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Abstract Background Advanced cancer of the cervical stump, occurring years after a laparoscopic supracervical hysterectomy (LASH), is a rare but serious clinical condition. Many patients who undergo a LASH are unaware of this possible complication. Upon diagnosis of advanced cervical stump cancer, a holistic approach including imaging, laparoscopic surgery and multimodal oncological therapy is required. Case presentation A 58-year-old patient presented to our department with the suspicion of advanced cervical stump cancer eight years after LASH. She reported pelvic pain, irregular vaginal bleedings and irregular discharge. Gynaecological examination revealed a locally advanced tumor of the uterine cervix with suspicion of infiltration of the left parametria and bladder. After thorough diagnostic imaging and laparoscopic staging, the tumor stage was determined as FIGO IIIB and the patient was treated with combined radiochemotherapy. The patient presented with tumor recurrence 5 months after the completion of therapy and she is currently being treated with multichemotherapy and immunotherapy regimens as palliative treatment. Conclusion Patients should be made aware about the risk of cervical stump carcinoma after LASH and the necessity for regular screening. Cervical cancer after LASH is often diagnosed at advanced stages and the treatment requires an interdisciplinary approach.

Background: Advanced cancer of the cervical stump, occurring years after a laparoscopic supracervical hysterectomy (LASH), is a rare but serious clinical condition. Many patients who undergo a LASH are unaware of this possible complication. Upon diagnosis of advanced cervical stump cancer, a holistic approach including imaging, laparoscopic surgery and multimodal oncological therapy is required. Case presentation: A 58-year-old patient presented to our department with the suspicion of advanced cervical stump cancer eight years after LASH. She reported pelvic pain, irregular vaginal bleedings and irregular discharge. Gynaecological examination revealed a locally advanced tumor of the uterine cervix with suspicion of infiltration of the left parametria and bladder. After thorough diagnostic imaging and laparoscopic staging, the tumor stage was determined as FIGO IIIB and the patient was treated with combined radiochemotherapy. The patient presented with tumor recurrence 5 months after the completion of therapy and she is currently being treated with multichemotherapy and immunotherapy regimens as palliative treatment. Conclusion: Patients should be made aware about the risk of cervical stump carcinoma after LASH and the necessity for regular screening. Cervical cancer after LASH is often diagnosed at advanced stages and the treatment requires an interdisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Several studies have previously reported that laparoscopic surgery using an energy sealing device generates hazardous surgical smoke. However, the droplets appearing on the surface of peritoneal fluid irrigated with saline, after dissection phase of laparoscopic gastrectomy were ignored for a long time. This study aimed to investigate the composition and clinical significance of these droplet particles. Methods: This study prospectively enrolled 15 patients with early gastric cancer (cT1NanyM0) who were scheduled for laparoscopic gastrectomy. Floating phases of peritoneal irrigation fluid containing droplets in dissected area were retrieved before and after surgical dissection. Using gas chromatography analysis, the areas under the peak were compared between the samples retrieved before and after surgical dissection. We also analyzed if the area value with significant change was related to the inflammatory response. Results: In gas chromatography, the area values after laparoscopic surgical dissection were significantly increased in 10 out of 37 kinds of fatty acids, compared to those before surgical dissection. The significant increase in area value of α-linoleic and eicosadienoic acids were positively correlated with the elevated level of C-reactive protein at postoperative day 2 (Spearman's ρ = 0.843, P < 0.001; Spearman's ρ = 0.785, P = 0.001). Conclusions: The lipid droplets, generated after laparoscopic lymphadenectomy during gastric cancer surgery, contained various types of fatty acids, and some of them have been found to be associated with inflammatory response. [ABSTRACT FROM AUTHOR]

Indocyanine green (ICG) fluorescence is an emerging technique in the surgical field. Among its various applications, it allows surgeons to have real-time visualization of the lymphatic drainage of an organ. The primary outcome of our study is the feasibility and safety of ICG-guided colorectal surgery. Our secondary outcome is the efficacy of ICG-guided lymphadenectomy and whether or not ICG positivity correlates with the identification of nodal metastasis. We conducted a single-center prospective study including 32 patients who underwent surgery for colorectal cancer. For each case, ICG was injected into the tumor area either prior to or during surgery. Tumor specimens and excised lymph nodes were analyzed using hematoxylin and eosin (H&E) staining. In all patients, ICG injected in the tumor area allowed clear visualization of the lymphatic drainage. A total of 499 lymph nodes were collected, with a mean of 16 per patient. Fifty ICG positive lymph nodes outside the standard lymphadenectomy zone were examined; however, none of the nodes showed signs of nodal metastasis. ICG-guided colorectal surgery is safe, feasible and easily reproducible, with a relatively low cost and no radiation exposure. ICG can help the surgeon to visualize the anatomical structures. We did not find an oncological diagnostic advantage in the use of ICG-guided nodal navigation. [ABSTRACT FROM AUTHOR]

This study aimed to demonstrate the feasibility, safety, and short-term oncological outcomes of laparoscopic restaging surgery for patients diagnosed with apparent early ovarian/fallopian tubal cancer by a prior surgery in Japan. A total of 22 patients with apparent early stage ovarian/fallopian tubal cancer underwent laparoscopic restaging surgery. Surgical results and oncological outcomes were retrospectively analyzed. The diagnosis of apparent early stage ovarian/fallopian tubal cancer was determined by prior laparoscopic or laparotomic surgery in 15 cases and 7 cases, respectively. The apparent stages IA, IC, and II were observed in 10, 10, and 2 cases, respectively. The average operation time and estimated blood loss was 266.7 ± 85.7 minutes and 252 ± 388.5 mL, respectively. The average total number of harvested lymph nodes was 88.2±24.4. Up-staging was found in 3 cases (13.6%), 1 case of IIIA1(ii) and 2 cases of IIIB. Lymph node metastasis was detected in 2 cases (9.0%). Intra- and postoperative complications (Clavien-Dindo classification ≥ III) occurred in 4 cases (18.1%). Three patients with recurrence were found during the median observation period of 17 months. All of these patients were diagnosed as stage III during restaging surgery. No recurrence was found in cases of stage I or II. Our study demonstrates that laparoscopic restaging surgery for early stage ovarian/fallopian tubal cancer is feasible and safe, and oncological outcomes are comparable to conventional staging surgery. Further large-scale randomized control studies are necessary to confirm the non-inferiority of laparoscopic restaging surgery compared with open surgery. [ABSTRACT FROM AUTHOR]

Study objective: The purpose of this study was to elucidate the surgical and oncological outcomes after laparoscopic surgery for endometrial cancer at our hospital. Materials and methods: Surgical outcomes, complications rates, 2-year survival rates, and recurrence rates were evaluated in 44 patients who underwent total laparoscopic hysterectomy (TLH) and 57 patients who underwent total abdominal hysterectomy (TAH) for endometrial cancer at our hospital between August 2010 and November 2013. Results: There was no significant difference between the two groups with respect to age or body mass index. More than 80% of patients in both groups had stage I cancer. In the TLH group, the histological types were endometrioid adenocarcinoma in 42 of 44 patients, carcinosarcoma in one patient, and serous adenocarcinoma in one patient. Operative times were significantly longer in the TLH group, but patients in this group had less intraoperative blood loss, shorter hospital stays, and reduced levels of postoperative pain, compared to patients in the TAH group. There were four cases of postoperative infection and one case of vessel injury in the TLH group. No patient in this group required blood transfusion or conversion to open surgery. There were recurrences in two (4.7%) patients in the TLH group (i.e., carcinosarcoma and serous adenocarcinoma) and in five (8.6%) patients in the TAH group. Conclusion: Laparoscopic surgery is safe and feasible for patients with early-stage endometrial cancer. However, patients with carcinosarcoma and other histologic types of endometrioid adenocarcinoma require special attention because of the high risk of recurrence and poor prognosis.

This review aims to analyse and describe the current role of laparoscopy in the treatment of cervical cancer. Laparoscopy has become an important tool in gynaecological oncology. Its general advantages in comparison with open surgery apply to oncological patients as much as they do to benign conditions. Data from retrospective and case-control studies have proven that treatment of early cervical carcinoma is successfully feasible by means of minimally invasive surgery with no compromise of oncological principles nor radicality. Thus, laparoscopy has entered guideline recommendations as an alternative to open procedures when operative therapy is indicated. Nevertheless, laparoscopic radical hysterectomy, as well as lymphadenectomy, remain demanding and require surgeons experienced in both operative oncology and endoscopy.

Background: Intrahepatic cholangiocarcinoma (ICC) and gallbladder cancer (GC) are relatively uncommon indications for minimal invasiveness, mainly due to the technical complexity required for a laparoscopic loco-regional lymphadenectomy. The aim of this presentation is to provide a step-by-step overview for the technical approach to laparoscopic lymphadenectomy of the hepatic pedicle and parenchymal transection.Materials and Methods: Two cases of an ICC and a GC are shown. Patients were placed supine in the modified French position. One optic port was inserted through open access and four more operative trocars were placed under direct vision in a standardized fashion. Lymphadenectomy of the common hepatic artery (station 8) and of the hepato-duodenal ligament for proper hepatic artery, common bile duct, and portal vein (stations 12A, 12B, and 12P, respectively) is shown. Parenchymal transection is depicted using alternation of an energy device with an ultrasonic aspirator, while intrahepatic vascular structures are sealed with bypolar forceps, clips, or stapled according to dimension.Results: In the first case operative time was 210 minutes, lymphadenectomy time (LT) 40 minutes, and estimated blood loss (EBL) 200 mL. Final pathology was consistent with ICC pT2N1(1/7)M0. In the second case, operative time was 180 minutes, LT 35 minutes, and EBL 150 mL. Final pathology reported gallbladder adenocarcinoma pT2N0(0/7)M0. Postoperative courses were uneventful; drains were removed on postoperative day (POD) 2. Patients were discharged on POD 3.Conclusions: Overcoming the technical limitation embodied by the need of performing an appropriate lymphadenectomy represents the milestone for having patients affected by primary biliary tumors of the liver enrolled to laparoscopy; therefore, this subgroup of patients can benefit from the advantages offered by minimal invasiveness. The leading assumption, however, remains the requirement of performing an oncologically adequate lymph nodal dissection. [ABSTRACT FROM AUTHOR]

Study objective The purpose of this study was to elucidate the surgical and oncological outcomes after laparoscopic surgery for endometrial cancer at our hospital. Materials and methods Surgical outcomes, complications rates, 2-year survival rates, and recurrence rates were evaluated in 44 patients who underwent total laparoscopic hysterectomy (TLH) and 57 patients who underwent total abdominal hysterectomy (TAH) for endometrial cancer at our hospital between August 2010 and November 2013. Results There was no significant difference between the two groups with respect to age or body mass index. More than 80% of patients in both groups had stage I cancer. In the TLH group, the histological types were endometrioid adenocarcinoma in 42 of 44 patients, carcinosarcoma in one patient, and serous adenocarcinoma in one patient. Operative times were significantly longer in the TLH group, but patients in this group had less intraoperative blood loss, shorter hospital stays, and reduced levels of postoperative pain, compared to patients in the TAH group. There were four cases of postoperative infection and one case of vessel injury in the TLH group. No patient in this group required blood transfusion or conversion to open surgery. There were recurrences in two (4.7%) patients in the TLH group (i.e., carcinosarcoma and serous adenocarcinoma) and in five (8.6%) patients in the TAH group. Conclusion Laparoscopic surgery is safe and feasible for patients with early-stage endometrial cancer. However, patients with carcinosarcoma and other histologic types of endometrioid adenocarcinoma require special attention because of the high risk of recurrence and poor prognosis. [ABSTRACT FROM AUTHOR]

Cervical cancer is the most prevalent genital tract neoplasm in Taiwan. Generally speaking, surgical staging is superior to clinical staging since histologic verification of tumor extent correlates better with the biologic behavior of disease. However, a major shortcoming of surgical staging by laparotomy is not only its association with high morbidity and prolonged recovery time, but also the development of postoperative peritoneal adhesions. Adhesion formation limits the mobility of the intestinal loops and exposes them to excess irradiation. The ability to prevent postoperative peritoneal adhesions is the impetus behind the ongoing investigation into the use of laparoscopic surgery. This outstanding feature of laparoscopy is extremely significant in the management of patients with cervical cancer, who are subjected to radiotherapy after lymphadenectomy. Laparoscopic lymphadenectomy, either partial (lymph node sampling) or complete, leads to minimal postoperative peritoneal adhesions and permits accurate assessment of the extent of disease for cervical cancer patients with early or advanced disease. This paper reviews recent reports and updates available information concerning the current practice of laparoscopic pelvic and paraaortic lymphadenectomy in the management of cervical cancer. Various aspects of laparoscopic lymphadenectomy and its clinical role are addressed here, including complications and any controversial issues.

Objectives: The aim of this study was to modify vaginal radical hysterectomy (VRH), design a series of surgical instruments specialised for this procedure, and to study the feasibility, morbidity, and outcome of cervical cancer patients treated with modified laparoscopic-assisted radical vaginal hysterectomy (LARVH). Materials and Methods:A total of 86 patients with early-stage cervical cancer (IB1-IIA1) underwent modified VRH and laparoscopic pelvic lymphadenectomy and para-aortic lymphadenectomy. Special instruments and modified procedures were used in VRH. Data were collected on operating time, blood loss, ureter separation time, nodal count, hospital stay, and complication recurrence and survival rates. Results: All patients successfully completed LARVH. Median operating time was 238 minutes, mean blood loss was 283 ml, median time for ureter separation was 18.5 minutes, median time to post-operative exhaustion was 23 hours, urine recovery was 10.3 days, and median hospital stay was 9.2 days. On average, 23.2 lymph nodes were harvested. Except for one case of left internal iliac vein with intraoperative and postoperative complications, no other major complications occurred, particularly no bladder and ureter injury. Surgical margins were negative in all cases. After median follow-up of 46 months, recurrence rate and overall survival for 84 patients were 3.57% and 97.62%, respectively. Discussion: Modified VRH with laparoscopic pelvic lymphadenectomy is an oncologically valid alternative for early stage cervical cancer treatment with minimal intraoperative and postoperative complications. The modification of this procedure and special instruments can enhance the feasibility and the safety of treatment. [ABSTRACT FROM AUTHOR]

Copyright of Strahlentherapie und Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Pelvic ± para-aortic lymphadenectomy (LAE) is an essential element of staging and treatment of different gynecologic malignancies. However, LAE can induce asymptomatic and symptomatic pelvic lymphoceles (LCs) in a considerable percentage of patients. Therapy of symptomatic LCs may cause additional morbidity. The best strategy to reduce the rate of LCs has not established yet. Materials and Methods Between January 2011 and May 2012, transperitoneal laparoscopic pelvic ± para-aortic LAE was performed at the Department of Gynecology at Charité University Hospital Berlin in 238 patients with cervical, endometrial, ovarian, or groin-positive vulvar cancer. The application of FloSeal (Baxter, Deerfield, IL) and CoSeal (Baxter) was used in 25 patients (group A) as an alternative to routine pelvic drainage after LAE. A case-control comparison was performed on 25 patients (group B) with bilateral drainage after complete LAE. The primary objective of this pilot study was to evaluate the feasibility and safety of the method. As a secondary objective, we evaluated the incidence of LCs and symptomatic LCs in both groups. The detection of LCs was performed during oncologic follow-up by sonography, computed tomographic imaging, or magnetic resonance imaging. Measurements and Main Results Pelvic (n = 50) or pelvic + para-aortic (n = 42) LAE was performed in 44 patients with cervical, 2 with endometrial, 1 with ovarian, and 2 with groin-positive vulvar cancer, respectively. In group B (n = 25), systematic bilateral pelvic drainage was placed after finishing LAE, whereas in group A (n = 25) LAE areas were sealed with 5 mL FloSeal on each side and sprayed with CoSeal afterward without placing drains. In 14 of 50 patients (28%), LCs were detected. In a subgroup of patients with cervical cancer (88% of the cohort), symptomatic LCs occurred in 11% in group A and 18% in group B. Operative revision of symptomatic LCs was necessary in 5% and 18% in groups A and B, respectively (p = .66). Mean Hospital stay was significant shorter in group A (6 days) versus B (8 days) (p = .027). Conclusion The results of this case-controlled pilot study indicate that the application of FloSeal and CoSeal after transperitoneal LAE is feasible and safe, may reduce hospital stay, and may potentially decrease the rate of symptomatic LCs in patients with gynecologic malignancies. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To evaluate the clinical presentation, epidemiology, risk factors, and treatment of chylous ascites after laparoscopic lymphadenectomy to treat gynecologic malignancies. Design: Retrospective study with review of outcomes (Canadian Task Force classification II-3). Setting: University research hospital. Patients: From November 2009 to December 2012, 997 patients underwent laparoscopic lymphadenectomy to treat gynecologic malignancies at our hospital. Interventions: Postoperative chylous ascites resolved with continuous drainage and dietary restriction or fasting. Measurements and Main Results: Nine of 997 patients (0.9%) developed chylous ascites postoperatively. Mean age of these 9 patients was 47.5 years. Median time from operation to development of chylous ascites was 4 days (range, 2–9 days). Chylous ascites developed on either day 1 in 6 patients, day 2 in 2 patients, and day 8 in 1 patient, after food intake. We found that postoperative chylous ascites was associated more with para-aortic lymphadenectomy than with pelvic lymphadenectomy (overall incidence, 0.9%; 4.08% in the para-aortic lymphadenectomy group vs 0.35% in the pelvic lymphadenectomy group). In all patients, chylous ascites resolved with conservative treatment. Median time to resolution was 7 days (range, 3–9 days). Drainage tubes were removed within 9 days after treatment. Conclusions: The incidence of chylous ascites after laparoscopic lymphadenectomy was 0.9%. Para-aortic lymphadenectomy was associated with postoperative chylous ascites. Chylous ascites was successfully treated with conservative management. An abdominal drainage tube can be a simple and effective approach and should be considered in the treatment of chylous ascites. [Copyright &y& Elsevier]

Introduction: Laparoscopic total gastrectomy (LTG) is seldom used for gastric cancer because the complex vascularization and lymphatic drainage makes lymphadenectomy and esophagojejunal anastomosis difficult and requires special skills. Our aim was to demonstrate the feasibility and accuracy of LTG in gastric cancer with D2 lymphadenectomy. Material and methods: Eighty-eight LTG and four laparoscopic remnant gastrectomies (LRGs) were performed over >12 years. The median patient age was 64 years, and the male/female ratio was 1.49/1. Eighty-seven patients had a D2 and only five patients had a D1 lymphadenectomy. We propose the retrospective analysis of intra- and perioperative mortality and morbidity. Results: In only four of 96 cases approached by laparoscopy, a conversion to laparotomy was needed. There were two (2.17%) perioperative deaths in 92 procedures and few complications. Histological data show 79 advanced gastric cancers (AGC), 11 early gastric cancers (EGC), and two gastric diffused lymphomas. The five-year Kaplan-Meier overall survival in patients with EGC and AGC was 100% and 58%, respectively. Conclusions: The results demonstrate the feasibility of an oncologically correct minimally invasive total gastrectomy. We would like to promote comparisons among different institutions to achieve better standardization of indications and techniques for a laparoscopic approach to gastric cancer. [ABSTRACT FROM AUTHOR]

Background: The State-of-the-Art Treatment for Locally Advanced Cervical Cancer (LACC) is Definite Radio-Chemotherapy based on the Image-guided intensity modulated External beam radiochemotherapy and MRI-based adaptive BRAchytherapy (EMBRACE) trial, according to the FIGO staging. This staging is based on clinical examination and imaging studies; however, there are limitations of imaging techniques which may result in adverse events or death due to insufficient or overtreatment. The aim of the study was to evaluate the feasibility and outcomes of surgical staging in LACC prior to radiotherapy (RT) to personalise target volumes for radiotherapy., Methods: From 2008 to 2018, 138 patients with FIGO 2018 stages IB3-IIIC2 cervical cancer underwent a pretherapeutic laparoscopic staging procedure. The pathological diagnosis was compared with the results of preoperative CT scan. Patients were treated with chemoradiotherapy tailored according to the staging results., Results: The mean patient age was 43 years, the mean body mass index was 27 kg/m 2 ; most lesions were squamous cervical cancer (92%). Staging CT scan had a 77% concordance with the histological findings. Sensitivity was 29%, specificity 85%, positive predictive value 21% and negative predictive value 89%. Surgical staging led to change of stage in 24% of cases. Para -aortic dissection led to change the initially planned radiotherapy fields in 47% of the cases. Major complications included involuntary section of the inferior mesenteric artery (IMA) without clinical repercussion, an infected retroperitoneal haematoma and a symptomatic lymphocele requiring laparoscopic drainage., Conclusion: Laparoscopic staging before primary chemoradiation in patients with LACC was feasible, safe and reproducible, allowing reduction of the radiotherapy treatment volumes of patients., Competing Interests: The authors have nothing to disclose in relation to this manuscript., (© the authors; licensee ecancermedicalscience.)

Objective. Assessing lymph-node status in prostate cancer patients with high accuracy is only possible with surgical staging, despite the evolution of modern imaging techniques. The use of surgical staging has to be balanced against the complications of the procedure, the individual patient's risk for harbouring metastasesand the consequences for the treatment of the patient if such metastases are present. The aim of this study was to investigate complications at 90 days using a standardized method (Clavien) in a consecutive series of patients submitted to laparoscopic extendedpelvic lymphadenectomy. Material and methods. This population-based study included 133 high-risk prostate cancer patients scheduled for external beam radiation. Laparoscopic extended pelvic lymphadenectomy and registration of complications wereperformed in a standardized fashion. Complications were registered on a five-grade scale, and differences between groups were compared with the chi-squared test. Results. The mean hospital stay was 1.3 days. Only three patients (2%) suffered from grade 3 complications after surgery, whereas 35 patients (26%) had grade 1 complications and another 11 patients (8%) were treated for grade 2 complications. Of all patients, 35% had lymph-node metastasis, of whom 50% received intensified oncological treatment including adjuvant androgen deprivation and regional lymph-node radiation. Thus, 65% of the patients could be spared regional lymph-node radiation and its associated long-term toxicity. Conclusions. Laparoscopic extended pelvic lymphadenectomy can be performed with minimal significant complications and short hospital stay in patients with high-risk prostate cancer. [ABSTRACT FROM AUTHOR]

The aim of the study was to prove the surgical and oncological safety of radical vaginal trachelectomy (RVT) and laparoscopic lymphadenectomy for patients with early-stage cervical cancer who are seeking parenthood.A database of 225 patients with early-stage cervical cancer and intention to treat by RVT after laparoscopic lymphadenectomy was prospectively maintained. A total of 212 patients were treated according to the protocol. The procedure was preformed in a standardized manner, and life table analysis was applied.In the cohort of patients treated according to protocol, 8 recurrences occurred and 4 patients died from recurrence. The median follow-up time was 37 months (range, 0-171 months). The 5-year recurrence-free and overall survival was 94.4% and 97.4%, respectively. Perioperative and short-term postoperative complications were rare (2.8% and 7.5%, respectively). No severe long-term complications occurred.Radical vaginal trachelectomy combined with laparoscopic lymphadenectomy is a safe method for treatment of patients with early-stage cervical cancer who are seeking parenthood. [ABSTRACT FROM AUTHOR]

Objective: The lymph node number as benchmark in oncologic operations depends on the patient's anatomy, surgeon's skill and pathologist's accuracy. The influence of the pathologist is barely evaluated. Methods: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. Results: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. Conclusion: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Cervical cancer is the most frequently encountered malignancy during pregnancy. Presence of nodal metastasis is the most important negative prognostic factor and its assessment represents a crucial parameter to decide if pregnancy can safely continue. We describe the results of 18 pregnant patients with cervical cancer who had their nodal status proved by means of laparoscopy. Material and methods: Eighteen patients with cervical cancer who underwent laparoscopic pelvic lymphadenectomy during pregnancy at Charité-University Berlin and Friedrich-Schiller-University Jena between 1999 and 2010 were analyzed retrospectively. Results: The mean age at diagnosis was 32years (26–40) and gestational age between 6 and 23weeks of pregnancy. The following FIGO stages of cervical cancer were treated: 1a1 for two women, 1a2 for one woman, 1b1 for thirteen women, 1b2 for one woman and 2a for one woman. The histological type was squamous carcinoma in nine cases and adenocarcinoma also in nine cases. All laparoscopic procedures were successfully completed; there was no surgery-associated mortality, morbidity, or conversion to laparotomy. Additionally, there were no complications for either mother or child related to the general anesthesia. The mean number of lymph nodes removed was 17 (6–46). Definitive cancer treatment was delayed for fourteen out of eighteen patients until delivery with an average delay interval of 17 (9–28) weeks. Lymph nodes were positive in 16% of the cases (3/18) and these patients received immediate cancer treatment. One patient decided to interrupt the gestation before delivery despite negative lymph nodes. Fourteen patients reached fetal maturity and gave birth to healthy babies by caesarean section. All patients are alive without evidence of disease at a mean follow-up time of 38 (5–128) months. Conclusion: Laparoscopic pelvic lymphadenectomy during pregnancy is feasible and safe. Results suggest that in patients with cervical cancer complicated by pregnancy a planned delay of oncologic treatment can be a safe option after tumor metastasis to lymph nodes has been histopathologically ruled out. [Copyright &y& Elsevier]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: Laparoscopic vaginal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy or chemoradiation in young women with stage IA2 to IB cervical cancers. The aim of this study is to describe the feasibility and outcome of laparoscopic radical vaginal trachelectomy and pelvic lymphadenectomy in women treated with early cervical cancers who wish to maintain fertility. Study design: From August 2000 through December 2004, 16 patients were offered this procedure. Patients were selected for this treatment on the basis of favorable cervical tumors and a desire to maintain fertility. Laparoscopic pelvic lymphadenectomies were performed in all patients. Vaginal radical trachelectomy was performed immediately if removed lymph nodes were negative. Obstetrical and oncological outcomes were evaluated. Results: Sixteen women underwent this procedure. The mean operative time was 142min (115–178min), with a mean blood loss of 180ml (120–230ml), and the average hospital stay was 6.7 days. No intraoperative or postoperative complications occurred. With an average follow-up of 28.2 months, there have been no recurrences. Five pregnancies have subsequently occurred, with two third-trimester deliveries, two miscarriages at 24 and 26 weeks’ gestation, and one patient is currently 18 weeks’ pregnant. Conclusions: Laparoscopy-assisted radical vaginal trachelectomy is an adequate treatment, with its minimally invasive procedure and shorter recovery time, for early-stage cervical cancer in women who wish to preserve fertility. However, fertility issues remain the largest unanswered problem with this technique. [Copyright &y& Elsevier]

Abstract: Objective. : To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. Methods. : Consecutive patients affected by stage IB–IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. Results. : 168 patients entered the study. The mean operative times were: 63 ± 7.6, 54 ± 6.7 and 75 ± 8.4 min (TPL vs EPL P < 0.001; EPL vs LPL P < 0.001; TPL vs LPL P < 0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P = ns). The average hospitalizations were: 5.6 ± 0.9, 3.2 ± 0.4 and 3.1 ± 0.3 days (TPL vs EPL P < 0.001; TPL vs LPL P < 0.001) for TPL, EPL and LPL respectively. Conclusions. : EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay. [Copyright &y& Elsevier]

Abstract: Objective. : The aim of this study is to evaluate the feasibility of extraperitoneal laparoscopic para-aortic and common iliac lymphadenectomy for cervical and endometrial carcinoma. Methods. : Seventy-six patients underwent extraperitoneal laparoscopic para-aortic and common iliac lymphadenectomy between February 1999 and September 2005. The lymph nodes dissected with the laparoscopic procedure included the inframesenteric para-aortic lymph nodes, the sacral lymph nodes, and the bilateral common iliac lymph nodes. The extraperitoneal laparoscopic operation was performed with pelvic open surgery using Lap Disc to ensure the safety of patients. Results. : The number of patients with cervical and endometrial carcinoma was 36 and 40, respectively. The median age of patients was 51 years (range 24–75 years). Conversion to open surgery was necessary in 8 patients. These include 3 patients who encountered blood loss of 400, 136 and 128 ml; 2 extremely obese women; and 3 patients who had peritoneal tears causing CO2 gas leakage. Among the remaining 68 patients, the median operating time for extraperitoneal laparoscopic para-aortic and common iliac lymphadenectomy was 75 min (range 45–145 min), and the median estimated blood loss was 5 ml (range 5–138 ml). The median total number of resected nodes was 14 (range 2–31), and 4 patients had lymph node metastasis. No patient encountered postoperative complications attributable to extraperitoneal laparoscopic para-aortic and common iliac lymphadenectomy. Conclusions. : Extraperitoneal laparoscopic para-aortic and common iliac lymphadenectomy with pelvic open surgery using Lap Disc is a feasible procedure, particularly in the surgeons learning phase. [Copyright &y& Elsevier]

To evaluate and compare laparoscopic-assisted surgical staging with conventional laparotomy for the treatment of endometrial carcinoma. From July 2001 to December 2003, a retrospective review of patients with endometrial carcinoma was carried out. The medical records of those patients who had undergone surgical staging with hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy (PLN) were evaluated. Primary outcome measures were operating time (OT), estimated blood loss, total number of lymph nodes yielded, intraoperative complications, postoperative complications, and length of hospital stay. A total of 64 cases were identified. Two cases were excluded because of incomplete records. Two cases with para-aortic lymphadenectomy and four cases with Wertheim's hysterectomy were excluded from the study. Thirty-six patients underwent laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy and PLN (laparotomy group). Twenty patients underwent the same surgery by laparoscopy, of which 19 were successfully carried out (laparoscopy group). One case was converted to laparotomy. The mean OT in the laparoscopy group was longer when compared with the laparotomy group (211 min vs 94 min, P < 0.001). The mean estimated blood loss in the laparoscopy group was less (200 mL vs 513 mL, P < 0.001). The post-operative hospital stay was shorter in the laparoscopy group (3.6 days vs 7.7 days, P < 0.001). The mean number of lymph nodes yielded was more in the laparoscopy group (26.1 vs 16.7, P = 0.004). Neither group had intraoperative complications and both had similar postoperative complication rates. Laparoscopic-assisted surgical staging for endometrial carcinoma is associated with significantly less blood loss, shorter hospital stay, longer OT time, and more lymph nodes yielded when compared with laparotomy. [ABSTRACT FROM AUTHOR]

Lymphadenectomy is an integral part of staging and treatment of gynecologic malignancies. We evaluated the feasibility and oncologic value of laparoscopic transperitoneal pelvic and paraaortic lymphadenectomy in correlation to complication rate and body mass index.Between August 1994 and September 2003, pelvic and/or paraaortic transperitoneal laparoscopic lymphadenectomy was performed in 650 patients at the Department of Gynecology of the Friedrich-Schiller University of Jena. Retrospective and prospective data collection and evaluation of videotapes were possible in 606 patients. Laparoscopic lymphadenectomy was part of the following surgical procedures: staging laparoscopy in patients with advanced cervical cancer (n = 133) or early ovarian cancer (n = 44), trachelectomy in patients with early cervical cancer (n = 42), laparoscopic-assisted radical vaginal hysterectomy in patients with cervical cancer (n = 221), laparoscopy before exenteration in patients with pelvic recurrence (n = 20), laparoscopic-assisted vaginal hysterectomy or laparoscopic-assisted radical vaginal hysterectomy in patients with endometrial cancer (n = 112), and operative procedures for other indications (n = 34).After a learning period of approximately 20 procedures, a constant number of pelvic lymph nodes (16.9–21.9) was removed over the years. Pelvic lymphadenectomy took 28 min, and parametric lymphadenectomy took 18 min for each side. The number of removed paraaortic lymph nodes increased continuously over the years from 5.5 to 18.5. Right-sided paraaortic, left-sided inframesenteric and left-sided infrarenal lymphadenectomy took an average of 36, 28, and 62 min, respectively. The number of removed lymph nodes was independent from the body mass index of the patient. Duration of pelvic lymphadenectomy was independent of body mass index, but right-sided paraaortic lymphadenectomy lasted significantly longer in obese women (35 vs. 41 min, P = 0,011). The overall complication rate was 8.7% with 2.9% intraoperative (vessel or bowel injury) and 5.8% postoperative complications. No major intraoperative complication was encountered during the last 5 years of the study.By transperitoneal laparoscopic lymphadenectomy, an adequate number of lymph nodes can be removed in an adequate time and independent from body mass index. The complication rate is low and can be minimized by standardization of the procedure. [Copyright &y& Elsevier]

Objectives: Because of the high rate of residual tumors after transurethral resection (TUR) and possible pT0 finding on postoperative vesical specimens after initial TUR, we studied the data achieved after a second TUR (reTUR) in pT2N0M0 bladder tumors who underwent adjuvant radiotherapy.Patients and Methods: Between February 1996 and January 2002, we studied 169 cases (91 males and 78 females) with pT2 bladder tumors, which underwent reTUR within four to six weeks from the initial resection. Tumor location was documented at both procedures on a designed map of the bladder. For the pT2G3 series (40 cases), we practiced laparoscopic lymphadenectomy concomitant with reTUR. For pT0N0 tumors (62 cases), we applied adjuvant external beam radiotherapy (66 Gy). For residual tumor after reTUR and N+ cases (107 patients), we applied radical cystectomy.Results: We found 95 cases (56.2%) with residual tumors at reTUR: 4 noninvasive tumors (4.2%), 70 with the same stage (73.7%) and 21 upstaged to pT3 (22.1%). Radical cystectomy was performed in all these cases. For the 74 pT0 cases (43.8%) we applied laparoscopic lymphadenectomy in high-risk tumors (40 G2/3 cases) concomitant with reTUR. So, we found 28 N0 cases (70%) and 12 N+ cases (30%), radical cystectomy being applied in this last series. Finally, for a total of 62 pT0N0 cases under external beam radiotherapy (66 Gy) we found 7 cases (11.3%) with local recurrences (3 cases with concomitant lymph node involvement) and 2 cases (3.2%) with systemic disease without local evidence. The disease-free survival was 85.4%. The mean follow-up period was 41 months (range 10–70 months).Conclusions: According to our experience the routine reTUR could detect an important rate of pT0 stage after initial TUR in pT2 bladder tumors. So, reTUR could better select patients for bladder preservation (adjuvant radiotherapy being used), in addition to laparoscopic lymph nodes evaluation for high-risk tumors. [Copyright &y& Elsevier]

ObjectiveTo describe techniques of morcellation without entry into the uterine cavity and discuss their use in the management of selected patients with endometrial cancer and fibroids. MethodCase series. ResultsEight patients with endometrial cancer arising in a fibroid uterus underwent laparoscopic hysterectomy, and in three cases morcellation was required. The mean uterine weight was 608 g (median 500 g). Four women had pelvic and one had pelvic plus aortic lymphadenectomy in addition to the hysterectomy. One woman had pelvic and another pelvic plus aortic lymph node metastases. The mean age, weight, and body mass index of the patients were 54.8 years, 214 lbs and 36.5, respectively. One nullliparous patient weighed 329 lbs, and another weighed 289 lbs. The mean anaesthetic time was 3.75 h, the mean estimated blood loss 770 ml, and the mean drop in haemoglobin 3.2 g/dl. The mean hospital stay was 2 days, and there were no complications although one patient was transfused. ConclusionsEndometrial cancers arising in a fibroid uterus can be treated laparoscopically in selected cases. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the results of transperitoneal laparoscopic pelvic lymphadenectomy as a separate staging procedure in patients with early prostate cancer. Patients and methodsThe results were reviewed from the first 27 patients with prostate cancer admitted for laparoscopic lymphadenectomy between January 1994 and March 1998. Initially, all patients with a negative bone scan and either a negative computed tomography or negative magnetic resonance scan were admitted for laparoscopic staging. After several reports detailing ways of reducing the number of negative lymphadenectomy operations, from July 1996 only those patients with a preoperative prostate specific antigen (PSA) serum level of >10 ng/mL were admitted to the study. All procedures were performed by one experienced laparoscopic surgeon. A radical retropubic prostatectomy was performed as a separate procedure by a consultant urologist within 2 weeks. The effectiveness of the staging operation was analysed by assessing the nodal yield, and the results, including operative duration, complications and length of stay, were compared with other published series. Further analysis was provided by reviewing the PSA levels, Gleason grade sum and clinical digital staging. ResultsThe nodal yield was similar to that published in series from other institutions, with a median (range) of 6.5 (0–12). However, the operation was significantly quicker, at a median (range) of 55 (40–110) min for a bilateral dissection. There were only minor complications, with no detectable reduction in complications with experience; the median (range) postoperative stay was 1 (1–4) days. Two of the 27 patients had metastatic disease within the lymph nodes. If a PSA level of >10 ng/mL had been instituted as an entry criteria at the start of the study, six patients would have been excluded and thus the positive lymphadenectomy rate would have been two of 21 patients (10%). Of 54 patients eligible to enter the study,... [ABSTRACT FROM AUTHOR]

In an observational study following the primary treatment of cervical carcinoma, financial data was gathered to address hospital and physician costs. This was done as a feasibility study to assess whether such data could be collected. As a corollary, we observed changes in these cost data relative to the implementation of laparoscopic lymphadenectomy in selected cases undergoing radical hysterectomy. Definition of costs were provided by Information Services Department of the University of Minnesota Hospital and Clinic (author W.H.). Twenty-seven apportionment codes were defined as standard categories to identify costs and were defined by patient accounting and assigned to every significant hospital event. Statistically, significant differences were noted in room and board costs, operating room cost, discharge needs, and miscellaneous services. Mean room and board costs were significantly less in those patients undergoing laparoscopic lymphadenectomy followed by a radical hysterectomy (Group B—defined in text). Miscellaneous service costs were also statistically, significantly different. However, with respect to those patients undergoing standard lymphadenectomy followed by radical hysterectomy (Group A), the operating room costs were statistically, significantly less. Overall adjusted hospital costs, which include professional services, were not different between the two groups. The feasibility of collecting data from the University of Minnesota Health System to access costs relative to a specific operative procedure, in this case radical hysterectomy, was evaluated. Significant requirements of time and labor costs were required, however. Timely, on-going assessment of hospital costs relative to hospital procedures would be a laudable goal for future assessments of resource allocation. The implementation of new technology in selected patients, in this case, laparoscopic lymphadenectomy, does not invariably increase cost in this health care system. [ABSTRACT FROM AUTHOR]

Abstract: Cervical cancer is the most frequently observed malignancy during pregnancy. The presence of nodal metastasis is the most important negative predictor factor, and its assessment is crucial in deciding whether the pregnancy can safely continue. To our knowledge, this is the first report of a twin pregnancy complicated by cancer of the uterine cervix that was sucessfully treated with laparoscopic pelvic lymphadenectomy and subsequently with neoadjuvant chemotherapy. A 35-year-old woman, gravida 2, para 1, with a dichorionic-diamniotic twin pregnancy underwent laparoscopic staging of the pelvic lymph nodes at 17 weeks of gestation. Cervical adenocarcinoma, grade 2, stage 1b1 with lymphovascular space invasion was diagnosed. Nineteen negative nodes were removed, and the patient was counseled to continue the pregnancy. On the basis of tumor size and detection of lymphovascular space invasion, cisplatin as neoadjuvant chemotherapy was administered until week 32 of gestation, when a cesarean section delivery was performed, along with radical hysterectomy. No complications to the neonates or to the mother due to the therapy were observed. This case demonstrates the safety of operative nodal staging during gestation, even in a twin pregnancy. Exclusion of nodal metastasis may improve oncologic outcomes, and neoadjuvant chemotherapy should be administered when indicated. [Copyright &y& Elsevier]