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Laparoscopic Transperitoneal Infrarenal Paraaortic Lymphadenectomy in Gynaecological Cancer
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S47–S70 Study Objective: Open radical hysterectomy is the classic surgical treatment for early cervix cancer. Minimally invasive radical trachelectomy (MIRT) is being offered to women interested in retaining fertility. The long term recurrence for MIRT surgery is believed to be consistent with that of the ORH. The primary goal of our study is to collect the world’s experience on cancer recurrence for MIRT surgery and compare it to the traditional ORH. Setting: A comprehensive literature search revealed 169 MIRT articles. Six centers have consistently been publishing series of their longitudinal cancer outcome after MIRT surgery. The most recent publication from each of these centers were utilized. Patients: We extracted all patients data, tumor characteristics (Histology: Squamous cell carcinoma (SCC), adenocarcinoma (ADC), tumor size and the presence or absence of lymph-vascular space invasion (LVSI)) as well as cancer recurrence. Measurements and Main Results: The analysis showed: 576 patients underwent MIRT. SCC constituted 356 patients (61.8%), while ADC made up 220 patients (38.2%). There were 543 patients (94.3%) with tumor measuring less than 2 cm; and 255 (44.3%) tumors with positive LVSI. Of the entire patients, 3.99% (23 of 576) had cancer recurrence. The recurrence for SCC was 3.92% (14 of 356) vs. 4.1% (9 of 220) for ADC. Tumors\2 cm recurred in 2.5% (14 of 543) vs. 15.1% (5 of 33) for tumors > 2 cm. The recurrence for tumors with + LVSI was 5.1% (13 of 255) vs. and 1.8% (6 of 328) for those without LVSI. Conclusion: Our study shows that minimally invasive radical trachelectomy surgery for early cervix cancer has a cancer recurrence consistent with the traditional open radical hysterectomy. Hence MITR surgery is effective without compromising cancer recurrence. The ideal eligible patients for MIRT surgery are those who have tumors measuring less than 2 cm without lymph vascular space invasion. 184
Open Communications 9dOncology (12:11 PM d 12:16 PM)
Laparoscopic Transperitoneal Infrarenal Paraaortic Lymphadenectomy in Gynaecological Cancer Perez-Medina T,2 Garcia-Espantaleon M,1 San-Frutos L,1 Pereira A,1 Iglesias E.2 1Obstetrics and Gynecology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain; 2Obstetrics and Gynecology, Autonoma University, Madrid, Spain Study Objective: To describe our results in laparoscopic transperitoneal paraaortic lymphadenectomy in gynecological malignancies. Design: Prospective descriptive study. Setting: University Tertiary Hospital. Patients: 25 patients with cervical, endometrial or ovarian cancer, candidates for paraaortic lymphadenectomy. Intervention: Transperitoneal lymphadenectomy from common iliac arteries up to the aortic crossing of the left renal vein. Measurements and Main Results: The indication for the procedure was staging for advanced cervical carcinoma (IB2, IIA2, IIB and III) in 16 patients (64%), complete staging for high-risk endometrial adenocarcinoma because of stage (IB and beyond), histological differentiation (G3, undifferentiated) or histology (papillary-serous or clear-cell) in 7 patients (28% cases), and complete staging in early-stage ovarian cancer in 2 patients (8%). The mean age was 47 years (rank 3572); the mean body mass index was 28. The procedure was satisfactory completed in all the cases. The reduction of hemoglobin was 1.7 (0.13.9). The time to complete the paraaortic procedure exclusively was 77 minutes (54-122), the mean number of harvested paraaortic lymphatic nodes was 11 (6-33). In 4 cases, one or more metastatic nodes were informed in the pathologic report. The mean hospital stay was 3.2 days (2-7). No complications occurred in our series. Conclusion: Laparoscopic Transperitoneal Infrarenal Paraaortic Lymphadenectomy is a safe and feasible minimally invasive technique for staging gynecological cancers. The advantages of this procedure include low morbidity, less haematic loss, a shorter hospital stay and a shorter postoperative period of recovery without significant increase of complications. Furthermore, it allows the patients to begin immediately their adyuvant therapy.
185
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Open Communications 9dOncology (12:17 PM d 12:22 PM)
Laparoscopic Nerve Sparing Radical Parametrectomy and Total Vaginectomy for the Patients with Vagina Cancer Chen Y, Xu H, Liang Z. Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China Study Objective: The objectives of this study were to describe our laparoscopic nerve-sparing radical parametrectomy/total vaginectomy technique and to assess the feasibility and safety of the procedure, as well as surgical outcomes. Design: Prospectively collected and analysis of 12 consecutive patients with vagina cancer underwent laparoscopic radical parametrectomy/total vaginectomy with pelvic/paraaortic lymphadenectomy. (Canadian Task Force classification II-2). Setting: Major university teaching hospital. Patients: The medical records for 12 consecutive patients who underwent endoscopic inguinal lymphadenectomy because of invasive vulvar cancer were prospectively collected. Intervention: Laparoscopic radical parametrectomy/total vaginectomy with pelvic/paraaortic lymphadenectomy. Measurements and Main Results: The laparoscopic nerve-sparing radical parametrectomy/total vaginectomy with pelvic/ paraaortic lymphadenectomy procedure was completed successfully and was conducted safely in all of the patients. There were no conversions to open surgery in these patients. The median operative duration was 158.5 min. The estimated blood loss was 135.2 ml. No intro-operative complication was found, and no patients required blood transfusion. All pelvic (average 22 (10w36) nodes, n = 9) and paraaortic nodes (9 nodes, n = 3) were negative for malignancy. Histology confirmed the absence of any residual cancer tissue in the margins of the parametrial tissue and vagina. The Foley catheter was removed on day 7 to 10. There were no long-term complications. One patient with stage IIIa cervical cancer received regional radiation therapy with total dose of 4560 Gy, two patients with vaginal adenocarcinoma received chemotherapy with total of 5-8 cycles of cisplatinum, 75 mg/m2 every 3 weeks. Other patients not required adjuvant therapy after the operation. All patients were follow-up 5 to 38 months and there were no recurrence patients. Conclusion: The technique described in this preliminary study appears to be safe, feasible, and easy in our population, with satisfactory recovery of voiding function. 186
Open Communications 9dOncology (12:23 PM d 12:28 PM)
Ovarian Borderline Tumors: Transvaginal Ultrasound Follow-Up in Patients after Surgery Exacoustos C,1 Perniola G,2 Lanzilotta V,1 Di Giovanni A,1 Benedetti Panici PL,2 Arduini D.1 1Department of Obstetrics and Gynecology, Universita degli Studi di Roma ‘‘Tor Vergata’’, Rome, Italy; 2Department of Obstetrics and Gynecology, Universita degli Studi di Roma ‘‘La Sapienza’’, Rome, Italy Study Objective: Controversy exists for role of TVS in the follow up of ovarian cancer and BOT. The aim of this study was to assess the diagnostic value of TVS in the follow up of patients submitted to cystectomy (CYS), unilateral salpingo-oophorectomy (USO) or bilateral salpingooophorectomy with/without total hysterectomy (radical surgery, RS) for BOT. Design: TVS follow up in patients treated for BOT. Setting: University hospital. Patients: 35 patients treated surgically for BOT. Intervention: Inclusion criteria were, previous surgery for BOT, at least 2 scan and a follow up period of more than 12 months. TVS findings especially ovarian lesions, tumor recurrences, site and sonographic characteristics of recurrences were evaluated. Measurements and Main Results: The median duration of follow-up was 59 months (range 12–120) with a mean number of scan of 5.2(2-15). 18 patients had serous, 13 mucinous, 2 endometriod, 1 clear cell and 1 serous/ mucinous borderline tumors. 8 patients underwent CYS, 18 USO, and 10 RS. 4 patients in the CYS group (50%), 3 in the USO group (18%), and 2
Open Communications 9dOncology (12:11 PM d 12:16 PM)
Laparoscopic Transperitoneal Infrarenal Paraaortic Lymphadenectomy in Gynaecological Cancer Perez-Medina T,2 Garcia-Espantaleon M,1 San-Frutos L,1 Pereira A,1 Iglesias E.2 1Obstetrics and Gynecology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain; 2Obstetrics and Gynecology, Autonoma University, Madrid, Spain Study Objective: To describe our results in laparoscopic transperitoneal paraaortic lymphadenectomy in gynecological malignancies. Design: Prospective descriptive study. Setting: University Tertiary Hospital. Patients: 25 patients with cervical, endometrial or ovarian cancer, candidates for paraaortic lymphadenectomy. Intervention: Transperitoneal lymphadenectomy from common iliac arteries up to the aortic crossing of the left renal vein. Measurements and Main Results: The indication for the procedure was staging for advanced cervical carcinoma (IB2, IIA2, IIB and III) in 16 patients (64%), complete staging for high-risk endometrial adenocarcinoma because of stage (IB and beyond), histological differentiation (G3, undifferentiated) or histology (papillary-serous or clear-cell) in 7 patients (28% cases), and complete staging in early-stage ovarian cancer in 2 patients (8%). The mean age was 47 years (rank 3572); the mean body mass index was 28. The procedure was satisfactory completed in all the cases. The reduction of hemoglobin was 1.7 (0.13.9). The time to complete the paraaortic procedure exclusively was 77 minutes (54-122), the mean number of harvested paraaortic lymphatic nodes was 11 (6-33). In 4 cases, one or more metastatic nodes were informed in the pathologic report. The mean hospital stay was 3.2 days (2-7). No complications occurred in our series. Conclusion: Laparoscopic Transperitoneal Infrarenal Paraaortic Lymphadenectomy is a safe and feasible minimally invasive technique for staging gynecological cancers. The advantages of this procedure include low morbidity, less haematic loss, a shorter hospital stay and a shorter postoperative period of recovery without significant increase of complications. Furthermore, it allows the patients to begin immediately their adyuvant therapy.
185
S57
Open Communications 9dOncology (12:17 PM d 12:22 PM)
Laparoscopic Nerve Sparing Radical Parametrectomy and Total Vaginectomy for the Patients with Vagina Cancer Chen Y, Xu H, Liang Z. Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China Study Objective: The objectives of this study were to describe our laparoscopic nerve-sparing radical parametrectomy/total vaginectomy technique and to assess the feasibility and safety of the procedure, as well as surgical outcomes. Design: Prospectively collected and analysis of 12 consecutive patients with vagina cancer underwent laparoscopic radical parametrectomy/total vaginectomy with pelvic/paraaortic lymphadenectomy. (Canadian Task Force classification II-2). Setting: Major university teaching hospital. Patients: The medical records for 12 consecutive patients who underwent endoscopic inguinal lymphadenectomy because of invasive vulvar cancer were prospectively collected. Intervention: Laparoscopic radical parametrectomy/total vaginectomy with pelvic/paraaortic lymphadenectomy. Measurements and Main Results: The laparoscopic nerve-sparing radical parametrectomy/total vaginectomy with pelvic/ paraaortic lymphadenectomy procedure was completed successfully and was conducted safely in all of the patients. There were no conversions to open surgery in these patients. The median operative duration was 158.5 min. The estimated blood loss was 135.2 ml. No intro-operative complication was found, and no patients required blood transfusion. All pelvic (average 22 (10w36) nodes, n = 9) and paraaortic nodes (9 nodes, n = 3) were negative for malignancy. Histology confirmed the absence of any residual cancer tissue in the margins of the parametrial tissue and vagina. The Foley catheter was removed on day 7 to 10. There were no long-term complications. One patient with stage IIIa cervical cancer received regional radiation therapy with total dose of 4560 Gy, two patients with vaginal adenocarcinoma received chemotherapy with total of 5-8 cycles of cisplatinum, 75 mg/m2 every 3 weeks. Other patients not required adjuvant therapy after the operation. All patients were follow-up 5 to 38 months and there were no recurrence patients. Conclusion: The technique described in this preliminary study appears to be safe, feasible, and easy in our population, with satisfactory recovery of voiding function. 186
Open Communications 9dOncology (12:23 PM d 12:28 PM)
Ovarian Borderline Tumors: Transvaginal Ultrasound Follow-Up in Patients after Surgery Exacoustos C,1 Perniola G,2 Lanzilotta V,1 Di Giovanni A,1 Benedetti Panici PL,2 Arduini D.1 1Department of Obstetrics and Gynecology, Universita degli Studi di Roma ‘‘Tor Vergata’’, Rome, Italy; 2Department of Obstetrics and Gynecology, Universita degli Studi di Roma ‘‘La Sapienza’’, Rome, Italy Study Objective: Controversy exists for role of TVS in the follow up of ovarian cancer and BOT. The aim of this study was to assess the diagnostic value of TVS in the follow up of patients submitted to cystectomy (CYS), unilateral salpingo-oophorectomy (USO) or bilateral salpingooophorectomy with/without total hysterectomy (radical surgery, RS) for BOT. Design: TVS follow up in patients treated for BOT. Setting: University hospital. Patients: 35 patients treated surgically for BOT. Intervention: Inclusion criteria were, previous surgery for BOT, at least 2 scan and a follow up period of more than 12 months. TVS findings especially ovarian lesions, tumor recurrences, site and sonographic characteristics of recurrences were evaluated. Measurements and Main Results: The median duration of follow-up was 59 months (range 12–120) with a mean number of scan of 5.2(2-15). 18 patients had serous, 13 mucinous, 2 endometriod, 1 clear cell and 1 serous/ mucinous borderline tumors. 8 patients underwent CYS, 18 USO, and 10 RS. 4 patients in the CYS group (50%), 3 in the USO group (18%), and 2