Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: Morbidity and long-term follow-up

Abstract

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS M A N U S C R I P T A C C E P T E D ARTICLE IN PRESS2 ABSTRACT Objectives: To study the feasibility, morbidity and outcome of cervical cancer patients treated with laparoscopic assisted radical vaginal hysterectomy (LARVH). Methods:The study group included 53 women with cervical cancer (stage Ib). They included women undergoing LARVH at the joint cancer-centres between 1994 -2002.Data was collected on operating-time, nodal-yield, hospital-stay, complications recurrence rate and survival rate. The group was followed up until 2006. RESULTS:Of 53 women who were selected for LARVH, in 2 women LARVH was abandoned when nodes were positive at frozen section. The median age was 42 years while the operating-time was 210min with a nodal yield of 23 and a hospital-stay of 5 days. Final histology revealed 10 women with lympho-vascular invasion, 1 nodal metastases and invasion of parametrium / vagina in 2 women. 7 received adjuvant radiotherapy. 3 had chemo-radiation. Complications included voiding-difficulty (6), urinary tract infection (5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late complications included lymphoedema (4), urinary incontinence (4), voiding-problems (2), lymphocyst (1), venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months. 4 women had recurrence, of which 3 women died. The five year survival was 89%. CONCLUSIONS:Vaginal radical hysterectomy with laparoscopic pelvic lymphadenectomy is feasible and safe with regards to mortality and has low morbidity.

New pattern-based personalized risk stratification system for endocervical adenocarcinoma with important clinical implications and surgical outcome

“…However, morbidity for radical surgery and lymph node resection are significant including voiding difficulty, urinary tract infection, hemorrhage, port-site hematoma, pain, pyrexia, and nerve injury as early complications. Late complications include lymphedema, lymphocyst, urinary incontinence, voiding difficulty, venous thrombosis and rectocele, in addition to the loss of childbearing capability for these often young patients [24, 25, 31]. …”

From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy

“…All comparisons between open and laparoscopic‐based radical operations for the treatment of women with early cervical cancer favour laparoscopy with respect to blood loss, hospital stay, recovery, and cosmetic result, and show an identical oncological outcome, if reported 11‐45 . LARVH and TLRH have been successfully performed in more than 2000 patients.…”

Aspects of Therapy for Cervical Cancer in Germany 2012 - Results from a Survey of German Gynaecological Hospitals

“…The sentinel concept appears to be applicable with high sensitivity and detection rates for tumours < 2 cm; even so there are reservations due to the low prevalence of positive lymph nodes in cases of tumours in stages IA1-IB1 [14,15]. Beside the classical abdominal RH, in recent years other procedures such as total laparoscopic RH [16][17][18][19][20], laparoscope-assisted radical vaginal RH [21][22][23][24] or vaginal-assisted laparoscopic RH [25], robot-assisted RH [26][27][28] and TMMR [29] have been developed and provided highly promising oncological results. Nerve-sparing operations also help to markedly reduce the postoperative morbidity.…”