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Objective@#To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer.@*Methods@#Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC-Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm, ≥1.0 cm, serum level of SCC-Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high-risk factors of common iliac lymph node (CILN) and para-aortic lymph node (PALN) metastases were also analyzed.@*Results@#The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3% (48/81). The CILN and/or PALN metastasis rate was 24.7%(20/81), and among them, the MAD of CILN and/or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC-Ag for evaluating lymph node metastasis was 4.8 ng/ml. The accuracy, specificity and Youden index of SCC-Ag≥4.8+ MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC-Ag≥4.8 ng/ml group and 68.3%, 65.4% and 0.4 of SCC-Ag≥4.8 ng/ml+ MAD≥0.5 cm group (P<0.05). All of the 21 patients in SCC-Ag≥4.8 ng/ml+ MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and/or PALN was 38.1%. While only 4 cases of 17 patients in SCC-Ag<4.8 ng/ml+ MAD<1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P<0.001). The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and/or MAD of CILN and/or PALN was 0.5~1.0 cm were associated with the CILN and/or PALN metastases (all P<0.05).@*Conclusions@#Those patients with MAD≥1.0 cm+ SCC-Ag≥4.8 ng/ml and with high-risk factors of CILN and/or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC-Ag<4.8 ng/ml combined with MAD<1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.
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Objective@#To introduce the laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branched and to evaluate its feasibility and safety for cervical cancer and its effect to bladder function and to provide some reference to simplify the surgical procedures of laparoscopic type C1 hysterectomy.@*Methods@#The clinicopathologic data of the patients with stage ⅠA2~ⅡB cervical cancer and who underwent the laparoscopic C1 hysterectomy based on anatomic landmark of the uterus deep vein and its branches between March 2010 and December 2015 was retrospectively analysed.@*Results@#A total of 99 patients received laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches, in which 93 patients reserved unilateral or bilateral pelvic autonomic nerve successfully, the other 6 patients were transfered to receive type C2 hysterectomy due to adhesions, bleeding or the low possibility of curative resection. The failure rate of the surgery was 6.1% (6/99). The average age of these 93 patients was 44.4±8.2 years (range 25~61 years) and there was one case of stage ⅠA2, 84 stage ⅠB1, 2 stage ⅠB2, 5 stage ⅡA1 and 1 stage ⅡB. The number of patients with squamous cell carcinoma was 67, adenocarcinoma was 19, adenosquamous carcinoma was 3, small cell neuroendocrine carcinoma was 3 and mixed type was 1. The average operation time was 4.1±0.5 h, the average amount of intraoperative blood loss was 103.8±84.0 ml and the mean number of excisional pelvic lymph nodes was 29.7±8.9. There was no patient with positive parametrial margin, positive vaginal margin or intraoperative ureteral injury. The postoperative catheter extraction time was 20.3±8.4 d. The median follow-up time was 20 months (rang 5~44 months), the long-term bladder dysfunction rate was 8.6% (8/93). The numbers of locally uncontrolled and distantly metastasis case were both one and both patients died. The fatality rate were 2.2% (2/93). The two-year disease-free survival and overall survival rate were 97.6% and 96.2%, respectively.@*Conclusion@#Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches is a safe and feasible treatment method for cervical cancer and it provides a new approach for simplifying the surgical procedures of laparoscopic type C1 hysterectomy.
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Objective To analyze the clinicopathologic features of mucinous cervical adenocarcinoma (ADC) and supply some reference for its diagnosis,treatment and prognosis.Methods Totally 88 cases with primary mucinous ADC diagnosed between January 2003 and December 2007 in Jiangxi Maternal and Child Health Hospital were retrieved.Their clinical and pathological data were reviewed and analyzed.Results Among 88 patients,70 cases of them were endocervical ADC,11 cases were minimal deviation adenocarcinoma (MDA),2 cases were intestinal subtype and 5 cases were villoglandular ADC.The positive rate of cervical Pap smear cytology was only 28％ (10/36).There were 10 cases were performed several times of cervical Pap smear cytology test and biopsies,while still no abnormality was found.Finally,7 cases of them were diagnosed by cervical excisional biopsy and endocervical curettage,including 5 cases with endocervical ADC and 2 cases with MDA; 2 cases (1 case with stage Ⅰ b1 endocervical ADC and 1 case with Ⅰ b1 MDA) were diagnosed by cold knife conization,and 1 case with stage Ⅰ b1 endocervical were diagnosed by uteroscopically directed biopsy.The overall 5-year survival rate was 60.0％.Using univariate analysis results showed that age (P =0.046),stage (P =0.007),tumor size (P =0.007) and therapeutic methods (P =0.009) were significant prognostic factors.Multivariate analysis showed that therapeutic methods was an independent predictor for survival (P =0.013).Stage Ⅱ b-Ⅲ b MDA patients occupied 7/11 of all MDA patient,while there was only one such patient of 5 cases with villoglandular ADC.The overall HPV infection rate was 65％ (57/88),and there was no obvious differences about the HPV infection rates among different types of mucinous ADC.Conclusions Cervical smear cytology is of little significance to the diagnosis of mucinous cervical adenocarcinoma.Early stage mucinous ADC is difficult to be detected,especially for MDA.Cervical excisional biopsy,endocervical curettage,cold knife conization,uteroscope are beneficial to its diagnosis.Therapeutic methods is an important prognostic factor for mucinous ADC and comprehensive treatment should be given to those patients with risky postsurgical factors.