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1.
Gynecol Oncol ; 120(3): 353-7, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21215440

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the feasibility of the sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging in the early stage invasive cervical cancer in patients undergoing radical hysterectomy and pelvic lymphadenectomy. METHODS: Between March 2007 and June 2009, a prospective consecutive study was designed for SLN mapping. Twenty-two patients with cervical cancer FIGO stage IB1 (n=20) or stage IIA1 (n=2) underwent SLN identification with preoperative SPECT/CT and planar images (technetium-99m colloid albumin injection around the tumor) and posterior intraoperative detection with both blue dye and a handheld or laparoscopic gamma probe. Complete pelvic lymphadenectomy was performed in all cases by open (n=2) or laparoscopic (n=20) surgery. RESULTS: In the present series, a total of 35 SLN were detected with planar images and 40 SLN were identified and well located by SPECT/CT lymphoscintigraphy (median 2.0 nodes per patient). In 5/22 patients (22.7%) SPECT/CT procedure improves the number of localized SLN. Intraoperatively, 57 SLNs were identified, with a median of 3 SLNs per patient by gamma probe (a total of 53 hot nodes) and a median of 2 nodes per patient after blue dye injection (a total of 42 blue nodes). Microscopic nodal metastases (eight nodes, corresponding to four patients) were confirmed in 18.18% of cases; all these lymph nodes were previously detected as SLN. The remaining 450 nodes, including SLNs, following complete pelvic lymphadenectomy, were histologically negative. CONCLUSIONS: Sentinel lymph node detection is improved by SPECT/CT imaging because of the increased number of SLN detected and the better tridimensional anatomic location, allowing easier intra-operative detection with gamma probe and showing, in this series, a 100% negative predictive value.


Subject(s)
Sentinel Lymph Node Biopsy/methods , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Uterine Cervical Neoplasms/pathology , Adult , Aged , Female , Humans , Middle Aged , Neoplasm Staging , Prospective Studies , Uterine Cervical Neoplasms/mortality
2.
Acta Obstet Gynecol Scand ; 87(7): 723-30, 2008.
Article in English | MEDLINE | ID: mdl-18607826

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the safety and feasibility of extraperitoneal laparoscopic paraaortic lymphadenectomy for suspected lymph node recurrence of gynecological cancers. DESIGN: Descriptive study. SETTING: Unit of Gynecologic Oncology of an acute-care teaching hospital in Barcelona, Spain. POPULATION: Between December 2002 and October 2007, eight women underwent extraperitoneal laparoscopic paraaortic lymphadenectomy for suspected lymph node recurrence, detected by magnetic resonance image (MRI), computed tomography (CT) scan or 18F-fluorodeoxyglucose positron emission tomography (PET) scanning. The suspicious nodes were removed through an extraperitoneal laparoscopic approach. RESULTS: The median age of patients was 66.5 years (range: 54-74). The median operating time was 157.5 minutes (range: 120-240). The median blood loss was 112.5 mL (range: 50-150). The mean nodal yield was 9.4+/-4.72 (range: 1-16). There were no intraoperative or postoperative complications. The median hospital stay was two days. Histological examination revealed metastasis in seven of eight patients. CONCLUSIONS: The extraperitoneal laparoscopic paraaortic lymphadenectomy for lymph node recurrence of gynecological cancers is a safe and feasible procedure which should be considered where there is isolated involvement of retroperitoneal lymph nodes. This procedure is a minimally invasive technique that allows an excellent approach to the paraaortic lymph nodes.


Subject(s)
Genital Neoplasms, Female/pathology , Laparoscopy , Lymph Node Excision/methods , Aged , Aorta, Abdominal , Diagnostic Imaging , Feasibility Studies , Female , Humans , Lymphatic Metastasis , Middle Aged , Neoplasm Recurrence, Local/surgery
3.
J Minim Invasive Gynecol ; 15(5): 531-7, 2008.
Article in English | MEDLINE | ID: mdl-18657483

ABSTRACT

STUDY OBJECTIVE: To estimate the feasibility and results of sentinel lymph node identification and radical hysterectomy with pelvic lymphadenectomy entirely completed by laparoscopy versus laparotomy in early stage cervical cancer. DESIGN: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). SETTING: Acute care, teaching hospital. PATIENTS: From September 2000 through January 2005, 50 consecutive patients with International Federation of Gynecology and Obstetrics stage IA2, IB1, and IIA disease less than 4 cm underwent radical hysterectomy and lymphadenectomy with intraoperative sentinel lymph node biopsy. INTERVENTIONS: The operation was performed entirely by laparoscopy in 20 patients and using the conventional abdominal approach in 30. Feasibility of sentinel lymph node identification, surgical morbidity, overall survival, and recurrence rate-free survival in both groups were compared. MEASUREMENTS AND MAIN RESULTS: The overall detection rate of the sentinel lymph node was 100% (false negative 0%). A mean of 2.50 sentinel nodes/patient was detected in the laparotomy group compared with a mean of 2.55 nodes in the laparoscopic group (p=.874). Bifurcation of the right common iliac artery was the most frequent nodal location. Blood loss and length of stay were significantly lower in the laparoscopic group, but surgical time was significantly longer. The median follow-up was 35 months (range 5-57) in the laparotomy group and 22.5 (range 2-52) in the laparoscopic group. Differences in overall survival and disease-free survival were not observed. CONCLUSION: Sentinel lymph node identification and radical hysterectomy in the initial treatment of early stage cervical cancer can be performed safely by laparoscopy with lower morbidity and overall survival and recurrence-free survival similar to standard laparotomy.


Subject(s)
Hysterectomy/methods , Laparoscopy/methods , Laparotomy , Sentinel Lymph Node Biopsy/methods , Uterine Cervical Neoplasms/surgery , Adult , Aged , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Retrospective Studies
4.
Gynecol Oncol ; 110(3 Suppl 2): S33-5, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18538379

ABSTRACT

During the last years, and coinciding with the beginning of the concomitant treatment with radio-chemotherapy, a better control of local cervical cancer has been reached, although failures in the systemic control of the illness have been more frequent. One of the main causes is not treating the illness at the level of the para-aortic lymph nodes, basically because their affectation is unknown and because imaging tests have a high percentage of false negative results. At this time, it is when laparoscopic para-aortic lymphadenectomy arises, in order to be able to know the extension of the illness better before treatment. A extraperitoneal laparoscopic approach is described in order to reduce complications derived from a possible extended irradiation. Between August 2001 and October 2007, a total of 69 patients with bulky and locally advanced cervical cancer (FIGO stages IB2, IIA > 4 cm and IIB-IVA) underwent extraperitoneal laparoscopic lymphadenectomy for surgical staging. Extraperitoneal aortic lymphadenectomy by laparoscopic approach is a technique with low morbidity. Special laparoscopic material is not required and if it is performed by a team trained in technical endoscopics it is not difficult. Radio-chemotherapy treatment began immediately after laparoscopy because of its minimal aggression.


Subject(s)
Uterine Cervical Neoplasms/surgery , Adolescent , Adult , Aged , Female , Humans , Lymph Node Excision/methods , Middle Aged , Neoplasm Staging , Treatment Outcome , Uterine Cervical Neoplasms/pathology
5.
Gynecol Oncol ; 103(3): 865-70, 2006 Dec.
Article in English | MEDLINE | ID: mdl-16828149

ABSTRACT

OBJECTIVES: To determine the usefulness of sentinel lymph node biopsy in early stage vulvar cancer and to assess recurrences after surgical treatment with sentinel node identification or surgical treatment without sentinel node identification. METHODS: We reviewed the records of 55 patients with early stage vulvar cancer operated on between 1995 and 2005. A prospective series of 28 patients who underwent vulvectomy and lymphadenectomy with intraoperative sentinel lymph node identification between 2000 and 2005 (SLN group) was compared with a retrospective series of 27 patients who underwent vulvectomy and lymphadenectomy without sentinel node procedure between 1995 and 2000 (non-SLN group). Patients in the sentinel node identification group underwent preoperative lymphoscintigraphy (technetium-99 colloid albumin injection around the tumor) and intraoperative mapping with isosulfan blue dye. RESULTS: In the SLN group, 9 tumors were T1 and 19 were T2, with a total of 40 groins dissected and 9 positive nodes in 7 patients. Sixty-two sentinel lymph nodes were detected with a mean of 2.2 sentinel nodes per patient (range 0-4). A false negative case was found. In the non-SLN group, 7 tumors were T1 and 20 were T2, with a total of 49 groins dissected and 9 positive nodes in 6 patients. Recurrence occurred in 8 patients (28.6%) in the SLN group and in 6 (26.9%) in the non-SLN group (P=0.8). CONCLUSIONS: Sentinel lymph node identification in early stage vulvar cancer is a feasible. Analysis of recurrence may allow considering this procedure as a possible alternative to inguino-femoral lymphadenectomy.


Subject(s)
Neoplasm Recurrence, Local/surgery , Sentinel Lymph Node Biopsy/standards , Vulvar Neoplasms/surgery , Adult , Aged , Aged, 80 and over , False Negative Reactions , Feasibility Studies , Female , Gynecologic Surgical Procedures/methods , Humans , Lymph Node Excision/methods , Medical Records , Middle Aged , Neoplasm Recurrence, Local/pathology , Predictive Value of Tests , Prospective Studies , Retrospective Studies , Vulvar Neoplasms/pathology
6.
J Minim Invasive Gynecol ; 12(6): 522-4, 2005.
Article in English | MEDLINE | ID: mdl-16337581

ABSTRACT

A 60-year-old patient had undergone a subtotal hysterectomy through a standard laparotomy approach due to multiple uterine myomas 6 years before. She had a 1-month history of postmenopausal uterine bleeding. An endocervical polyp was found and excised. The histopathologic examination showed a poorly differentiated adenocarcinoma. Magnetic resonance imaging of the abdomen and pelvis revealed the mass (4x2x2.5 cm) without parametrial involvement previously identified on vaginal examination. There was no retroperitoneal adenopathy. The patient was successfully treated with total laparoscopic radical trachelectomy in association with laparoscopic intraoperative detection of the sentinel lymph node.


Subject(s)
Adenocarcinoma/surgery , Cervix Uteri/surgery , Uterine Cervical Neoplasms/surgery , Adenocarcinoma/diagnosis , Female , Gynecologic Surgical Procedures/methods , Humans , Hysterectomy , Laparoscopy , Middle Aged , Sentinel Lymph Node Biopsy , Uterine Cervical Neoplasms/diagnosis
7.
J Minim Invasive Gynecol ; 12(2): 113-20, 2005.
Article in English | MEDLINE | ID: mdl-15904613

ABSTRACT

STUDY OBJECTIVE: To describe the feasibility and outcome of total laparoscopic radical hysterectomy with pelvic lymphadenectomy in early cervical cancer. DESIGN: Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: Acute-care, teaching hospital. PATIENTS: Twenty-seven nonconsecutive patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 (n = 4) or IB1 (n = 23) cancer of the cervix. INTERVENTION: Laparoscopic type II (n = 9) or type III (n = 18) hysterectomy with systematic bilateral pelvic lymphadenectomy. Monopolar coagulation, vascular clips, and harmonic scalpel were used. Resection of the cardinal and uterosacral ligaments was performed with Endo GIA stapling and the harmonic scalpel. MEASUREMENTS AND MAIN RESULTS: Histopathologically, there were 20 cases of squamous carcinoma, 6 adenocarcinomas, and 1 adenosquamous carcinoma. The operation was performed entirely by laparoscopy in 26 patients. One patient underwent laparotomy because of equipment failure. The patients' mean age was 45.1 years (95% CI 41.7-48.4), with a median body mass index of 26.0 kg/m2. The mean number of resected pelvic nodes was 19.1 (95% CI 17.02-21.2). Three patients had microscopic metastatic nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 400 mL (range 250-700 mL). The median length of stay was 5 days. Major intraoperative complications did not occur. All patients are free of disease after a median follow-up of 32 months (range 4-52 months). CONCLUSION: Radical hysterectomy can be successfully completed by laparoscopy in patients with early cervical cancer. This procedure may reduce the morbidity associated with abdominal or transvaginal radical hysterectomy.


Subject(s)
Hysterectomy/methods , Laparoscopy/methods , Lymph Node Excision/methods , Neoplasm Invasiveness/pathology , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Adult , Aged , Carcinoma, Adenosquamous/mortality , Carcinoma, Adenosquamous/pathology , Carcinoma, Adenosquamous/surgery , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Cohort Studies , Confidence Intervals , Female , Humans , Middle Aged , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Assessment , Spain , Survival Analysis , Treatment Outcome , Uterine Cervical Neoplasms/mortality
8.
Gynecol Oncol ; 97(1): 292-5, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15790481

ABSTRACT

BACKGROUND: We present a case of umbilical metastasis after laparoscopic retroperitoneal paraaortic lymphadenectomy for cervical cancer. CASE: A 59-year-old woman with stage IIIB cervical adenocarcinoma underwent laparoscopic paraaortic lymphadenectomy as well as a conventional laparoscopy to assess the presence of peritoneal carcinomatosis. The pathologic examination revealed metastasis in one paraaortic node. Peritoneal cytology proved negative for malignant cells. Seven months after completion of chemoradiotherapy, the patient presented a 2.5-cm umbilical tumor involving the trocar tract together with recurrence of the cervical mass. Histological examination of the excised umbilical mass showed recurrence of the cervical adenocarcinoma, with strong peritumoral CD31 immunocytochemical expression. CONCLUSION: The peritumoral increase in microvessel density and strong CD31 positivity suggests angiogenesis as a potential factor lead to seeding of tumor cells at the umbilical port.


Subject(s)
Abdominal Neoplasms/secondary , Adenocarcinoma/secondary , Neoplasm Seeding , Umbilicus/pathology , Uterine Cervical Neoplasms/pathology , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Female , Humans , Laparoscopy/adverse effects , Lymph Node Excision/adverse effects , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis , Middle Aged , Retroperitoneal Space , Uterine Cervical Neoplasms/surgery
9.
Gynecol Oncol ; 96(1): 187-93, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15589599

ABSTRACT

OBJECTIVES: To describe the feasibility and results of total laparoscopic radical hysterectomy with intraoperative sentinel lymph node identification in patients with early cervical cancer. METHODS: Between March 2001 and October 2003, 12 patients with FIGO stage IA(2) (n = 1) or IB(1) (n = 11) cancer of the cervix underwent surgical treatment through the laparoscopic route. All patients underwent a laparoscopic sentinel node identification with preoperative lymphoscintigraphy (technetium-99 m colloid albumin injection around the tumor) and intraoperative lymphatic mapping with isosulfan blue dye and a laparoscopic gamma probe followed by systematic bilateral pelvic lymphadenectomy and laparoscopic type II (n = 5) or type III (n = 7) hysterectomy. RESULTS: A mean of 2.5 sentinel nodes per patient (range 1-4) was detected, with a mean of 2.33 nodes per patient by gamma probe and a mean of 2 per patient after blue injection (combined detection rate 100%). The most frequent localization of the nodes was the interiliac region. Histopathologic examination of sentinel nodes including cytokeratin immunohistochemical analysis did not show metastasis. Microscopic nodal metastases were not found. The mean number of resected pelvic nodes was 18.6 per patient (range 10-28). The operation was performed entirely by laparoscopy in all patients and no case of laparotomy conversion was recorded. The mean duration of operation was 271 min (range 235-300), with a mean blood loss of 445 mL (range 240-800), and a mean length of stay of 5.25 days (range 3-10). No major intraoperative complications occurred. After a median follow-up of 20 months (range 5-34), all patients are free of disease. CONCLUSIONS: This study shows the feasibility of the combination of laparoscopic intraoperative sentinel node mapping and laparoscopic radical surgery in the context of minimally invasive surgery for the management of patients with early cervical cancer.


Subject(s)
Lymph Nodes/pathology , Sentinel Lymph Node Biopsy , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , Adult , Female , Humans , Hysterectomy , Laparoscopy , Lymph Node Excision , Lymph Nodes/diagnostic imaging , Lymph Nodes/surgery , Middle Aged , Neoplasm Staging , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Aggregated Albumin , Uterine Cervical Neoplasms/diagnostic imaging
10.
Gynecol Oncol ; 92(3): 845-50, 2004 Mar.
Article in English | MEDLINE | ID: mdl-14984951

ABSTRACT

OBJECTIVES: We investigated the feasibility of sentinel lymph node identification using radioisotopic lymphatic mapping with technetium-99m-labeled human serum albumin and isosulfan blue dye injection in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. METHODS: Between September 2000 and October 2002, 25 patients with cervical cancer FIGO stage I (n=24) or stage II (n=1) underwent sentinel lymph node detection with preoperative lymphoscintigraphy (technetium-99m colloid albumin injection around the tumor) and intraoperative lymphatic mapping with blue dye and a handheld or laparoscopic gamma probe. Complete pelvic or paraaortic lymphadenectomy was performed in all cases by open surgery or laparoscopic surgery. RESULTS: In 23 evaluable patients, a total of 51 sentinel lymph nodes were detected by lymphoscintigraphy (mean 2.21 nodes per patient). Intraoperatively, 61 sentinel lymph nodes were identified, with a mean of 2.52 nodes per patient by gamma probe and a mean of 1.94 nodes per patient after isosulfan blue injection. Forty percent of sentinel nodes were found in the interiliac region and 25% in the external iliac area. Microscopic nodal metastases (four nodes) were confirmed in 12% of cases. All these lymph nodes were previously detected as sentinel lymph nodes. The remaining 419 nodes after pelvic lymphadenectomy were histologically negative. CONCLUSIONS: Sentinel lymph node identification with technetium-99m-labeled nanocolloid combined with blue dye injection is feasible and showed a 100% negative predictive value, and potentially identified women in whom lymph node dissection can be avoided.


Subject(s)
Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Organotechnetium Compounds , Radiopharmaceuticals , Rosaniline Dyes , Serum Albumin , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/pathology , Adult , Aged , Female , Humans , Hysterectomy , Intraoperative Care , Lymph Node Excision , Lymph Nodes/surgery , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Radionuclide Imaging , Sentinel Lymph Node Biopsy/methods , Uterine Cervical Neoplasms/surgery
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