RESUMEN
Objective: To investigate the factors affecting the prognosis of stage â a2-â ¡a2 cervical cancer after laparoscopic radical hysterectomy (LRH), and to compare the prognosis and recurrence sites of patients with different colpotomy paths. Methods: The clinical data of 965 patients with stage â a2-â ¡a2 cervical cancer who underwent LRH in the First Affiliated Hospital of Army Medical University from January 2015 to December 2018 were collected. The median age was 47.0 years of all patients with a median follow-up of 62 months (48-74 months). Cox regression was used to perform the univariate and multivariate analysis of the clinicopathological factors associated with the prognosis that included disease-free survival (DFS) and overall survival (OS). Patients were categorized into LRH through vaginal colpotomy (VC group, n=475) and LRH through intracorporeal colpotomy (IC group, n=490) according to the colpotomic approaches. The prognosis and recurrence sites of patients in each group were compared. Results: (1) During the follow-up period, 137 cases recurred (14.2%, 137/965) and 98 cases died (10.2%, 98/965). The 5-year DFS and OS were 85.8% and 89.9%, respectively. In univariate analysis, positive vaginal margin (PVM) was significantly affected the 5-year OS of patients with cervical cancer (P=0.023), while clinical stage, maximum diameter of tumor, degree of pathological differentiation, lymph node metastasis (LNM), depth of cervical stromal invasion, parametrium involvement, and uterine corpus invasion (UCI) were significantly associated with 5-year DFS and OS in patients with cervical cancer (all P<0.05). In multivariate analysis, clinical stage (HR=1.882, 95%CI: 1.305-2.716), LNM (HR=2.178, 95%CI: 1.483-3.200) and UCI (HR=3.650, 95%CI: 1.906-6.988) were independent risk factors of 5-year DFS (all P<0.001). Clinical stage (HR=2.500, 95%CI: 1.580-3.956), LNM (HR=2.053, 95%CI: 1.309-3.218), UCI (HR=3.984, 95%CI: 1.917-8.280), PVM (HR=3.235, 95%CI: 1.021-10.244) were independent risk factors of 5-year OS (all P<0.05). (2) Different colpotomy paths did not significantly affect the 5-year DFS and OS of patients with stage â a2-â ¡a2 cervical cancer. The 5-year DFS in VC group and IC group were 85.9% and 85.6% (P=0.794), and the 5-year OS were 90.8% and 89.3% (P=0.966), respectively. Recurrence patterns consisted of intraperitoneal recurrence, pelvic recurrence, vaginal stump recurrence, and lymph node and distant metastasis. The intraperitoneal recurrence rate of VC group was significantly lower than that of IC group [0.6%(3/468) vs 2.3% (11/485), P=0.037], while the rates of pelvic recurrence, vaginal stump recurrence, lymph node and distant metastasis and overall recurrence were not significantly different between two groups (all P>0.05). Subgroup analysis of patients with different clinical stages, LNM and UCI showed that statistical differences of the intraperitoneal recurrence rates between two groups were only in patients without LNM (0.5% vs 2.3%, P=0.030) or without UCI (0.7% vs 2.3%, P=0.037). Conclusions: Clinical stage, LNM, PVM and UCI are independent risk factors for the prognosis of patients with stage â a2-â ¡a2 cervical cancer. For patients without LNM or UCI, LRH through VC could reduce the intraperitoneal recurrence rate, while it is not enough to improve 5-year DFS and OS of patients. Low proportion of intraperitoneal recurrence, intra-operative tumor cells spillage to vagina stump and pelvic cavity might be the explanation.
Asunto(s)
Laparoscopía , Neoplasias del Cuello Uterino , Femenino , Humanos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/cirugía , Histerectomía , Útero , Pronóstico , Metástasis LinfáticaRESUMEN
Surgery is the primary treatment for early cervical cancer. Radical hysterectomy by laparotomy and minimally invasive surgery have been widely used for years. The results of the LACC study has overturned the clinical practice of the cervical cancer, and the radical hysterectomy by laparotomy is the only standard operation. Based on the studies of laparoscopy or robot-assisted laparoscopy comparing laparotomy for the risk factors of survival outcomes, as well as a series of methods for improving oncology outcomes, it suggests that the minimally invasive surgical approach in early cervical cancer should be reconsidered. Focusing on this topic, this paper discussed the risk factors that might affect the oncology outcome of minimally invasive surgery, and analyzed the surgical indications and recurrence patterns. Hence, to promote the standardized operation of "tumor-free" in the procedure of the minimally invasive surgery might be improve the patient survival outcomes.
Asunto(s)
Laparoscopía , Neoplasias del Cuello Uterino , Femenino , Humanos , Histerectomía/efectos adversos , Histerectomía/métodos , Laparoscopía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estadificación de Neoplasias , Estudios RetrospectivosAsunto(s)
Micosis , Penicillium , Absceso/diagnóstico , Errores Diagnósticos , Humanos , TalaromycesRESUMEN
Objective: To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy. Methods: From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage â b1, â b2, â ¡a1 and â ¡a2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study. Results: There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH ï¼P=0.010ï¼. Stratify analysisï¼ including stage of disease ï¼â b1 and â ¡a1ï¼ï¼ histologic subtypes ï¼squamous-cell carcinoma, adenocarcinomaï¼ï¼ lymph node metastasisï¼ revealed that, â Stage of disease: in stage â b1, the OS at five years of mLVRH was higher than that in TLRH group ï¼98.6% vs 93.6%, P=0.012ï¼. In stage â ¡a1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% ï¼P=0.007ï¼. â¡ Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference ï¼P=0.046ï¼ï¼ for adenocarcinoma, the OS at five years were 91.0% and 88.6%ï¼ and there was no difference between two groups ï¼P=0.230ï¼. ⢠Lymph node metastasisï¼ the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively (P=0.156ï¼ P=0.093ï¼. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage â b1 (97.0% vs 92.8%, P=0.039). However, for stage â ¡a1, there was no significant difference between mLVRH and TLRH group ï¼88.2% vs 75.8%, P=0.074ï¼. Conclusions: The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in â b1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.
Asunto(s)
Histerectomía/métodos , Laparoscopía/métodos , Escisión del Ganglio Linfático , Neoplasias del Cuello Uterino/cirugía , Adulto , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patologíaRESUMEN
Several plano-convex aluminum thin films, ~30 nm thick in the center and ~2 mm in diameter, were deposited on microscope cover slides to function as inverse-Gaussian transmittive filters. By placing one of these filters in front of the Gaussian He-Ne laser, we can modify the beam intensity profile in the downstream direction. To yield a uniform beam, the position of the filter must be aligned in the transverse plane for maximum intensity at the output of the filter. These filters are easy to fabricate and are inexpensive. Most important, they can help produce collimated phase-coherent uniform beams, which are useful in high-precision fringe-analysis techniques.