Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm.

OBJECTIVE: There is recent evidence that demonstrates worse oncologic outcomes associated with minimally invasive radical hysterectomy when compared with open radical hysterectomy, particularly in patients with tumors >2 cm. The aim of our study was to retrospectively evaluate the oncological outcomes between laparoscopic and open radical hysterectomy in International Federation of Gynecology and Obstetrics(FIGO) 2009 stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm. METHODS: A retrospective review of medical records was performed to identify patients who underwent either laparoscopic or open radical hysterectomy during January 2010 and December 2018. Inclusion criteria were: (1) histologically confirmed cervical cancer including all histological types; (2) FIGO 2009 stage IB1; (3) tumor size ≤2 cm (determined by pelvic examination, magnetic resonance imaging or transvaginal ultrasound); (4) had undergone radical hysterectomy (type II or III) with pelvic and/or para-aortic lymphadenectomy as primary surgical treatment; (5) had follow-up information. Patients with FIGO 2009 stage IA1 or IA2, tumor size >2 cm, or who received neo-adjuvant chemotherapy before surgery, those with cervical cancer incidentally found after simple hysterectomy, or with insufficient data were excluded. Concurrent comparison between the laparoscopic and open cohorts was made for disease-free survival and overall survival. RESULTS: A total of 325 cervical cancer patients were included; of these, 129 patients underwent laparoscopic surgery and 196 patients had open surgery. The median follow-up times were 51.8 months (range 2-115) for laparoscopic surgery and 49.5 months (range 3-108) for open surgery. Patients in the laparoscopic group had significantly worse 5 year disease-free survival than those in the open group (90.4% vs 97.7%; p=0.02). There was no significant difference in 5 year overall survival between groups (96.9% vs 99.4%, p=0.33). The Cox proportional hazards regression analysis indicated that laparoscopic surgery was associated with lower disease-free survival compared with open surgery (adjusted hazard ratio 4.64, 95% CI 1.26 to 17.06; p=0.02). In patients with non-squamous cell carcinoma or with grade II-III, laparoscopic surgery had a significantly worse 5 year disease-free survival compared with the open surgery group (74% vs 100%, p=0.01, and 88.8% vs 98.0%, p=0.02, respectively). CONCLUSION: Laparoscopic radical hysterectomy was associated with worse disease-free survival for stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm compared with open radical hysterectomy. Further studies may shed additional light on the impact of minimally invasive surgery in this low-risk patient population.

Malignant melanoma of the vagina: A case report and review of the literature.

Primary malignant melanoma of the vagina is an extremely rare variant of melanoma that accounts for <3% of all vaginal malignancies. Primary malignant melanoma of the vagina has a worse prognosis as compared with non-genital melanomas or other vaginal malignant neoplasms. A-35-year-old female had a diagnosis of primary malignant melanoma of the vagina. A local excision of the tumor was first performed, followed by a radical excision as a further therapeutic measure. The patient returned after three weeks, presenting with a vesico-vaginal fistula. A conservative operation was subsequently performed in order to improve the quality of life of the patient. Pelvic metastases were identified 6 months after the completion of the last surgical therapy and subsequent follow-up examinations were performed in another hospital. The present case study describes the clinical features and surgical procedures of this patient with primary malignant melanoma of the vagina. In conclusion, melanoma of the vagina is an extremely aggressive cancer and the overall prognosis is poor despite the various treatment options.

Outcome and prognostic factors of laparoscopic radical hysterectomy and pelvic lymphadenectomy in 148 patients with stage IB1 cervical cancer.

OBJECTIVE: To evaluate the surgical, oncological outcome and prognostic factors of laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy in patients with stage IB1 cervical cancer. MATERIALS AND METHODS: Patients with IB1 cervical cancer undergoing LRH at the First People's Hospital of Foshan between January 2000 and March 2010 were enrolled in this study. Follow-up data were available. RESULTS: A total of 148 patients were identified. One case converted to laparotomy. Median number of resected pelvic lymph nodes was 23. Median blood loss was 250 mL and median operative time was 257 minutes. Intraoperative and postoperative complications occurred in 5.4% and 6.75% patients, respectively. Other medical problems included 47 cases (31.75%) of bladder dysfunction. Twenty-seven patients (18.24%) had microscopic nodal metastasis. A total of 37 patients received adjuvant therapy. After a median follow-up of 28 months, 21 patients had a recurrence. The overall 5-year survival rate is 82%. Univariate analysis showed the factors affecting the survival rate were nonsquamous histologic type, high grade, deep cervical stromal invasion, lymphovascular space invasion, and lymph node metastasis (P = 0.016, P = 0.045, P = 0.021, P = 0.038, and P = <0.001). The Cox proportional hazards regression analysis indicated only lymph node metastasis (odds ratio = 6.293, P < 0.001) was an independent poor prognostic factor. CONCLUSIONS: Laparoscopic radical hysterectomy can be a safe alternative to abdominal RH for patients with IB1 cervical cancer. Lymph node metastasis was an independent poor prognostic factor.

Twelve-year experience with laparoscopic radical hysterectomy and pelvic lymphadenectomy in cervical cancer.

OBJECTIVES: This study aims to evaluate the morbidity, oncological outcome, and prognostic factors of cervical cancer patients treated with laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH). METHODS: Patients with cervical cancer undergoing LRH at the First People's Hospital of Foshan between August 1998 and March 2010 were enrolled in this study. The medical records were reviewed. RESULTS: A total of 240 patients were identified. According to FIGO stage, the number of patients with stage Ia2, Ib1, Ib2, IIa, and IIb was 2, 163, 34, 35, and 6, respectively. The conversion rate was 1.25%. Intraoperative and postoperative complications occurred in 7.08% and 9.16% patients, respectively. Other medical problems included 74 cases (30%) of bladder dysfunction. Excluding the lost cases, the median follow-up of 221 cases was 35 months, and 5-year survival rate for Ia2, Ib1, Ib2, IIa was 100%, 82%, 66%, 60%, respectively. Univariate analysis showed factors impacting the survival rate were FIGO stage>Ib1, non-squamous histologic type, deep cervical stromal invasion, and lymph node metastasis (P=0.027, 0.023, 0.007, 0.000). The Cox-proportional hazards regression analysis indicated that only lymph node metastasis (OR=3.827, P=0.000) was independent of poor prognostic factor. The 5-year survival rates in Ib1 were 88% with negative lymph nodes and 59% with positive lymph nodes (P=0.000). CONCLUSIONS: Our data demonstrate that LRH can be performed in stage Ia2-Ib1 or less advanced node negative cervical cancer patients without compromising survival. The feasibility of LRH for more advanced patients needs further investigations.

[Analysis of operative patterns of 2272 laparoscopic hysterectomies].

OBJECTIVE: To evaluate the clinical efficacy of four different operative patterns of laparoscopic hysterectomy: laparoscopically assisted vaginal hysterectomy (LAVH), laparoscopically introfasial subtotal hysterectomy (LISH), laparoscopically subtotal hysterectomy (LSH) and laparoscopically total hysterectomy (LTH). METHODS: A retrospective analysis on 2272 cases of laparoscopic hysterectomy was carried out, including operating time, blood loss, complication and postoperative recovery. RESULTS: For the two groups which preserved cervix, LISH was performed in 1323 cases. The operating time was (91 +/- 21) min, blood loss (93 +/- 23) ml, complication rate 4.1%. LSH was conducted in 229 cases, with an operating time (70 +/- 18) min, blood loss (69 +/- 17) ml, complication rate 0. The difference between the two groups was significant (all P < 0.01). For the two groups which excised cervix, LAVH was performed in 588 cases, with an operating time (119 +/- 28) min, blood loss (156 +/- 23) ml, complication rate 1.5%; while LTH was carried out in 132 cases, with an operating time (121 +/- 30) min, blood loss (193 +/- 38) ml, complication rate 1.2%. There were no significant differences between the two groups (all P > 0.05). All patients recovered well postoperatively. CONCLUSIONS: The four operative patterns are ideal for hysterectomy. Young patients should be operated with laparoscopic hysterectomy with preservation of cervix, old patients or patients with CIN should be operated with excision of cervix.