Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Objective

To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer.

Methods

From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone.

Results

There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival.

Conclusion

As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.     

Survival and prognostic factors comparing stage IB 1 versus stage IB 2 cervical cancer treated with primary radical hysterectomy

This study was undertaken to compare the survival rates of stage IB 1 versus stage IB 2 cervical cancer patients and to evaluate the prognostic factors after treatment primarily with radical hysterectomy and pelvic lymphadenectomy (RHPL). Patients with stage IB cervical cancer undergoing primary RHPL at Chiang Mai University Hospital between January 2002 and December 2009 were evaluated for survival and recurrence. Clinicopathological variables were analyzed to identify the prognostic factors affecting the survival of the patients. During the study period, RHPL was performed on 570 stage IB 1 and 110 stage IB 2 cervical cancer patients. With a median follow-up of 48 months, the 5-year disease-free survivals were 98.1% and 82.8% respectively (p<0.001). Multivariate analysis identified four significant prognostic factors affecting survival including sub-staging, non-squamous cell carcinoma histology, lymph node metastasis and the presence of lymph-vascular space invasion. In conclusion, with a primary radical hysterectomy, stage IB 1 cervical cancer patients have a significantly better survival rate than those with stage IB 2. Significant prognostic factors for stage IB cervical cancer include tumor histology, nodal status, and the presence of lymph-vascular space invasion.     

Class II versus Class III radical hysterectomy in early cervical cancer: An observational study in a tertiary center

Aims

The purpose of this observational study was to evaluate disease free survival (DFS), overall survival (OS), and local recurrence rate (LRR) in patients submitted to Class II RH compared with Class III RH in early FIGO stage cervical cancer (ECC).

Materials and methods

We investigated 127 patients with CC admitted to the National Cancer Institute of Milan from June 2001 to October 2011 treated with Class II RH, and compared them with 202 patients operated with Class III RH between March 1980 and March 2001. A total of 329 patients were collected.

Results

Median follow-up time was 91 months (IQ range:58–196). Five-year OS and DFS estimates were 89.5% (95%CI: 86.0–93.2%) and 85.6% (95%CI: 81.6–89.7%), respectively. Estimates of effect of surgical treatment (Class III RH versus Class II RH) on OS showed a HR of death = 3.38 (95%CI: 1.18–9.63, P = 0.0228), at univariable Cox analysis, and a HR = 3.08 (95%CI: 0.96–9.93; P = 0.0595) at multivariable analysis. For DFS, a HR of relapse = 2.51 (95%CI 1.10–5.72; P = 0.0290) comparing Class III vs Class II was found at multivariable analysis. Overall recurrence rate was 12.8%, whilst it was 16.3% for Class III and 7.1% for Class II respectively.

Conclusions

The present data suggest that the outcomes of Class II RH are comparable in terms of LRR and OS to those of Class III RH, according to literature data. The opportunity of extending the indication to all women with ECC needs further investigations. Clearer data are warranted by prospective controlled studies.     

Cost-utility analysis of treatments for stage IB cervical cancer

Objective

To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints.

Methods

A decision tree model was conducted to examine value for expenditure between the following: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women.

Results

From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%.

Conclusion

RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.     

保留盆腔自主神经的根治性子宫切除术治疗宫颈癌的临床研究

目的　探讨保留盆腔自主神经的根治性子宫切除术（ＮＳＲＨ）治疗宫颈癌的临床疗效及技术上的可行性。方法　选择我院２００８年４月至２００９年１０月ＦＩＧＯ分期为ⅠＢ～ⅡＢ的子宫颈癌患者６９例,研究组（ｎ＝３３）采用ＮＳＲＨ,对照组（ｎ＝３６）为传统的Ｐｉｖｅｒ-ＲｕｔｌｅｄｇｅⅢ型宫颈癌根治术ＲＨ,比较两组术后膀胱和直肠功能的恢复情况以及手术时间、术中出血量和手术切除范围。结果　研究组与对照组相比,术后残余尿＜１００ｍｌ的平均时间分别为（１２.６４±４.４９）ｄ和（１７.８９±４.１９）ｄ,术后残余尿＜５０ｍｌ的平均时间分别为（１４.３０±５.８７）ｄ和（１９.６９±４.４８）ｄ,术后肛门排气时间分别为（６２.９９±１１.９９）ｈ和（７９.３２±１３.２２）ｈ,术后排便时间分别为（９５.４２±１２.５４）ｈ和（１２０.０４±２１.００）ｈ,组间比较差异有统计学意义（Ｐ＜０.００１）。部分患者术后尿流动力学的测定结果显示,在膀胱灌注阶段和排尿阶段两组结果均有差异（Ｐ＜０.０５）。研究组与对照组总手术时间中位数分别为２５２ｍｉｎ（１８０～３３０ｍｉｎ）和２０５ｍｉｎ（１５０～２７０ｍｉｎ）,子宫切除时间中位数为８９ｍｉｎ（６５～１０５ｍｉｎ）和７０ｍｉｎ（５５～９０ｍｉｎ）,差异有统计学意义（Ｐ＜０.０５）。主、骶韧带和阴道切除的长度及术中出血量两组无显著性差异。结论　保留盆腔自主神经的根治性子宫切除术具有可行性和安全性,有利于术后膀胱、直肠功能的恢复。     

Extent of disease and results of adjuvant radiotherapy after radical hysterectomy and pelvic lymphadenectomy in the treatment of stage IB, IIA, and IIB cervical carcinoma

Background. To identify variable prognostic factors and analyze failure patterns in uterine cervix cancer after radical operation and adjuvant radiotherapy, a retrospective analysis was undertaken. Methods. We analyzed 124 patients with uterine cervix cancer, FIGO stage IB, IIA, and IIB, treated with radical hysterectomy and pelvic lymph node dissection followed by adjuvant radiotherapy between May 1985 and May 1995. Minimum follow-up period was 24 months. All these patients were treated with full-dose external radiotherapy using a linear accelerator or high-dose-rate intracavitary radiation. Results. Overall 5-year survival rate and relapse-free survival rate were 75.4% and 73.5%, respectively. Significant prognostic factors for relapse-free survival were wall involvement thickness, lymph node location and number, parametrium involvement, tumor size, stage, uterine body involvement, and vaginal resection margin involvement. By multivariate analysis, lymph node metastasis, tumor size, and vaginal resection margin involvement were significant prognostic factors. Treatment-related failure occurred in 33 cases. In stage IIB, 5-year relapse-free survival rate was only 56%, and 9 of 22 patients had recurrence. Conclusion. Postoperative radiotherapy results are good for patients with relatively low risk factors, but the results are poor for patients with multiple high-risk factors or stage IIB. To control recurrence for patients with high-risk factors, postoperative adjuvant radiotherapy alone is not a sufficient treatment method. Considering cost-effectiveness, it may be reasonable to treat with primary radical radiotherapy for patients with stage IIB cervical cancer and poor prognostic factors instead of a radical operation and adjuvant radiotherapy or chemotherapy regimen. Further investigation should be done. Received: November 13, 1998 / Accepted: May 27, 1999     

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy

Objective

To evaluate the feasibility and morbidity of total laparoscopic class C2 radical hysterectomy (TLRH) with pelvic lymphadenectomy in patients with locally advanced cervical cancer stage IB2 to IIB after neoadjuvant chemotherapy (NACT).

Methods

A prospective study was conducted from October 2004 to September 2009. Cervical cancer patients, stage IB2-IIB with complete clinical response after 3 courses of NACT with paclitaxel 175 mg/m², ifosfamide 5 g/m² and cisplatin 75 mg/m² (TIP) underwent TLRH.

Results

Forty patients were included, with a median age of 46 years (range, 25-65), BMI of 24 kg/m² (range, 15-49). FIGO staging was IB2 in 23, IIA > 4 cm in 6 and IIB in 11 patients. Four patients required conversion to laparotomy. Pathological evaluation showed 9 complete response (pCR), 9 partial response (pPR1) with microscopic tumour, and 15 partial response (pPR2) with macroscopic tumour. Three patients had no response. The median operative time was 305 min (range, 215-430); the median estimated blood loss was 250 ml (range, 100-400), with four postoperative blood transfusion; the median number of removed pelvic lymph nodes was 25 (range, 11-64). The median length of hospital stay was 6 days (range, 3-12). The median follow-up time was 37 months (range, 10-69), with three patients having a recurrence. One patient died of disease (DOD) after 12 months.

Conclusions

TLRH can be safely performed in patients with stage IB2-IIB carcinoma of cervix after NACT, with advantages of minimal blood loss and morbidity.     

Predictive factors of severe perioperative morbidity of radical hysterectomy with lymphadenectomy in early-stage cervical cancer: A French prospective multicentric cohort of 248 patients

ObjectiveThe purpose of this study was to assess the postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer and to determine risk factors of severe perioperative morbidity.MethodsData of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II) were analysed. Patients having a radical hysterectomy were included between 2005 and 2012 from 25 French oncologic centers. Postoperative complications were prospectively recorded in a pre-specified analysis.Results248 patients met the inclusion criteria. The median age was 44.5 years [25–85]. 88.7% of patients had a stage IB1 disease. There were 71.4% epidermoid carcinomas and 25% adenocarcinomas. 125 patients (50.4%) had a laparoscopic-assisted vaginal RH, 88 patients (35.5%) had a total laparoscopic RH, 26 patients (10.5%) had an open RH and 9 patients (3.6%) had a robotic-assisted RH. Sixteen patients (6.4%) had intraoperative complications. On a multivariate analysis, intraoperative complications were significantly associated with BMI >30 kg/m². The urinary, lymphovascular and neurologic complications rates were respectively 34.3%, 20.6% and 19.8%. 31 patients (12.5%) had severe postoperative complications (Clavien-Dindo ≥ 3 or CTCAE ≥ 3). On multivariate analysis, severe postoperative complications were associated with parametrial involvement, preoperative brachytherapy and inclusion in low surgical skills center.ConclusionsThis study based on prospective data showed that RH has low severe postoperative complications. The main complications were urinary infections and lower limb lymphedema. Patients with early-stage cervical cancer should be referred to expert center to ensure best surgical outcomes.     

Comparison of oncological outcomes and major complications between laparoscopic radical hysterectomy and abdominal radical hysterectomy for stage IB1 cervical cancer with a tumour size less than 2 cm

ObjectiveTo compare the oncological outcomes and major complications of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IB1 cervical cancer (FIGO 2009) with a tumour size less than 2 cm.MethodsWe retrospectively compared the oncological outcomes and major complications of 1207 stage IB1 cervical cancer patients with a tumour size less than 2 cm who received LRH (n = 546) or ARH (n = 661) in 37 hospitals.Results(1) There was no significant difference in 3-year overall survival (OS; 97.3% vs. 98.5%, P = 0.288) or 3-year disease-free survival (DFS; 95.1% vs. 95.4%, P = 0.792) between LRH (n = 546) and ARH (n = 661).(2) The rate of any 1 complication refers to the incidence of one or more complications in a patient, which was higher with LRH than ARH (OR = 4.047, 95% CI = 2.035–8.048, P < 0.001). Additionally, intraoperative complications occurred with LRH (OR = 12.313, 95% confidence intervals [CI] = 1.571–96.493, P = 0.017), and postoperative complications (OR = 3.652, 95% CI = 1.763–7.562, P < 0.001) were higher with LRH than ARH. The ureteral injury rate was higher with LRH than with ARH (1.50% vs. 0.20%, OR = 9.814, 95% CI = 1.224–78.712, P = 0.032). The ureterovaginal fistula rate was higher with LRH than ARH. The rates of obturator nerve injury, bladder injury, vesicovaginal fistula, rectovaginal fistula, venous thromboembolism, bowel obstruction, chylous leakage, pelvic haematoma, and haemorrhage were similar between the groups.ConclusionsThe oncological outcomes of LRH and ARH for stage IB1 cervical cancer patients with a tumour size less than 2 cm do not differ significantly. However, incidences of any 1 complication, intraoperative complications, and postoperative complications were higher with LRH than ARH, with complications manifesting mainly as ureteral injury and uterovaginal fistula.     

Minilaparoscopic radical hysterectomy for cervical cancer: Multi-institutional experience in comparison with conventional laparoscopy

Objective

To analyze the preliminary experience of three gynecologic oncology services with minilaparoscopic radical hysterectomy (mLRH) for the treatment of cervical cancer and to compare perioperative outcomes with those of conventional laparoscopic surgery (LRH).

Methods

Prospectively collected data on consecutive cervical cancer patients undergoing radical hysterectomy with a laparoscopic approach were analyzed retrospectively. Perioperative outcomes of women undergoing mLRH were compared to data from control patients who had undergone LRH with 5-mm instruments. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching.

Results

The study cohort consisted of 257 patients, 35 undergoing mLRH and 222 undergoing LRH. The two groups were comparable in terms of demographic and tumor characteristics. No significant differences were observed between groups in terms of operative time, blood loss, lymph node yield, amount of parametrial or vaginal cuff tissue removed, and percentage of intra- or postoperative complications, both in the entire cohort and in the PS matched group. No conversions were needed from mLRH to standard laparoscopy or from minilaparoscopy to open surgery. Conversion from standard laparoscopy to open surgery was necessary in 2 patients. A shorter hospital stay was observed among women who had mLRH than in those undergoing LRH [2 (1–10) vs 4 (1–14) days, p = 0.005]. This difference remained significant after PS matching.

Conclusion

Our preliminary study suggests that in experienced hands minilaparoscopy is a feasible and safe technique for radical hysterectomy and yields results that are equivalent to those of LRH.     

腹腔镜在早期宫颈癌根治术中的应用效果评价

目的 探讨腹腔镜手术治疗早期宫颈癌的可行性、安全性及临床价值。方法 收集2009年1月至2014年12月在广西医科大学附属肿瘤医院妇瘤科行宫颈癌根治术的623例早期宫颈癌患者的病历资料,按手术方式分组：腹腔镜组374例,开腹组249例。回顾性分析两组患者的基本情况、手术时间、术中出血量、术中淋巴结切除数目、宫旁组织及阴道切除长度及手术并发症。结果 腹腔镜手术组成功实施368例,成功率98.40％（368／374）,中转开腹6例,中转开腹率1.60％ （6／374）。腹腔镜组在手术时间、术中出血量、术后下床活动时间、肛门排气时间均优于开腹组,差异均有统计学意义（P＜0.05）,而两组淋巴结切除数、宫旁组织和阴道切除长度比较,差异均无统计学意义（P＞0.05）。在术中及术后并发症方面,除尿潴留外,两组差异均无统计学意义（P＞0.05）。结论 腹腔镜下宫颈癌根治术较传统开腹手术创伤小、术中出血量少、术后并发症少及术后恢复快,是治疗早期宫颈癌有效、安全的方法。     

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer

Objective

To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer.

Methods

We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010.

Results

About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT.

Conclusion

Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.     

The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective

Type III radical hysterectomy reported in 1974 by Piver, Rutledge, and Smith is considered worldwide by many as the standard surgical therapy for invasive cervical carcinoma stage IB and IIA. With the increasing number of robotic surgeries being performed for early stage cervical cancer worldwide, the purpose of the paper is to present our personal perspective of the 21st century role of Piver-Rutledge type III radical hysterectomy for stage IB cervical cancer in the era of robotic surgery using the da Vinci robot.     

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in patients with Ib1 stage cervical cancer: Analysis of surgical and oncological outcome

Aim

To evaluate safety, feasibility and oncological outcome of total laparoscopic radical hysterectomy (TLRH) in patients with early invasive cervical cancer.

Methods

Data of patients with Ib1 cervical cancer who underwent TLRH were prospectively collected. Inclusion criteria were: good general condition, tumor size <3 cm, and no evidence of lymph node metastases in imaging study (MRI and/or CT and/or PET). Radical hysterectomy was performed with a PlasmaKinetic tissue management system. Adjuvant therapy was administered according to surgical risk factors.

Results

Between September 2001 and October 2007 107 patients underwent laparoscopic radical hysterectomy and pelvic lymphadenectomy. Conversion to laparotomy was necessary in 6 patients. Median number of resected pelvic lymph nodes was 26. Median blood loss was 200 ml and median duration of surgery was 305 min. Minor intraoperative complications were registered in two patients, while five patients needed a second surgery for postoperative complications. Thirteen patients had microscopic nodal metastasis. A total of 24 patients received adjuvant therapy. After a median follow-up of 30 months 11 patients had a recurrence; survival rate is 95%.

Conclusion

Total laparoscopic radical hysterectomy, in experienced hands, has to be considerate an adequate and feasible surgical technique. Considering historical data the oncological outcome can be considered comparable to patients treated with laparotomy, as the relapse rate in our population was 11% and the overall survival good.     

219例子宫颈癌根治术的并发症分析

目的分析子宫颈癌根治术后并发症及其相关因素,探讨其防治措施。方法1995年1月至2003年12月间,施行子宫颈癌根治术219例。其中ⅠA期26例（ⅠA1期17例,ⅠA2期9例）,ⅠB期142例（ⅠB1期78例,ⅠB2期64例）,ⅡA期40例,Ⅱb期3例,另外8例为外院治疗后无法分期。采用子宫颈癌根治术204例,改良子宫颈癌根治术15例。结果发生手术并发症49例,发生率为22．4％。手术并发症主要为尿潴留、淋巴囊肿、腹部伤口感染,其发生率分别为10．0％、7．8％和6．8％。子宫颈癌根治术并发症发生率高于改良子宫颈癌根治术。术前外院介入化疗、根治性放疗和既往有腹部手术史者的手术并发症发生率为分别为50．0％（2／4）、100％（1／1）和25．0％（13／52）,差异无统计学意义。87例术前辅助放疗的手术并发症发生率（25．3％）高于未辅助放疗者（19．4％）,但差异无统计学意义（P=0．239）。结论子宫颈癌根治术后并发症与术式有关,术前辅助腔内后装放疗不增加并发症,适当缩小手术范围可减少手术并发症。     

Neoadjuvant chemotherapy and radical surgery compared to radical surgery alone in bulky stage IB–IIA cervical cancer

AIM: The aim of this study was evaluation of the efficacy of neoadjuvant chemotherapy (NACT) and radical hysterectomy on long-term survival in stage IB-IIA locally advanced cervical cancer as compared with radical surgery alone. METHODS: We reviewed all patients with cervical cancer stage IB-IIA who were treated with two treatment modalities, i.e. NACT followed by radical hysterectomy and lymphadenectomy, and radical hysterectomy alone between March 1996 and March 2004. There were 22 patients in the NACT group (group 1) and 160 patients in the immediate radical surgery group (group 2). All patients in group 1 were followed for more than 108months, and long-term survival and factors affecting recurrence were evaluated. RESULTS: Nineteen patients in the NACT arm underwent radical surgery. Pelvic lymph node metastasis was found in 8 patients in this group and in 36 in the radical surgery group. Eighteen patients in the NACT group and 96 patients in the radical surgery group were scheduled for adjuvant postoperative chemoradiation. During the 9-year follow-up, recurrence rate was 47.1% and 30.2% in NACT and control groups, respectively. In the NACT group lymph node metastasis was a significant independent risk factor for recurrence. Overall survival in the NACT arm was not statistically significantly lower than the control arm (p=0.06). CONCLUSION: NACT did not improve long-term overall survival of bulky early-stage cervical cancer patients compared to primary radical surgery.     

Comparison of modified Cherney incision and vertical midline incision for management of early stage cervical cancer

Objective

The aim of this study was to compare operative feasibility and surgical outcome of the modified Cherney incision and vertical midline incision in patients undergoing radical hysterectomy and pelvic lymphadenectomy.

Methods

Between March 2005 and December 2007, retrospective data of 78 patients (n=17; modified Cherney incision, n=61; vertical midline incision) with early stage cervical cancer who received radical hysterectomy and pelvic lymphadenectomy were reviewed.

Results

Baseline characteristics of patients who underwent modified Cherney incision and vertical midline incision were similar except for age (mean±SD: 32.3±3.4 yr vs. 52.5±8.4 yr, p<0.001). Patients who received modified Cherney incision had earlier initiation of soft diet (mean±SD: 46.5±19.5 hr vs. 56.4±25.4 hr, p<0.016) and shorter hospital stay compared to those who received vertical midline incision (mean±SD: 18.0±4.8 days vs. 21.7±3.7 days, p<0.042). There was no difference in the number of dissected pelvic lymph nodes, hemoglobin change, postoperative pain, postoperative ileus, Foley indwelling duration, and perioperative complications.

Conclusion

Excluding the selection bias for age, there was no significant difference of the clinical outcome between the modified Cherney incision group and the vertical midline incision group. Modified Cherney incision can be cosmetically performed in young age women obtaining equal number of lymph nodes without increased operative morbidity compared to vertical midline incision.     

Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy

BACKGROUND: Removal of the parametrial soft tissue is recommended for patients with cervical cancer undergoing radical hysterectomy. Parametrectomy results in significant morbidity. The objective of the study was to determine factors predictive of parametrial tumor spread and to define a subset of patients at low risk for parametrial disease. METHODS: Patients with invasive cervical cancer who underwent radical hysterectomy from 1989-2005 were examined. Analysis was performed to determine factors associated with parametrial tumor spread. Survival estimates were determined using the Kaplan-Meier method. RESULTS: A total of 594 patients were identified. Parametrial metastases were documented in 64 (10.8%). Factors associated with parametrial disease were: histology, advanced grade, deep cervical invasion, lymphovascular space invasion (LVSI), large tumor size, advanced stage, uterine or vaginal involvement, and pelvic or para-aortic lymph node metastases (P < .0001 for each). Parametrial metastases were associated with increased risk of recurrence and decreased disease-free and overall survivals (P < .0001). A subgroup analysis was performed to identify patients at low risk for parametrial spread. In pelvic node-negative women parametrial disease was noted in 6.0% (30/498) compared with 47.9% (34 of 71) of those with positive pelvic nodes (P < .0001). If further stratified to women with negative nodes, no LVSI, and tumors < 2 cm, the incidence of parametrial disease was only 0.4%. CONCLUSIONS: Parametrial spread is a strong predictor of recurrence and decreased survival. Parametrial invasion is rare in patients with small tumors, no LVSI, and negative pelvic nodes (no poor prognostic factors). Further study is warranted to determine the feasibility of omitting parametrectomy in these low-risk patients.     

宫颈癌IB1、IB2期的临床回顾性分析

目的 分析宫颈癌分期中ＩＢ１、ＩＢ２期的治疗结果以及淋巴结转移、宫颈间质浸润、组织分级与预后的关系。方法 ３５６例ＩＢ期宫颈癌全部行广泛性子宫切除和盆脸淋巴清除术,７２例辅以术前放疗（ＩＢ１期３９例,ＩＢ２期３３例）,８３例行术后放疗（ＩＢ１期６１例,ＩＢ２期２２列１例行术前,术后放疗（ＩＢ２期５例,ＩＢ２期６例）。结果 随访５年以上者２４９例,总的５年存活率６９．９％,ＩＢ１期为７３．３％（１８