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Introduction: Residual or recurrent cervical cancer post-CCRT is a challenging clinical issue, even though there has been much effort in recent decades to increase patient survival after radiation. There is a paucity of literature regarding the role of hysterectomy in recurrent/residual disease after radiation in LACC patients. Such a procedure is controversial and not routinely performed because of difficulties in obtaining tumor-free margins and the high rate of associated morbidity. Aims and Objectives: Evaluate outcomes and morbidities in patients who had undergone hysterectomy for residual or recurrent disease after radiation in LACC patients. Material and Methods: This is a prospective observational study on radiotherapy-treated LACC patients (IIB-III) with residual disease or recurrent disease who have undergone adjuvant hysterectomy. This study has been conducted at AHPGIC, Cuttack, with a sample size of 30 patients. Results: 18/30 patients underwent extrafascial hysterectomy, and rest 12 patients had radical hysterectomy. No significant difference in complications, achieving tumor free margins or recurrences post adjuvant hysterectomy based on the radicality of surgery was observed. 5 cases of recurrences post-adjuvant hysterectomy were detected. Some of the factors which had significant association with recurrences post adjuvant hysterectomy were non squamous histology, no preoperative brachytherapy, deep stromal invasion and positive surgical margins. Median follow-up time was 14 months (12–27 months). Conclusion: This study shows that adjuvant hysterectomy is feasible with good outcome and acceptable morbidity after chemoradiotherapy in cervical cancer patients "If selection of patients for adjuvant hysterectomy is appropriate." [ABSTRACT FROM AUTHOR]

Study objective: In order to reduce the risk of vaginal recurrence, we have chosen total laparoscopic modified radical hysterectomy instead of extrafascial hysterectomy in the treatment of endometrial cancer. The aim of this study was to assess the safety of this method. Design: Retrospective study of gynecological patients. Setting: Yokohama City University Medical Center, Yokohama, Japan. Patients: Forty-nine patients who underwent total laparoscopic modified radical hysterectomy for the treatment of endometrial cancer at our hospital between December 2011 and September 2015. Interventions: Total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy (n = 20), total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy (n = 18), or total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic and para-aortic lymphadenectomy (n = 11). Measurements and Main Results: The surgical outcomes were analyzed and compared to previous reports. The median operative time was 204 minutes (range, 99–504 minutes) and the median intraoperative blood loss was 150 mL (range, 0–680 mL). No patients needed a blood transfusion, conversion to laparotomy, or reoperation. Intra- and postoperative complications were observed in three patients and nine patients, respectively. The amount of blood loss and the incidence of complications in our study were almost identical to previous reports of laparoscopic hysterectomy. The operative time in our study was equivalent to previous reports of total laparoscopic modified radical hysterectomy. Conclusion: Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely.

Purpose: To describe the procedure of laparoscopic extrafascial hysterectomy to avoid ureter injury. Methods: Data were obtained from: (1) anatomic study of ten fresh female cadavers to measure the distance between the point where the ureter and uterine artery cross and the level of section of the ascending branch of the uterine artery during extrafascial dissection of the uterine pedicle and uterosacral ligament (Paris School of Surgery). The Wilcoxon test was used to compare measurements within each subject. P < 0.05 was considered to denote significance; (2) prospectively collected clinical data from women undergoing laparoscopic extrafascial hysterectomy from July 2006 to March 2014 at Poissy University Hospital, to describe the laparoscopic extrafascial hysterectomy technique with analysis of surgical complications using the Clavien–Dindo classification. Results: Anatomic study: The mean (SD) distance between the point where the ureter and uterine artery cross and the level of the section of the ascending branch of the uterine artery were: 11.6 mm (5.2) in neutral position and 25 mm (7.5) after pulling the uterus laterally; and 25mm (8.9) after sectioning the ascending portion of the uterine pedicle and 38.6 mm (4.5) after complete uterine artery pedicle dissection through the uterosacral ligaments. After release of the ureter, the curve in front of the uterine artery disappeared. Clinical laparoscopic study: Sixty-eight patients underwent laparoscopic extrafascial hysterectomy. No ureteral complications occurred. Conclusion: Laparoscopic extrafascial hysterectomy is a safe and feasible procedure. Combined lateralization and elevation of the uterus, section of the ascending branch of the uterine artery, and its extrafascial dissection along the uterosacral ligament contribute to protecting the ureter during the procedure. [ABSTRACT FROM AUTHOR]

Study objective In order to reduce the risk of vaginal recurrence, we have chosen total laparoscopic modified radical hysterectomy instead of extrafascial hysterectomy in the treatment of endometrial cancer. The aim of this study was to assess the safety of this method. Design Retrospective study of gynecological patients. Setting Yokohama City University Medical Center, Yokohama, Japan. Patients Forty-nine patients who underwent total laparoscopic modified radical hysterectomy for the treatment of endometrial cancer at our hospital between December 2011 and September 2015. Interventions Total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy ( n = 20), total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy ( n = 18), or total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic and para-aortic lymphadenectomy ( n = 11). Measurements and Main Results The surgical outcomes were analyzed and compared to previous reports. The median operative time was 204 minutes (range, 99–504 minutes) and the median intraoperative blood loss was 150 mL (range, 0–680 mL). No patients needed a blood transfusion, conversion to laparotomy, or reoperation. Intra- and postoperative complications were observed in three patients and nine patients, respectively. The amount of blood loss and the incidence of complications in our study were almost identical to previous reports of laparoscopic hysterectomy. The operative time in our study was equivalent to previous reports of total laparoscopic modified radical hysterectomy. Conclusion Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely. [ABSTRACT FROM AUTHOR]

Objetivo: Evaluar la sobrevida global y libre de enfermedad en pacientes con tratamiento concomitante de radioquimioterapia más histerectomía extrafascial en cáncer de cuello uterino IB2. Método: 31 pacientes con cáncer cérvico-uterino en etapa IB2 fueron tratadas con radioquimioterapia concomitante más histerectomía extrafascial programada en 4 a 6 semanas. Se efectuó radioterapia pelviana externa e implante de braquiterapia útero-vaginal con dosis preoperatoria entre 70-75 Gy a punto A y quimioterapia con cisplatino. Resultados: La edad promedio de las pacientes fue de 41 ± 8 años. El 81% de los casos fue carcinoma escamocelular. La histerectomía extrafascial se realizó 4 a 6 semanas post-radiación en el 85% de los casos. El 79% y el 13% de las pacientes recibieron 5 y 4 ciclos de quimioterapia respectivamente. La mediana de seguimiento fue de 38 meses. La sobrevida global y libre de enfermedad estimada a 5 años fue de 86% y 79% respectivamente. Hubo diferencia significativa en la sobrevida global en los subgrupos sin o con enfermedad residual macroscópica en la pieza operatoria (pAim: To evaluate overall and disease free survival in cervical cáncer IB2 patients with concomitant chemo-radiotherapy and posterior extrafascial hysterectomy treatment. Methods: Between July 2005 to December 2009, a total of 31 eligible patients with IB2 cervical cancer were treated with chemoradiotherapy and posterior hysterectomy in the Carlos Van Buren Hospital Oncology Unit. Radiotherapy consisted in external pelvic radiation and a utero-vaginal brachitherapy with low rate doses to get preoperatory doses between 70 and 75 Gy to the A point and a concomitant Cisplatin based chemotherapy. After this treatment, the patients received extrafascial hysterectomy 4 to 6 weeks completed chemoradiotherapy. Results: The mean age was 41 ± 8 years. 81% of the patients had an spinocelular carcinoma. The extrafascial hysterectomy was made between 4 to 6 weeks post-radiation in 85% of the patients. 79% and 13% of the patients received 5 and 4 chemotherapy cycles respectively. The median follow up was 38 months. The 5 years overall survival and disease free survival estimates were 86% and 79% respectively. There was a significant difference between subgroups of patients with and without macroscopic residual disease in the operatory specimen (p

Purpose For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy. Materials and methods Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix ± parametria treated with neoadjuvant external beam radiotherapy (45-50.4 Gy in 25-28 fractions) and image-based HDR brachytherapy (5-5.5 Gy times 3-4 fractions) ± chemotherapy followed by extrafascial hysterectomy performed at a median of 6 weeks after radiotherapy. Results All patients had clinical cervical extension, 50% also had parametria extension, and 31% had nodal involvement. At the time of surgery 91% had no clinical cervical involvement, 58% had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24%. Median follow-up from the time of surgery was 20 months (range: 0-153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96%, 89%, 84%, 73%, and 100%. The 3-year rate of grade 3 complications was 11%, with no grade 4 + toxicity. Conclusions Neoadjuvant radiation therapy ± chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5-5.5 Gy times 3-4 fractions, for a cumulative EQD2 of 60-70 Gy, is well tolerated with high rates of clinical and pathological response. [ABSTRACT FROM AUTHOR]

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The primary objective of this study was to compare disease-free survival (DFS) and overall survival (OS) of patients with and without completion surgery. The secondary objective was to compare DFS and OS of patients who had had systematic simple extrafascial hysterectomy or extended hysterectomy. The other objectives were to compare early and late complications with and without completion surgery and between the various surgical techniques.One hundred seventy-one patients with advanced cervical cancer were included in a retrospective, multicenter series.The rate of pelvic control was 81.29% in our study after chemoradiotherapy, but histological residual cervical tumor persisted in nearly half of cases (49.71%). After a mean follow-up of 33 months, OS and DFS were not significantly higher in surgically treated patients, nor was the complication rate higher. Overall survival and DFS were not better after radical hysterectomy than after extrafascial hysterectomy. Statistically significant predictors of survival were clinical stage, tumor size, node extension, and residual tumor after chemoradiotherapy.There is no consensus regarding the maximal residual tumor volume after chemoradiotherapy suitable for surgery as there is no reliable imaging yet. Therefore, extrafascial hysterectomy with bilateral pelvic lymphadenectomy seems as a reasonable option if there are histological factors suggesting poor prognosis. [ABSTRACT FROM AUTHOR]

The current guidance for the management of women with stage IA2 cervical carcinoma is that whatever the primary surgical intervention, pelvic lymphadenectomy should be included. The role of lymphadenectomy in the management of cervical carcinoma remains somewhat confused, as the procedure has not been proven to be therapeutic, although it is claimed that the information gained is valuable in determining the need for adjuvant therapy.For lymphadenectomy to have clinical utility in the care of women with stage IA2 cervical carcinoma, a sufficiently high incidence of node positivity would be required to justify the morbidity of the procedure for the whole group.The objective of this paper was to establish the incidence of pelvic lymph node positivity in stage IA2 cervical carcinoma.A PubMed search using the words "stage IA2 cervical carcinoma," "microinvasive cervical carcinoma," "stage IA cervical carcinoma," "stage I cervical carcinoma," and "lymphadenectomy in cervical carcinoma" was performed; the articles were divided into those that adhered to the International Federation of Gynecology and Obstetrics (FIGO) definition of a stage IA2 tumor and those that did not. Sentinel node studies were not included, as this procedure does not form part of the FIGO guidelines.Studies adhering to the FIGO definition showed a 0.5% incidence of lymph node metastases in stage IA2 cervical carcinomas, which is not as high as was previously believed (7.3%).The very low rate of positive lymph nodes in correctly staged IA2 cases cannot justify the inclusion of lymphadenectomy as part of standardized care for these patients. [ABSTRACT FROM AUTHOR]