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Tytuł pozycji:

Laparoscopic Modified Radical Hysterectomy for Early Invasive Cervical Cancer.

Tytuł :
Laparoscopic Modified Radical Hysterectomy for Early Invasive Cervical Cancer.
Autorzy :
Semaan, Assaad
Khoury, Roy
Abdallah, Rony
Mackoul, Paul
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Temat :
CERVICAL cancer diagnosis
TUMOR classification
Źródło :
Journal of Gynecologic Surgery; Sep2010, Vol. 26 Issue 3, p183-187, 5p, 3 Charts
Czasopismo naukowe
Background: Total laparoscopic modified radical hysterectomy (MRH) is a safe and feasible procedure with significantly less morbidity than reported in the literature for open or laparoscopic radical hysterectomy. Objectives: The purpose of this study is to evaluate the feasibility, safety, and morbidity of laparoscopic MRH for early cervical cancer. Methods: Twenty (20) patients with stage IA-IB1 cervical cancer were eligible to undergo total laparoscopic MRH at our institution between January 2004 and November 2007. Data collected included age, body–mass index, stage, histopathologic subtype, tumor grade, estimated blood loss, perioperative blood transfusions, number and status of lymph nodes obtained, status of surgical margins, length of hospital stay, intraoperative and postoperative complications, and disease-free interval. Results: Twenty (20) patients were included in our study. None of the surgeries required conversion to laparotomy. Prior history of abdominal or cervical surgery was present in 9 patients (45%). Four (4) patients had prior cesarean sections, 3 patients had laparoscopic bilateral tubal ligation, 1 patient had diagnostic laparoscopy, and 3 had already undergone cold knife conization of the cervix. The median patient age was 48.2 years (range, 31–84 years). Three (3) patients had stage IA1, 8 patients had stage IA2, and 9 had stage IB1. Twelve (12) patients had squamous cell carcinoma, 7 had adenocarcinoma, and 1 had adenosquamous carcinoma. The median weight was 72 kg (range, 50–104 kg). No complications related to trocar insertion occurred in our study group. In addition, none of the patients experienced any major intraoperative complication. The urinary catheter was routinely removed on postoperative day 1. Only 2 patients experienced a voiding difficulty that subsequently resolved on postoperative days 4 and 6 with continuous catheterization of the bladder. Only 1 patient required a postoperative blood transfusion. All but 2 patients were discharged from the hospital within 1 day after the surgery. The median number of resected pelvic lymph nodes was 12 (range, 5–25). One (1) patient had two nodes that tested positive for metastases. The surgical margins were free of all disease in all except 1 patient, who had a positive vaginal margin. Four (4) patients were treated with postoperative adjuvant therapy. The median follow-up time was 16 months (range, 3–48 months). All patients remain free of disease at the time of this report. Conclusions: Total laparoscopic MRH is a safe and feasible procedure with significantly less morbidity than reported in the literature for open or laparoscopic radical hysterectomy. Future studies with longer follow-up are needed to determine the impact of this approach on long-term outcomes and survival. (J GYNECOL SURG 26:183) [ABSTRACT FROM AUTHOR]
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