage cervical carcinoma, cervical carcinoma with central tumor recurrence or persistence after primary radiotherapy, and endometrial carcinoma with cervical involvement treated with RH with or without nerve-sparing technique were included. The perioperative and postoperative complications and bladder function of these patients were analyzed. RESULTS Ninety-seven patients with early-stage cervical cancer and 24 patients with clinical stage II endometrial cancer underwent RH with or without nerve-sparing technique in a nonrandomized fashion. There was no statistically significant difference between the 2 procedures in terms of duration of surgery, intraoperative blood loss, duration of hospitalization, and morbidity. Patients who underwent the nerve-sparing approach had a statistically significant earlier return of bladder function, with a mean of 9.4 days for the cervical cancer cases (vs 21 days in the non-nerve-sparing group) and a mean of 8.5 days for the endometrial cancer cases (vs 22.6 days in the non-nerve-sparing group). CONCLUSIONS The technique of sparing the pelvic autonomic nerves during RH for early-stage cervical cancer and clinical stage II endometrial cancer is comparable to the conventional method in terms of perioperative complications and morbidity, but is more favorable in terms of return of bladder function.
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Affiliation(s)
- Elizabeth E Espino-Strebel
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Philippines.
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Ditto A, Martinelli F, Mattana F, Reato C, Solima E, Carcangiu M, Haeusler E, Mariani L, Raspagliesi F. Class III Nerve-sparing Radical Hysterectomy Versus Standard Class III Radical Hysterectomy: An Observational Study. Ann Surg Oncol 2011; 18:3469-78. [DOI: 10.1245/s10434-011-1767-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Indexed: 11/18/2022]
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Oncologic Results and Surgical Morbidity of Laparoscopic Nerve-Sparing Radical Hysterectomy in the Treatment of FIGO Stage IB Cervical Cancer: Long-Term Follow-Up. Int J Gynecol Cancer 2011; 21:355-62. [DOI: 10.1097/igc.0b013e31820731bb] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives:The aim of this study was to evaluate a long-term follow-up data for oncologic results and surgical morbidity of a laparoscopic nerve-sparing radical hysterectomy (NSRH) in the treatment of FIGO stage IB cervical cancer.Methods:This was a retrospective study that comprised consecutive 125 patients with cervical cancer stage IB1 (n = 105) and IB2 (n = 20) who underwent a laparoscopic NSRH (Piver type III) by a gynecologic oncologist without selecting patients from January 1999 to December 2007.Results:In regression analysis, the operating time (R2linear = 0.311,P< 0.001) and estimated blood loss (R2linear = 0.261,P< 0.001) were decreased, whereas the number of harvested pelvic lymph nodes (R2linear = 0.250,P< 0.001) was increased. Seventeen patients (13.6%, 17/125) were found to have pelvic node metastasis. Para-aortic node metastasis had occurred in 2 patients (5.1%, 2/39). There were high urological complications (13/125, 10.4%) related to radical surgery. Forty-one patients (33%) needed transfusions. Positive surgical margins did not exist. Patients were able to self-void at a mean of 10.3 days postoperatively. The return rates to normal voiding function at postoperative 14 and 21 days were 92.0% and 95.2%, respectively. Thirteen patients (IB1 n = 9, IB2 n = 4) experienced a recurrence postoperatively. Six patients (IB1 n = 3, IB2 n = 3) died of recurrent disease. Five-year disease-free survival rates of cervical cancer IB1 and IB2 were 92% and 78%, respectively (P= 0.1772). Five-year overall survival rates of cervical cancer IB1 and IB2 were 96% and 83%, respectively (P= 0.0437).Conclusions:A laparoscopic NSRH for FIGO stage IB cervical cancer was comparable to open NSRH in terms of early recovery of bladder function. It did not compromise surgical radicality, but revealed high urological complications, long operating time, and much blood loss, compared with conventional radical hysterectomy. However, these surgical morbidities were corrected with increase in experiences.
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Charoenkwan K. A simplified technique for nerve-sparing type III radical hysterectomy: by reorganizing their surgical sequence, surgeons could more easily identify key nerves. Am J Obstet Gynecol 2010; 203:600.e1-6. [PMID: 21111111 DOI: 10.1016/j.ajog.2010.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 09/07/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
Nerve-sparing radical hysterectomy was developed in an attempt to minimize complications, including bladder, colorectal, and sexual dysfunction which are associated with disruption of the pelvic autonomic nerves during resection of the parametrium. In this article, the author proposes a simple, effective technique for identification and preservation of the pelvic nerves during type III radical hysterectomy. The essential technical considerations include the sequential approach to parametrial resection, starting from the posterior part, the direct visualization of the main nerve trunks at all sites during parametrial resection, and the avoidance of direct manipulation and unnecessary dissection of the nerves. Operative outcomes of 22 patients with cervical or uterine cancer who underwent type III radical hysterectomy from August 2008 to March 2010 were reviewed. Comparing with the earlier method performed at the author's institution, the present technique was associated with an increased proportion of patients who had a postvoid residual urine volume (PVR) under 50 mL at postoperative day 7 (55% vs 27%) and a shorter median duration before this PVR was reached (7 days vs 9 days). The systematic approach proposed in this article would make the nerve-sparing technique for radical hysterectomy more straightforward and applicable to various settings. A thorough understanding of anatomy and adequate surgical skills are always vital components of successful nerve-sparing radical hysterectomy.
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Ditto A, Martinelli F, Hanozet F, Reato C, Solima E, Zanaboni F, Grijuela B, Carcangiu M, Haeusler E, Raspagliesi F. Class III NSRH: Oncological outcome in 170 cervical cancer patients. Gynecol Oncol 2010; 119:192-7. [DOI: 10.1016/j.ygyno.2010.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 07/21/2010] [Accepted: 07/24/2010] [Indexed: 10/19/2022]
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Shen Y, Wang Z. Total laparoscopic radical hysterectomy for treatment of uterine malignant tumors: analysis of short-term therapeutic efficacy. ACTA ACUST UNITED AC 2010; 30:375-8. [PMID: 20556585 DOI: 10.1007/s11596-010-0360-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Indexed: 12/22/2022]
Abstract
To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy (TLRH) for the treatment of uterine malignancies, we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009. Data collected included operative time, estimated blood loss, lymph node count, time for the recovery of normal temperature and time to resumption of normal bladder function, intraoperative and postoperative complications. The procedure was completed laparoscopically in 108 patients. Two patients were converted to laparotomy due to common iliac vein injury. The mean overall operative time was 200.6+/-38.6 min; the mean operative blood loss was 280.5+/-128.3 mL; he mean number of pelvic lymph nodes that were resected wa26. 0+/-5.8. The time for recovery of normal temperature and the normal bladder function after the operation was 5.8+/-2.9 d and 15.2+/-4.3 d. There were 2 (1.8%) common iliac vein injuries during the operation and 10 (9.1%) bladder retentions post operation. It was concluded that TLRH is feasible, minimally invasive and provides promise for the treatment of uterine malignancies.
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Affiliation(s)
- Yi Shen
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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