The role of surgical debulking in cancer of the uterine cervix

Potish, Roger A.; Downey, Gordon O.; Adcock, Leon L.; Prem, Konald A.; Twiggs, Leo B.

doi:10.1016/0360-3016(89)90145-4

Cited by 72 publications

(33 citation statements)

References 19 publications

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“…The benefits of surgical resection of metastatic LN in patients with locally advanced cervical cancer have been previously described. 6,7,31,32 In the present study, survival was significantly decreased in patients with gross LN metastases, compared to microscopic or no LN metastases (Fig. 3).…”

Section: Discussionsupporting

confidence: 56%

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

et al. 2008

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Objective: To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. Methods: From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. Results: Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. Conclusion: Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear.

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Section: Discussionsupporting

confidence: 56%

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

et al. 2008

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“…Women with positive para-aortic lymph nodes had the worst outcome [14]. One series reported a relapse-free survival of 57% and pelvic failure rate of 20% in patients with grossly involved but resectable pelvic lymph nodes [15]. Patients whose pelvic lymph nodes were unresectable exhibited a relapse-free survival of 0% and a pelvic failure rate of 56% [15].…”

Section: Primary Diseasementioning

confidence: 99%

The Role of Intraoperative Radiation Therapy (IORT) in the Treatment of Locally Advanced Gynecologic Malignancies

Carmen¹,

McIntyre

Goodman³

2000

The Oncologist

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The prognosis in women with locally advanced primary or recurrent gynecologic malignancies is rather poor. Doses of external beam radiation necessary to treat gross or microscopic recurrence among patients surgically treated or previously irradiated exceed what is tolerated by normal structures. In this group of patients, intraoperative radiation therapy (IORT) can be utilized to maximize local tumor control, minimizing the radiation exposure of dose-limiting surrounding structures. Review of the available literature indicates that IORT may improve long-term local control and overall survival in women with pelvic sidewall and/or para-aortic nodal recurrence. The most encouraging results have been reported in the cases of microscopic residual disease, following surgical debulking. The

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“…în același centru a arătat că la 84% dintre pacientele cu cancer cervical aflat în stadiile IB și IIA, ganglionii pelvieni invadați au putut fi extirpați și nici una dintre pacientele la care acest lucru nu a fost posibil nu a supraviețuit la 5 ani [22].…”

Section: Justificarea Limfadenectomiei Pelvineunclassified

“…Un alt studiu de amploare efectuat de GOG (protocolul 71) a comparat rezultatele radioterapiei pelvine și intracavitare urmate sau nu de histerectomia radicală [22]. Datele parțiale ale acestui studiu atestă faptul că intervenția chirurgicală îmbunătățește controlul local al bolii, dar nu influențează supraviețuirea la distanță.…”

Section: Justificarea Limfadenectomiei Pelvineunclassified

Modalități Diverse de Tratament în Cancerul de Col Uterin Clinic Evident (Stadiile I B și II A)

2014

J de Chirurgie

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This paper aims to update certain aspects of the therapeutic attitude on cervical cancer, a disease that currently is, worldwide, the second leading cause of cancer death in women and thus has increasingly come to the attention of general surgeons. The obvious clinical forms of cervical cancer are brought into discussion, meaning those in the FIGO IB1, IB2 and IIA stages, these being, by far, the most numerous cases we meet in the clinic. Unlike early cervical neoplastic lesions (stages 0 and IA) where the therapeutic attitude is relatively well codified and uniform, in obvious clinical forms there is a great variability of therapeutic approaches, with results that are close to those from the studied literature, indicating according to various statistics a survival rate at 5 years of 80% and 90% for stage I disease and between 60% and 80% for stage II patients.Keywords: Cervical Uterin Cancer; Radical Hysterectomy; Radiotherapy; Chemotherapy IntroducereCancerul de col uterin continuă să reprezinte o problemă de sănătate, peste tot în lume fiind a doua mare cauza de deces prin cancer în rândul femeilor cu peste 500.000 de cazuri noi diagnosticate anual și cu o rată a mortalității de aproximativ 50% [1]. Dintre cazurile noi diagnosticate, aproximativ 79% apar în țările în curs de dezvoltare în timp ce în Statele Unite, cancerul de col uterin este a șasea leziune malignă, ca frecvență, în rândul femeilor cu 12.900 noi cazuri diagnosticate pe an și cu aproximativ 4.400 decese anual [1].Aceste discrepanțe se explică prin diferențele privind implementarea programelor de prevenție a cancerului de col uterin, mult mai ferme în țările dezvoltate.În aceste țări, citologia cervicală reprezintă un foarte bun instrument de screening pentru leziunile pre-invazive, pe când în țările în curs de dezvoltare cele mai multe femei sunt diagnosticate cu forme invazive cu simptomatologie asociată și, în consecință, cu un prognostic mai rezervat [2]. Tratamentul cancerului de col uterin clinic evidentSpre deosebire de leziunile cervicale incipiente (stadiile 0 și IA) unde atitudinea terapeutică este relativ bine codificată și unitară, în formele clinic evidente (stadiile IB și IIA) există o mare variabilitate de abordare terapeutică, cu rezultate foarte apropiate așa cum reiese și din studiile analizate.Atât chirurgia cât și radioterapia pot fi utilizate ca primă modalitate terapeutică a cancerului de col uterin în stadiile IA și IIA, cu rezultate aparent asemănătoare.Astfel, Landoni și colab. au analizat, într-un studiu randomizat, rezultatele chirurgiei radicale versus radioterapie în stadiile IB și IIA ale cancerului cervical, negăsind diferențe semnificative nici în ceea ce privește intervalul liber de boală și nici în ceea ce privește supraviețuirea la distanță. Totuși, la 84% dintre pacientele cu tumori cervicale mari (> 4 cm), supuse intervenției chirurgicale radicale ca prim timp, li s-a efectuat radioterapie adjuvantă în condițiile existenței unor factori de risc adiționali [3]. Este recunoscut faptul că, în cazul tumo...

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The role of surgical debulking in cancer of the uterine cervix

Cited by 72 publications

References 19 publications

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

The Role of Intraoperative Radiation Therapy (IORT) in the Treatment of Locally Advanced Gynecologic Malignancies

Modalități Diverse de Tratament în Cancerul de Col Uterin Clinic Evident (Stadiile I B și II A)

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