Utility of bipolar electrocautery scissors for abdominal hysterectomy

OBJECTIVE: This was an evaluation of usefulness of bipolar electrocautery scissors for abdominal hysterectomy. STUDY DESIGN: Fifty women with uterine fibromatosis underwent abdominal hysterectomy: 25 randomly selected patients were operated on with conventional technique and the other 25 patients were operated on with bipolar electrocautery scissors. In both groups operating time, number of ligations, and blood loss were assessed. Data were compared by analysis of variance and chi(2) test as appropriate. RESULTS: In the bipolar group the average operating time was 25% shorter than in the conventional group (P <.01), and the number of ligations and the amount of blood loss were significantly reduced (P <.01). There was no increase in the complication rate. CONCLUSIONS: Bipolar electrocautery scissors were confirmed to be safe and useful for open surgery by reducing the operating time and blood loss without increasing postoperative morbidity. Thus their use would lower the cost of surgery.     

A comparison of cold knife, CO2 laser, and electrosurgical loop conization in the treatment of cervical intraepithelial neoplasia

Thirty patients with histologically confirmed high-grade squamous intraepithelial lesions (SIL) were treated by either cold knife, laser, or electrosurgical loop conization, all of which were performed under general anesthesia. The three methods were compared with respect to the immediate surgical complications, ease of performance, delayed complications, and quality of histologic specimens. The electrosurgical loop conization had decreased blood loss and reduced operative time and proved to be tissue sparing. There were no significant differences in the three groups in the persistence rates of cervical intraepithelial neoplasia (CN) after treatment. Histologic analysis revealed comparable coagulation artifact in the laser and electrosurgical loop groups that the cold knife group did not have. The endocervical component of the electrocautery showed extensive denudation and coagulation artifact that made recognition of CIN extremely difficult. We conclude that the electrocautery should be used only as an excisional method of the transformation zone for lesions well defined on the ectocervix, since it is unreliable if the lesion extends into the endocervix.     

Cervical conization: cold knife and laser excision in residency training.

During a 2-year period, 293 consecutive conizations performed by residents in obstetrics and gynecology were reviewed. One hundred sixty-one patients underwent laser excision and 132 women were treated by cold knife conization. Average operating times for laser excision and knife conization were 31 and 33 minutes, respectively. Combined minor and major complication rates for laser and knife cones were 19 and 30%, respectively. Major complications including cervical stenosis and heavy bleeding were seen in 20% of knife conizations and 6% of laser excisions. Average blood loss for knife conization was 65 mL, and average blood loss for laser conization was 34 mL. Among those examined in follow-up with cervical cytology and colposcopy, no patient in the laser excision group showed evidence of persistent dysplasia, compared with one patient (3%) in the knife conization group. The reported data suggest no difference in operating time, length of anesthesia, or success of treatment between laser excision and knife conization performed by residents in training. Fewer complications were seen in the laser excision group.     

子宫颈锥形切除术后全子宫切除95例临床分析

目的:分析子宫颈锥形切除术(宫颈锥切)后全子宫切除的指征,重点探讨宫颈锥切后腹腔镜子宫切除(LH)的可行性、安全性和手术要点。方法:回顾性分析2005年11月~2007年10月北京协和医院开展的95例宫颈锥切后全子宫切除术的手术指征、手术时间、出血量、残余宫颈病理、术中及术后并发症等。结果:(1)95例宫颈锥切后全子宫切除中,80例为LH,15例为开腹子宫切除(AH)。患者年龄43.2±5.9岁,术前诊断包括宫颈上皮内瘤变(CIN)Ⅲ及以下18例(18.9%)、CINⅢ累腺35例(36.8%)、宫颈原位癌(CIS)23例(24.2%)、宫颈浸润性鳞癌ⅠA1期19例(20.0%);(2)15例AH和25例LH是在宫颈锥切6周后施术,55例LH是在宫颈锥切后72h内。LH组和AH组手术时间分别为60.8±17.1min和88.0±19.8min(P<0.01),术中出血分别为54.3±24.4ml和103.3±48.1ml(P<0.01)。LH组和AH组的术后住院时间为4.5±1.1天和5.8±1.4天(P<0.01);(3)子宫切除标本的阴道断端边缘均未见病变,但残余宫颈中48例(50.5%)存在持续性病变(39例为CINⅡ及以下病变,4例为CINⅢ,3例为CIS,2例为浸润癌);(4)全组无1例需术中/术后输血,无膀胱、输尿管和肠道损伤发生。LH组患者无1例中转开腹,但4例放置专用举宫器困难,其中1例发生子宫穿孔但未引起并发症;(5)宫颈锥切后72h内行LH的55例中,7例(12.7%)术后出现发热(超过38.5℃),宫颈锥切6周后行LH或AH的40例中,仅1例(2.5%)术后发热。LH组1例患者术后发生阴道残端出血。结论:全子宫切除是某些诊断性宫颈锥切患者锥切后再处理措施之一。对于宫颈锥切后全子宫切除,LH具有优势和特点,其手术时间短,术中出血少,术后住院时间短。正确放置LH专用举宫器最大限度地上举子宫、锐性分离子宫膀胱腹膜返折是减少锥切后LH并发症的关键。     

Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta): a comparison with open Wertheim/Meigs hysterectomy

The objective of this study was to compare the safety, efficacy, and short-term benefits of the Coelio-Schauta procedure with open Wertheim/Meigs radical abdominal hysterectomy. We retrospectively analyzed records of our first 35 consecutive patients undergoing laparoscopically assisted radical vaginal hysterectomy (LARVH) for early cervical cancer and 32 consecutive patients of open radical hysterectomy (ORH) performed between 1999 and 2005 in our institution. We analyzed patient age, bodyweight, previous abdominal surgery, operating time, blood loss, perioperative complications, postoperative bladder dysfunction, other postoperative complications, and histologic type. The FIGO stage, excision margins, node count and node status, follow-up, and recurrence rates were also taken into account. We excluded stage IA and stage II disease patients to reduce the impact of tumor size on the outcome of the surgery. This left 27 patients with stage IIB disease who had LARVH and 28 patients with stage IB disease who had ORH. These patients formed the study group. The cohorts were similar in age, bodyweight, previous abdominal surgery, histologic subtype, FIGO stage, resection margins, node count and node status, length of follow-up, and recurrence. There were statistically significant differences between LARVH and ORH for duration of surgery (mean 160 vs 132 min), intraoperative blood loss (479 vs 715 mL), hospital stay (mean 5 vs 9.3 days), postoperative complications (6 vs 20 patients), and duration of bladder catheterization (mean 4.4 vs 8.8 days). Four LARVH patients and no ORH patients had urinary tract injury that was repaired. None had long-term sequelae. Our data confirm that LARVH is a suitable alternative to ORH hysterectomy for small-volume stage IB1 cervical cancer with similar clinical efficacy and a superior postoperative recovery and postoperative morbidity profile. Urinary tract trauma is a clear risk in the early stages of the learning curve.     

A new topical hemostatic agent in gynecologic surgery

Experiences with a topical hemostatic agent, microfibrillar collagen (MFC), material made from beef hide dermis are recounted. Topical hemostasis is facilitated by virtue of its fibrillar structure forming a sticky matrix for platelet aggregation. The material was used in women undergoing cervical conization to determine its absorption at hysterectomy 6 weeks later. In another group, it was used as the sole hemostatic agent at conization and compared with a control group in which conventional sutures were used. A larger group who underwent abdominal hysterectomy allowed comparison between MFC on the bladder muscularis and conventional suture ligature in terms of blood loss, operating time success of method used, and complications.     

宫颈冷刀锥切术和宫腔镜下宫颈锥切术治疗高级别宫颈上皮内瘤变的疗效分析

目的:比较宫颈冷刀锥切术(CKC)和宫腔镜下宫颈锥切术(TCRC)对于宫颈上皮内瘤变(CIN)Ⅱ、Ⅲ的临床疗效。方法:选取2010年1月1日至2014年6月1日就诊于南方医科大学珠江医院,手术、病理及随访资料完整的CINⅡ、Ⅲ患者共176例,其中CKC组62例,TCRC组114例。比较两组患者年龄、孕产次数及术前病理分级并评估手术时间、术中出血量、术后阴道流血及病理切缘阳性和术后宫颈狭窄、复发等情况。结果:两组患者年龄、孕产次数及术前CIN分级差异均无统计学意义(P0.05)。CKC组术中平均出血量(14.16±14.10 ml)、平均住院时间(5.73±1.43天)与TCRC组(29.80±20.55 ml,4.75±1.23天)比较差异有统计学意义(P0.05)。CKC组平均手术时间(33.15±11.42分钟)、术后阴道流血率(33.9%)、病理切缘阳性率(3.2%)、宫颈狭窄率(4.8%)、复发率(4.8%)与TCRC组(分别为33.18±14.61分钟、21.1%、5.3%、4.4%、3.5%)比较差异无统计学意义(P0.05)。CKC组术前宫颈活检病理和术后病理结果一致率为74.2%(46/62),TCRC组为72.8%(83/114),kappa值0.75。结论:两种方法用于治疗高级别宫颈上皮内瘤变均安全有效。与CKC相比,TCRC可减少患者住院时间,但可能增加术中出血量,需在手术中注意。     

Superiority of electrocautery over the suture method for achieving cervical cone bed hemostasis

OBJECTIVE: To compare the efficacy of electrocautery with that of the suture method for achieving hemostasis of the cervical cone bed. METHODS: We performed a retrospective chart review of all patients who underwent cold-knife conization of the cervix over a 5-year period. Patients were categorized into two groups: the cautery group, in which the cone bed was electrocauterized with a hand-held electrocoagulation device; and the suture group, in which hemostasis was achieved by a continuous locking suture placed circumferentially around the cone bed. Outcome measures evaluated include estimated blood loss, operative time, and incidence of complications, including secondary hemorrhage, cervicitis, and cervical stenosis. Data were analyzed by Student t test, chi(2) test, linear regression, and multiple logistic regression where appropriate. RESULTS: There were 156 women in the cautery group and 35 in the suture group. The cautery group had significantly lower estimated blood loss (27 mL versus 101 mL; P <.01) and shorter operative time (34 versus 43 minutes; P <.01) than the suture group. The procedure-related complication rate was 6.4% in the cautery group, compared with 14.3% in the suture group (P = nonsignificant). A higher use of lateral sutures, vasopressors, and thrombotic agents was seen in the cautery group. However, even after adjusting for these variables, mean estimated blood loss (33 mL, P <.01) and mean operative time (34 minutes, P <.01) were significantly less in the cautery group than in the suture group. CONCLUSIONS: Cauterization of the cone bed is superior to suture as a method of achieving hemostasis, with significantly less blood loss and shorter operative time.     

48例阴式扩大性子宫颈切除术临床分析

目的探讨阴式扩大性宫颈切除术保守性治疗Ⅰa1期宫颈鳞癌及不适于行宫颈锥切术的宫颈上皮内瘤变（CIN）Ⅲ级患者的可行性及安全性。方法2002年7月-2007年5月,选择经环形电切术（LEEP）并活检后病理诊断的宫颈鳞癌Ⅰa1期（除外脉管癌栓）、大面积CINⅢ（阴道镜下病变面积≥3／4）、CINⅢ合并阴道上段上皮内瘤变（VAIN）、CINⅡ-Ⅲ锥切术后或LEEP术后复发、病变残存、切缘阳性,且要求保留子宫和（或）生育功能的患者,行阴式扩大性宫颈切除术治疗,对其临床资料进行分析。结果48例患者顺利实行阴式扩大性宫颈切除术,其中Ⅰa1期宫颈鳞癌患者5例,大面积CINⅢ患者38例（9例累及腺体）,CINⅢLEEP术后病变残存2例、切缘阳性2例,CINⅡ锥切术后复发1例。患者年龄27-40岁,中位年龄34岁,平均手术时间60min（30-100min）,平均出血量加ml（5-300ml）,平均住院天数10d（7-17d）。随访1～39个月,随访时间的中位数为14个月,无术后并发症及复发病例。结论阴式扩大性宫颈切除术是一种保守性治疗Ⅰa1期宫颈鳞癌、大面积CINⅢ、CINⅢ合并VAIN以及CINⅡ-Ⅲ锥切术后复发、病变残存、切缘阳性等不适于行宫颈锥切术患者的、安全有效的术式。     

Carbon dioxide laser for combination excisional-vaporization conization

Extensive cervical intraepithelial neoplasia may simultaneously involve large areas of the ectocervix, even extending to the vaginal fornices, as well as the endocervical canal. In such instances conventional sharp knife conization would result in virtual removal of the cervix if the surgeon wished to completely circumscribe the entire lesion. By combining a narrow carbon dioxide laser excisional conization with ectocervical vaporization, cervical intraepithelial neoplasia may be eradicated by a virtually bloodless surgical procedure and fertility may be preserved. Sixty-one combination conizations with 6 months to 4 years of follow-up are reported. In 95% of the cases biopsy demonstrated cervical intraepithelial neoplasia in three or more ectocervical quadrants, and 16% had extension of disease into the vagina. The technique of combination conization uses 20 to 30 W of power and 1/2 to 1 mm spots for excision and 10 to 15 W and 1 to 1.5 mm spots for vaporization. The average time to complete the entire procedure was 21 minutes. In three of 61 cases endocervical margins were positive; there were no instances of persistence of neoplasia at either the ectocervical or the vaginal margins. Four complications were observed, all related to delayed bleeding; however, only two patients required the placement of a suture. The volume of tissue removed by a large excisional conization is more than two times greater than that of a laser combination conization.     

Needle excision of the transformation zone: A new method for treatment of cervical intraepithelial neoplasia

OBJECTIVE: This study was undertaken to evaluate a new needle electrode for conization of the cervix that was developed in my department. STUDY DESIGN: This was a prospective study of 58 unselected women with histologically verified cervical intraepithelial neoplasia who underwent conization with the diathermy needle. The operations were performed with local anesthesia as outpatient procedures. Follow-up time was 5 years. RESULTS: All cones were removed in one piece and were of high histologic quality. Mean (+/-SD) operating time, including anesthesia, was 7.9 +/- 2.7 minutes. Mean depth of thermal damage was 0.29 +/- 0.21 mm, and mean blood loss was 12.5 +/- 9.4 mL. No late complications have been noted, and 94.8% of patients have required no further treatment. CONCLUSION: Needle excision of the transformation zone is a simple and effective outpatient procedure that yields a one-piece cone specimen of high quality and carries a success rate of 94.8%.     

Persistence and recurrence of in situ cervical adenocarcinoma after primary treatment. About 121 cases

OBJECTIVE: The aim of this study is to assess the results of conservative management of adenocarcinoma in situ (AIS) of the uterine cervix. PATIENTS AND METHODS: Retrospective multicentric study with 121 cases. Patients with cervical invasive lesions were excluded. General characteristics of population, diagnosis circumstances, treatment, histology and evolution were studied. RESULTS: Conservative treatment was performed in 98.3% of cases with 64% of negative margins. In the positive margins group, 80% of conservative treatments were performed by electrosurgical loop. Length of cone resection is significantly higher for conization with negative margins (p<0.001). The rate of residual lesion was 18% in negative margins group and 46% in positive margins group. Two noninvasive and one invasive recurrence were deplored. DISCUSSION AND CONCLUSION: Conservative surgery for patients with AIS could be considered in young patients but several conditions should be respected: careful follow-up after conservative treatment; cold knife conization; length of cone specimen greater than 25 mm and negative margins.     

Residual and recurrent lesions after conization for cervical intraepithelial neoplasia grade 3.

OBJECTIVES: To evaluate the importance of regular and long-term follow-up of patients who had conization for cervical intraepithelial neoplasia grade 3 (CIN 3); and to assess the risk of residual/recurrent lesions of the cervix uteri. METHODS: Retrospective analysis of 934 patients with CIN 3 who underwent conization over the period 1 January 1985-31 December 1997. The analysis included 38 (4.1%) patients who had involved resection margins and 896 (95.9%) patients who had free resection margins. RESULTS: Twenty-three out of 934 (2.5%) patients had another operation (reconization in 17 and hysterectomy in six) whereas one patient had a biopsy. Residual or recurrent lesion after conization was found in 23 patients out of 934 (2.5%). Three patients had invasive cervical cancer (0.3%), 19 had CIN 3 (2.0%) and one patient had CIN 1 (0.1%). One of the 24 patients (4.2%) was diagnosed with no lesion after repeated operation. Eleven patients out of 38 (28.9%) with involved resection margins during the first conization had residual/recurrent disease, compared with eight out of 896 patients (0.9%) who had free resection margins. CONCLUSION: Another operation is recommended only in cases when, on the basis of cytological, colposcopical and histological findings, the gynecologist suspect the residual/recurrent lesions.     

Laparoscopic modified radical hysterectomy: a strategy for a clinical dilemma

OBJECTIVE: To investigate the role of laparoscopic modified radical (type 2) hysterectomy when cervical cancer cannot be excluded or documented preoperatively. METHODS: Between 1996 and 2004, 50 patients with cervical intraepithelial neoplasia (CIN III) or adenocarcinoma in situ (AIS) involvement of cone endocervical margins and/or endocervical curettings, who were not candidates for observation or repeat conization, underwent laparoscopy to perform a modified radical hysterectomy. RESULTS: Forty-nine (98.0%) modified radical hysterectomies were completed laparoscopically and one (2.0%) patient required a laparotomy. Of the overall group, 35 (70.0%) had residual pathology; 26 (52.0%) were precancerous lesions, and 9 (18.0%) had invasive disease (5 adenocarcinomas, 3 squamous lesions, and 1 adenosquamous carcinoma). Of the nine with cancer, one had stage IA1 disease, three had stage IA2 disease, and five had stage IB1 disease. Five (55.6%) invasive lesions were diagnosed intraoperatively (frozen section), and a laparoscopic pelvic and lower aortic lymph node dissection was performed. The median operative time was 96 min (range 58-185), blood loss 100 ml (50-450), and postoperative hospital stay 2.5 days (range 1-14). There were no incidences of prolonged urinary retention fistulas, or other serious complications. All patients with cancer remain disease-free (median follow-up 44.2 months, range 1-88.7 months). CONCLUSIONS: Laparoscopic modified radical hysterectomy is a treatment option for patients for whom cervical cancer cannot be definitively excluded, and can be completed with acceptable operative time, blood loss, and hospitalization.     

Laparoscopic radical hysterectomy using pulsed bipolar system: comparison with conventional bipolar electrosurgery

OBJECTIVE: To compare the efficacy, results and complications of using the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional bipolar electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopic radical hysterectomy and pelvic lymphadenectomy in the management of early invasive cervical carcinoma. METHODS: This was a retrospective case-control study. We recruited consecutively 38 patients with cervical cancer for laparoscopic radical hysterectomy with pulsed bipolar system. For comparison, we recruited consecutively the latest 38 patients with cervical cancer for laparoscopic radical hysterectomy with conventional bipolar electrosurgery in the same period. From Jan. 2001 to Dec. 2005, total 76 patients with cervical cancer for laparoscopic radical hysterectomy were recruited for statistical analysis. RESULTS: No significant difference was found between the two groups in terms of age, body weight, staging, and hospital stay. There were statistically significant difference in blood loss and operative time. The blood loss was more in conventional bipolar electrosurgery group (mean 564 ml, median 500 ml, range 50-2400 ml) compared with pulsed bipolar system group (mean 397 ml, median 350 ml, range 100-1200 ml) (p<0.03). But there was no statistically significant difference in blood transfusion between the two groups (p=0.454). The operation time for the conventional bipolar electrosurgery group (mean 229 min, median 232 min, range 121-352 min) was longer than that for the pulsed bipolar system group (mean 172 min, median 177 min, range 65-267 min) (p<0.001). None of the laparoscopic procedure was required to be converted to laparotomy. There was no significant difference in the intra-operative complication, but there was statistically less postoperative complication in the pulsed bipolar system group (p<0.01). There was no significant difference in recurrence rate in both groups. CONCLUSIONS: Our findings indicate that pulsed bipolar system is more effective in laparoscopic radical hysterectomy when compared with conventional bipolar electrosurgery. Pulsed bipolar system has advantage over conventional bipolar electrosurgery in less blood loss, shorter operative time, less postoperative complication and may offer an alternative option for patients undergoing laparoscopic radical hysterectomy.     

Loop-cone cerclage in pregnancy: a 5-year review

OBJECTIVE: The purpose of this study was to evaluate the efficacy and outcomes of patients undergoing conization utilizing a technique of loop-cone cerclage when a diagnostic cone biopsy was required in pregnancy. METHODS: All loop conizations between 1997 and 2001 were reviewed; 15 patients were identified who underwent cone- cerclage with 13 medical records completely available for review. Abstracted data included age, parity, pap smears prior to and during pregnancy, and histology obtained during colposcopy. The operative time for the procedure, estimated blood loss, complications, pathology of loop specimen, and pregnancy outcomes were recorded. RESULTS: Thirteen charts were available for complete review. The mean operating time was 22 min; 11 patients had less than 50 cc blood loss and two patients had a 250 cc blood loss. The median age was 26.5, average parity was 2, and mean gestational age was 24.1 weeks. Six patients had abnormal pap smears prior to pregnancy, one woman had previously undergone colposcopy, and there was no documentation of previous pap smears in six patients. During pregnancy, on pap smear, nine patients had HSIL, three patients had ASCUS/LSIL, and one patient had adenocarcinoma. Thirteen patients underwent colposcopy and biopsy; eight patients had the question of invasive disease, five patients had endocervical glandular involvement with carcinoma in situ, which were the indications for conization. There were no intraoperative or late postoperative complications. All patients delivered at term. CONCLUSIONS: While the need for conization during pregnancy is rare, there are indications when it is necessary. Loop-cone cerclage is a safe method for performing diagnostic and therapeutic conization during pregnancy.     

Negative predictive value of human papillomavirus test following conization of the cervix uteri.

OBJECTIVE: The goal of this study was to determine/evaluate the negative predictive value of human papillomavirus (HPV) testing following conization of cervix uteri. METHODS: A prospective analysis was undertaken on 79 cone biopsies of women with high-grade lesions (cervical intraepithelial neoplasia (CIN) III). HPV testing was performed on cervical smears before and after conization. We correlated the margin status (defined as positive cone margin or endocervical curettage status) and positive conization HPV status with the residual disease in a hysterectomy specimen. A Digene II kit was used to perform HPV testing. HPV detection was done by Hybrid Capture assay. RESULTS: Of the 79 patients, 47(59.5%) had positive margins after conization. HPV testing was positive in 37 cases (78.7%) and negative in 10 cases (21.3%). Residual disease was found in 31 of 47 (66%) postconization hysterectomy specimens. No residual lesions were found in HPV-negative cases. Of the 32 cases with negative margins following conization, HPV testing was negative in 25 cases (78%) and was positive in 7 cases (22%). Among these 25 cases with negative HPV tests, no residual lesion was detected, and in 7 HPV-positive cases, only one residual lesion was found. CONCLUSION: HPV testing is potentially an effective tool in predicting residual dysplasia after conization and could potentially assist in the decision between hysterectomy and conservative follow-up in women with CIN III.     

The management and follow-up of patients with high-grade cervical glandular intraepithelial neoplasia

Maini M, Lavie O, Comerci G, Cross PA, Bolger B, Lopes A, Monaghan JM. The management and follow-up of patients with high-grade cervical glandular intraepithelial neoplasia. Int J Gynecol Cancer 1998; 8 : 287–291.
The purpose of this study was to evaluate if the status of the margins on large loop excision of the transformation zone (LLETZ) can predict the presence of residual cervical glandular intraepithelial neoplasia (CGIN) and to assess the efficacy of cervical conization as primary management of CGIN. Between January 1989 and March 1997 fifty patients with a diagnosis of CGIN made by LLETZ were treated in the Department of Gynaecological Oncology at the Queen Elizabeth Hospital, Gateshead. Presence or absence of CGIN at cone margins, results of cervical cytological examinations before and following conization, colposcopic examination, and results of histopathologic assessment of any surgical specimens taken after initial cone biopsy were analyzed in this study. Of the 50 patients with CGIN, managed by conization, in 34 (68%) CGIN was present at the surgical margins and in 16 (32%) the margins were clear. Eleven (32.3%) patients with CGIN at the margins of excision had evidence of residual disease and there was only one of the 16 (6.25%) patients with clear margins ( P = 0.03). Two cases of invasive adenocarcinoma were identified in the group of patients with positive margins. In a mean follow-up time of 32.35 months, no case of invasive carcinoma was identified in the completely excised group. In our retrospective study LLETZ was found to be an adequate primary management for CGIN, and the excision margin status of the LLETZ specimen did appear to be a prognostic factor for residual disease.     

The clinical significance of blood transfusion at the time of radical hysterectomy

A retrospective review was conducted to evaluate the clinical implications of perioperative blood transfusion in the surgical management of stage IB cervical cancer. The investigation focused on 126 patients treated with radical hysterectomy and retroperitoneal lymph node dissection who were found to have clear surgical margins, negative retroperitoneal lymph nodes, and no lymph-vascular space involvement in the hysterectomy specimen, and who had no perioperative radiation therapy, no history of immunosuppression with medication, and at least 18 months of follow-up. The distributions of age, weight, operative time, nodal yields, mean lesion diameters, median depths of invasion, and histologic subtypes were not statistically different between the transfused and untransfused groups. The average estimated blood loss among the transfused patients was 1104 mL, compared with 764 mL among the untransfused patients (P = .015). Among the 68 who received blood perioperatively, there were ten recurrences (14.7%), compared with two (3.4%) among the 58 patients who did not receive blood (P = .035). In this select population of patients, in which perioperative transfusion was isolated as a variable, transfusion adversely affected the outcome of surgical therapy.     

Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization

Objective

To evaluate the efficacy of cold knife conization with electrocauterization and the feasibility of conservative management in patients with stage IA1 carcinoma of the cervix according to margin status after conization.

Methods

Medical and histopathological records of 108 patients with stage IA1 cervical carcinoma were reviewed retrospectively. Patients underwent cold knife conization with electrocauterization or conization followed by hysterectomy. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher grade lesion.

Results

Forty patients underwent conization followed by hysterectomy; of 27 women with positive margins, 14 (35%) had a residual lesion. Sixty-eight patients underwent conization without further surgical intervention. Forty patients had a negative resection margin without recurrence, while 28 had a positive resection margin: positive exocervical (n = 11), positive endocervical (n = 17). Among these, there were 7 cases of recurrence: positive exocervical (n = 1); positive endocervical (n = 6).

Conclusion

Cold knife conization with electrocauterization appears to be a safe treatment option for patients with stage IA1 cervical carcinoma if careful follow-up is guaranteed for patients with CIN 3 exocervical resection margins. However, patients with CIN 3 endocervical resection margins should be managed surgically with repeat conization or hysterectomy.