Radical Vaginal Hysterectomy and Trachelectomy in Early-Stage Cervical Cancer

Erasmo Bravo, Catalina Alonso Montemurro, Sergio Rojas Sepulveda, Jaime Cartagena Bustamante, Hector Pinto

Oncologic Gynecology Unit, Gustavo Fricke Hospital, Vi?a del Mar, Chile.
Oncologic Gynecology Unit, Van Buren Hospital, Valparaíso, Chile.

DOI: 10.4236/ojog.2014.48070                

Abstract

Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 5 years in both hospitals, are presented. Laparoscopic systemic pelvic lymphadenectomy with radical vaginal hysterectomy or radical vaginal trachelectomy was performed to patients, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: Between April 2008 and May 2013, 110 patients were submitted to this technique. 15 patients had their surgery aborted: 13 presented positive nodes for carcinoma in contemporary biopsy and 2 had extensive cervical compromise when performing radical vaginal hysterectomy or trachelectomy. Analysis of the remaining 95 cases shows an average age of 43.9 years (26 - 61), all of them had given birth before, 23 (21%) of them through C-section. BMI averaged 30.5 and 31 (28.2%) had cone surgery performed previously. Average duration of surgery was of 220 minutes. Postoperative hospitalization averaged 3.1 days. Bleeding volume was estimated at 125 cc and one patient required blood transfusion. En 25 patients’ uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 25.4 pelvic nodes were obtained. Complications 13.6% with eight patients suffered bladder injury, two had rectovaginal fistula, 3 patients requires surgical repair of ureteral obstruction, two patients present thromboembolic disease. The disease-free and overall survivals are consistent with reports in the literature. Conclusion: We believe that handling patients with this technique is possible and has the advantages of vaginal and laparoscopic surgery with minimal complications.

Keywords

Radical Vaginal Hysterectomy, Radical Vaginal Trachelectomy, Early-Stage Cervical Cancer

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sonoda, Y. and Abu-Rustum, N. (2007) Schauta Radical Vaginal Hysterectomy. Gynecologic Oncology, 104, 20-24. http://dx.doi.org/10.1016/j.ygyno.2006.10.026
[2]	Angioli, R., Martin, J., Heffernan, T., et al. (2001) Radical Vaginal Hysterectomy Classic and Modified. Surgical Clinics of North America, 81, 829-838.
[3]	Dargent, D. (1987) A New Future for Schauta’s Operation through Pre-Surgical Retroperitoneal Pelviscopy. European Journal of Gynaecological Oncology, 8, 292-296.
[4]	Querleu, D., LeBlanc, E. and Castellain, B. (1991) Laparoscopic Pelvic Lymphadenectomy in the Staging of Early Cervical Carcinoma of the Cervix. American Journal of Obstetrics & Gynecology, 164, 579-581. http://dx.doi.org/10.1016/S0002-9378(11)80025-6
[5]	Childers, J.M., Hatch, K.D., Tran, A.N., et al. (1993) Laparoscopic Para-Aortic Lymphadenectomy in Gynecologic Malignancies. Obstetrics & Gynecology, 82, 741-747.
[6]	Hertel, H., Kohler, C., Michels, W., et al. (2003) Laparoscopic-Assisted Radical Vaginal Hysterectomy (LARVH): Prospective Evaluation of 200 Patients with Cervical Cancer. Gynecologic Oncology, 90, 505-511. http://dx.doi.org/10.1016/S0090-8258(03)00378-0
[7]	Morgan, D., Hunter, D., McCracken, G., et al. (2007) Is laparoscopically Assisted Radical Vaginal Hysterectomy for Cervical Carcinoma Safe? A Case Control Study with Follow up. BJOG, 114, 537-542. http://dx.doi.org/10.1016/S0090-8258(03)00378-0
[8]	Pahisa, J., Martinez-Román, S., Torné, A., et al. (2010) Comparative Study of Laparoscopically Assisted Radical Vaginal Hysterectomy and Open Wertheim-Meigs in Patients with Early Stage Cervical Cancer. International Journal of Gynecologycal Cancer, 20, 173-177.
[9]	Bravo, E., Parry, S. and Alonso, C. (2012) Radical Vaginal Trachelectomy and Laparoscopic Pelvic Lymphadenectomy in 1B1 Cervical Cancer during Pregnancy. Gynecologic Oncology Reports, 2, 78-79. http://dx.doi.org/10.1016/j.gynor.2012.04.002