Search

The purpose of this study was to investigate the surgical techniques and clinical feasibility of nonuterine manipulator and enclosed colpotomy to avoid cancer cell spillages in laparoscopic radical trachelectomy (LRT) for patients with early-stage cervical cancer.We performed the newly optimized surgical techniques of round ligament suspension and vaginal purse-string suture in LRT in 12 patients with early-stage cervical cancer from May 2019 to October 2020. Surgical information and postoperative results were recorded.All 12 patients successfully underwent LRT with round ligament suspension and vaginal purse-string suture, and no conversion to laparotomy was required. The median operation time was 268.5 min (range 200-320 min), including 5 min of round ligament suspension, and the median blood loss was 20 mL (range 5-50 mL). The median number of pelvic lymph nodes removed was 27 (range 19-35), and median amounts of paracervical tissue was 24 mm (range 21-26 mm) and vaginal tissue was 18 mm (range 16-26 mm). No intraoperative complication or serious postoperative complications were reported.Round ligament suspension and vaginal purse-string suture techniques are feasible and effective in LRT. They can replace uterine manipulator and unprotected colpotomy with satisfactory perioperative outcomes.

The purpose of this study was to evaluate the feasibility of "cuff-sleeve" sutures for reconstructing a functional neocervix in laparoscopic radical trachelectomy (RT).A retrospective analysis of a case series.A teaching hospital.Twenty-five patients who were diagnosed as early-stage cervical cancer from June 2017 to October 2020 in Sun Yat-sen Memorial Hospital.Laparoscopic RT with the "cuff-sleeve" suture method for cervicovaginal reconstruction.Twenty-five patients successfully underwent the laparoscopic RT with the "cuff-sleeve" suture method for cervicovaginal reconstruction, and no intraoperative complications occurred or conversion to laparotomy was needed. For all patients, approximately 80% of the cervical length was removed. Surgical radicality and negative surgical margins were also confirmed. During a median follow-up time of 29 months (range 8-48 months), no severe postoperative complications were observed. No cervical stenosis or secondary abnormal menstruation was reported. After the removal of the uterine stent 6 months after surgery, the neocervix length was approximately 14 mm (range 10-19 mm) and almost all the neocervixes were restored closely to the original anatomy. Four of 8 patients attempting actively to conceive were successful, and the cervical length of these pregnant patients was greater than or equal to 15 mm in all but one measurement at different gestational age. Three patients were ongoing pregnant, and the other had delivered successfully with a 16- mm cervix at term without cerclage.The "cuff-sleeve" suture method in cervicovaginal reconstruction is feasible in laparoscopic RT. This simplified suture technique can provide a functional neocervix to reduce cervical stenosis and incompetence.

e17509 Background: Postoperative adjuvant therapy decisions for early-stage cervical cancer (ESCC) without high risk factor, including parametrial extension, positive nodes and positive margins, now depend on Sedlis criteria, which do not mention the degree of differentiation. In this study, we aimed to explore the benefit of adjuvant chemotherapy for patients of ESCC with poor differentiation but without positive Sedlis criteria after radical hysterectomy, and develop a score to predict the recurrence risk in these patients, so as to further improve the indications of postoperative adjuvant therapy for patients of ESCC. Methods: Patients of ESCC with pathologically proven poor differentiation after radical hysterectomy were prospectively included in a multicenter study. Univariate Cox proportional hazards regression were developed to evaluate the independent risk factors for recurrence. The log-rank test was performed to compare the progression-free survival (PFS) and overall survival (OS) of adjuvant chemotherapy (ACT) and no further treatment (NFT) groups. Selected variables were analyzed in a Multivariate Cox Regression Model and used to build a nomogram for ESCC to predict the survival probabilities. Results: In total, 352 patients were randomly assigned to two groups, a training group and a validation group, at a ratio of 1:1 (176 patients: 176 patients). In both of training and validation cohort, the ACT groups had longer PFS than the NFT groups ( P= 0.007 and 0.016, respectively), while the differences of OS were not statistically significant ( P= 0.922 and 0.107, respectively). In the multivariate analysis, ACT was proved an independent prognostic factor for the PFS (P = 0.048), and the strongest predictor of PFS even analyzing with other potential independent prognostic factors (HR 0.116, 95%CI 0.014-0.981). Five factors, including postoperative treatment, histologic type, isthmus uteri involvement, FIGO stage, SCCA level, were included in the nomogram to predict survival probabilities in the training cohort and performed well in the validation cohorts. Conclusions: For the patients of ESCC who don't meet to Sedlis criteria but with poor differentiation, ACT after radical hysterectomy can reduce the recurrence rate.

e17519 Background: The mainly causes may due to the use of uterine manipulator and unprotected vaginal incision. To avoid these disadvantages, we modified the procedures by using ‘8’ suture suspension of the uterine instead of the uterine manipulator and vagino-purse-string suture before cutting of the vaginal. The aim of this study is to evaluate surgical data and oncological outcome of LRH without uterine manipulator based‘8’suture suspension method for early-stage cervical cancer. Methods: Patients with cervical cancers who underwent‘8’ suture suspension LRH in our center between January 2018 to August 2020 were retrospective analyzed. Without the use of uterine manipulator, a 2-0 absorbable suture was used to make an‘8’suture at the fundus of the uterine, and then make a coil. Another suture was passed through the coil to manipulate the uterus towards suitable directions. When separating the rectovaginal space, a needle with suture was pierced into the abdominal cavity from the abdominal wall above the pubic symphysis and passed through the coil to pull the uterus upwards and forwards, which was remove when separating the vesicovaginal space. Before cutting of the vaginal, a vagino-purse-string suture was made to prevent the tumor exposure in the abdominal cavity. Surgical data, postoperative complications, relapse rate and disease-free survival rate were evaluated. All operations were performed by the same surgical team. Results: A total of 48 cervical cancer patients were included in this study. Eight patients were stage IA2, 37 patients were stage IB and 3 patients were stage IIA1. There were 37 patients with squamous carcinoma while 11 with adenocarcinomas. The mean operative time was 199min (ranged from 120 to 290min). The median time of hospital stay after surgery was 7 days (ranged from 4 to 17 days). The mean blood loss volume was 40ml (ranged from 5 to 200 ml). The mean of number of removed lymph nodes are 30. The median time of removing urinary tube was 18 days (ranged from 12 to 25 days). The median time of postoperative exhaust time was 3 days(ranged from 2 to 4 days). There were no intraoperative complications, while postoperative complications were observed in 4 patients with fever. The median follow- up times were 16 months. During the follow-up time, there were no recurrence. Conclusions: The‘8’suture suspension LRH is a feasible and safe surgical procedure for early stage cervical cancer, with acceptable surgical and oncological outcomes in the hands of well-trained and experienced laparoscopic surgeons.[Table: see text]