Our Experience of Laparoscopic Anterior Exenteration in Locally Advanced Cervical Carcinoma

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• 作者：Shailesh Puntambekar ; MS^a ; ^{shase63@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Vikrant Sharma ; MS ; FNB^a ; Arun V. Jamkar ; MS^b ; Yamini Gadkari ; DNB^a ; Geetanjali Joshi ; MS^a ; Seema Puntambekar ; MS^a ; Hirav Parikh ; MS ; FNB^a ; Shivam Vatsal ; MS^a
• 关键词：Advanced carcinoma cervix ; Laparoscopic anterior exenteration ; Palliation ; Ureterosigmoidostomy
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：23
• 期：3
• 页码：396-403
• 全文大小：1760 K

文摘

To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients.

Design

A retrospective cohort study.

Setting

Galaxy Care Laparoscopy Institute, Pune, India.

Patients

Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients.

Interventions

The same surgeon and team performed all the operations for uniformity in 10 operative steps.

Measurements and Main Results

The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%.

Conclusion

Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival.