Cervical cancer commonly metastasizes first to the pelvic lymph nodes and then subsequently spreads to distant organs, making lymph node metastases the most significant prognostic factor in cervical cancer, and the strategy for its treatment directly influences prognosis. This review focuses on the treatment strategies for cases of cervical cancer with bulky pelvic lymph nodes. Concurrent chemoradiotherapy is the standard treatment modality for patients with pelvic lymph node metastases, but it is inadequate for bulky pelvic lymph nodes. Accordingly, surgical resection of the bulky lymph nodes has been attempted, and its therapeutic significance has been reported. If the bulky lymph nodes are unresectable, definitive concurrent chemoradiotherapy is performed. If it yields an inadequate degree of lymph node shrinkage, boosted radiation should be considered. The addition of chemotherapy after concurrent chemoradiotherapy has also been reported to be effective in patients with lymph node metastases and is currently being evaluated in clinical trials.
: A 31-year-old nulligravid woman with a 3 year history of infertility visited our hospital. After consultation and a transvaginal ultrasound and MR imaging, her uterine anomaly was identified as complete septate uterus: class V (a) by the American Fertility Society (AFS). She had a doubled uterine cervix and a vaginal septum. Hysteroscopic metroplasty was performed with the aid of a laparoscopy. Both tubal patencies were confirmed with indigocarmine in a laparoscopic image. Laparoscopic electronic cautery was also done on the left ovarian endometrioma (stage 1 endometriosis; the revised American Society for Reproductive Medicine (rASRM) classification 4 point minimal). We distrained an intrauterine device in the uterine cavity and removed it after two cycles of menstruation. The patient subsequently became pregnant during her third menstrual cycle and the current progress of her pregnancy is favorable.
Abstract:Since the Food and Drug Administration warning in 2011 against transvaginal mesh operation for pelvic organ prolapse, this operation is avoided owing to its severe complications. Instead, laparoscopic sacrocolpopexy (LSC) is selected by many urogynecologists. For the strong attachment between the cervix and mesh, supracevical hysterectomy is usually performed before LSC. Uterine removal from the intra-abdominal space requires intraperitoneal shredding or morcellation of the specimen. In cases of unexpected uterine malignancy, shredding or morcellation of the uterine specimen may interfere with the appropriate staging and increase the risks of malignant cell dissemination. We here report a case of uterine endometrioid adenocarcinoma diagnosed after supracervical hysterectomy and sacrocolpopexy for pelvic organ prolapse. The patient was 49 years old (gravida 4, para 2). She underwent laparoscopic supracervical hysterectomy and LSC for pelvic organ prolapse. Preoperative transvaginal ultrasound did not show thickening of the endometrium, and the endometrial cytology was negative. However, the pathologic examination after the initial operation showed uterine endometrioid adenocarcinoma, stage I. Accordingly, she was referred to our hospital and underwent trachelectomy, pelvic lymph node dissection, and paraaortic lymph node biopsy. This case indicates that we need to be aware of the possibility of uterine malignancy in cases of laparoscopic supracervical hysterectomy and LSC.
Objective: We retrospectively assessed perioperative risk for laparoscopic salpingo-oophorectomy in elderly women. Design: We performed 13 laparoscopic salpingo-oophorectomy procedures in women aged 70 and older. During the same period, 18 patients aged 45 to 59 also underwent bilateral laparoscopic salpingo-oophorectomy. We defined the latter group of patients as the control group. We compared the older group with the control group with regard to underlying diseases, preoperative evaluations, surgical methods, intraoperative complications, postoperative complications, and hospitalization.
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