Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (6): 76-80.doi: 10.6040/j.issn.1671-7554.0.2021.0328

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Clinical efficacy of laparoscopic radical hysterectomy without lift and tumor spillage in 25 cases of early-stage cervical cancer

WANG Lu, ZHAO Xinrui, ZHU Lin   

  1. Department of Gynecology, The Second Hospital of Shandong University, Jinan 250033, China
  • Published:2021-06-10

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Abstract: Objective To explore the feasibility and clinical efficacy of laparoscopic hysterectomy without lift and tumor spillage for cervical cancer at early stage. Methods A total of 25 patients with cervical cancer who received laparoscopic hysterectomy without lift and tumor spillage at The Second Hospital of Shandong University during Mar. 2020 and Jan. 2021 were enrolled. During the surgery, the neoplasia was sealed via the vagina. The lymph nodes were bagged immediately after dissection, sutures were pulled to lift the uterus, the vaginal end was ligated and occluded, and the uterus was bagged immediately after hysterectomy to ensure no tumor spillage. Results All 25 patients successfully completed laparoscopic hysterectomy without conversion to open surgery, and there were no ureteral or intestinal injuries. The average operation time was(205.3±18.7)min, and average intraoperative bleeding volume was(79.28±20.16)mL. The widths of the excised left and right parauterine tissues were(2.8±0.6)cm and(2.9±0.4)cm, respectively. The lengths of excised main ligament, uterosacral ligament and vagina were(2.9±0.35)cm,(3.18±0.36)cm, and(3.2±0.21)cm, respectively. The number of dissected pelvic lymph nodes was(22.5±4.3). No lymph node metastasis was observed. The margins of hysterectomy and vaginectomy were negative. The mean time of postoperative ventilation was(34.18±8.67)h, and the catheter removal time was(11.05±3.67)d. Conclusion This surgical approach is safe and feasible, which ensures not only enough resection range, but also no tumor spillage during operation.

Key words: Cervical carcinoma, Laparoscope, Without lift, Non-tumor spillage, Hysterectomy

CLC Number: 

  • R737.33
[1] Brotherton JM, Fridman M, May CL, et al. Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study [J]. Lancet, 2011, 377(9783): 2085-2092.
[2] 王宇, 宋淑芳, 刘凤. 我国宫颈癌流行病学特征和发病高危因素的研究进展[J]. 中国妇幼保健, 2019, 34(5): 1206-1208.
[3] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[4] Lei J, Ploner A, Elfström KM, et al. HPV vaccination and the risk of invasive cervical cancer [J]. N Engl J Med, 2020, 383(14): 1340-1348.
[5] Tewari KS, Monk BJ. Evidence-based treatment paradigms for management of invasive cervical carcinoma [J]. J Clin Oncol, 2019, 37(27): 2472-2489.
[6] Brucker SY, Ulrich UA. Surgical treatment of early-stage cervical cancer [J]. Oncol Res Treat, 2016, 39(9): 508-514.
[7] Chang WC, Lee LC, Huang SC, et al. Application of laparoscopic surgery in gynecological oncology [J]. J Formos Med Assoc, 2010, 109(8): 558-566.
[8] Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer [J]. N Engl J Med, 2018, 379(20): 1905-1914.
[9] Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer [J]. N Engl J Medc, 2018, c379(20): 1895-1904.
[10] Matsuo K, Chen L, Mandelbaum RS, et al. Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally-invasive surgery versus laparotomy [J]. Am J Obstet Gynecol, 2019, 220(5): 469.e1-469.e13.
[11] Tewari KS. Minimally invasive surgery for early-stage cervical carcinoma: interpreting the laparoscopic approach to cervical cancer trial results [J]. J Clin Oncol, 2019, 37(33): 3075-3080.
[12] Matsuo K, Shimada M, Yamaguchi S, et al. Association of radical hysterectomy surgical volume and survival for Early-Stage Cervical Cancer [J]. Obstet Gynecol, 2019 133(6): 1086-1098.
[13] Alfonso Dueas-González, Campbell S. Global strategies for the treatment of early-stage and advanced cervical cancer [J]. Curr Opin Obstet Gynecol, 2016, 28(1): 11-17.
[14] Pathiraja P, Tozzi R. Advances in gynaecological oncology surgery [J]. Best Pract Res Clin Obstet Gynaecol, 2013, 27(3): 415-420.
[15] Li X, Li J, Jiang Z, et al. Oncological results and recurrent risk factors following abdominal radical trachelectomy(ART): An updated series of 333 patients [J]. BJOG, 2019, 126(9): 1169-1174.
[16] Karam A, Dorigo O. Minimally invasive surgery for gynecologic cancers-a cautionary tale [J]. JAMA Oncol, 2020, 6(7): 991-993.
[17] 熊光武, 张国楠. 对早期宫颈癌腹腔镜与开腹手术远期疗效差异的思考[J]. 中国微创外科杂志, 2019, 19(1): 1-3.
[18] Choi CH, Lee JY, Lee YY, et al. Comparison of laparoscopic-assisted radical vaginal hysterectomy and laparoscopic radical hysterectomy in the treatment of cervical cancer [J]. Ann Surg Oncol, 2012, 19(12): 3839-3848.
[19] Lago V, Tiermes M, Padilla-Iserte P, et al. Protective maneuver to avoid tumor spillage during laparoscopic radical hysterectomy: vaginal cuff closure [J]. J Minim Invasive Gynecol, 2021, 28(2): 174-175.
[20] Yang Y, Liu Y, Li G, et al. Vaginal stump ligation for cervical cancer [J]. Iran J Public Health, 2017, 46(10): 1332-1337.
[21] Wiebren AA, Tjalma. The survival after a radical hysterectomy for cervical cancer by open surgery is significantly better than after minimal invasive surgery: evidence beats gut feeling! [J]. Eur J Obstet Gynecol Reprod Biol, 2018, 229: 195-197. doi: 10.1016/j.ejogrb.2018.07.027.
[22] Ferrandina G, Corrado G, Scambia G. Minimally invasive surgery and quality of life in cervical cancer [J]. Lancet Oncol, 2020, 21(6): 746-748.
[23] Martino MA, Bixel K, Msiv A, et al. A novel technique to minimize contamination for cervical cancer surgery patients [J]. J Minim Invasive Gynecol, 2020, 27(7): 1624-1630.
[24] Boyraz G, Karalok A, Basaran D, et al. Vaginal closure with endoGIA to prevent tumor spillage in laparoscopic radical hysterectomy for cervical cancer [J]. J Minim Invasive Gynecol, 2019, 26(4): 602. doi: 10.1016/j.jmig.2018.07.015.
[25] Ramirez PT. Quality indicators in cervical cancer surgery: a valiant step in the right direction [J]. Int J Gynecol Cancer, 2020, 30(1): 1-2.
[26] Gaffney DK. Optimal therapy for IB2 and IIA2 cervical cancer: surgery or chemoradiotherapy? [J]. J Gynecol Oncol, 2012, 23(4): 207-209.
[27] Melamed A, Rauh-Hain JA, Ramirez PT. Minimally invasive radical hysterectomy for cervical cancer: when adoption of a novel treatment precedes prospective, randomized evidence [J]. J Clin Oncol, 2019, 37(33): 3069-3074.
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