The aim of this study was to compare the rate of incomplete resection and treatment outcome of the second-pass technique with those of single-pass technique in loop electrosurgical excisional procedure (LEEP). From 1997 to 2002, 683 women were diagnosed as squamous dysplasia via LEEP in our institution. Age, parity, LEEP technique, grade of lesion, glandular extension, margin status, residual tumor and recurrence were obtained by reviewing medical records. Positive margin was defined as mild dysplasia or higher grade lesions at resection margin of the LEEP specimen. In women who underwent hysterectomy, residual tumor was defined as mild dysplasia or higher grade lesions in hysterectomy specimen. In women who did not underwent hysterectomy, Pap smear more than atypical squamous cells of undetermined significance or biopsy result more than mild dysplasia within two years after LEEP were regarded as cytologic or histologic recurrences, respectively. Treatment failure of LEEP was defined as residual tumor or histologic recurrence. The second-pass technique significantly reduced the endocervical margin positivity (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63). However, the second-pass technique did not reduce the treatment failure (OR, 0.62; 95% CI, 0.29-1.32). In conclusion, the second-pass technique markedly reduced the endocervical margin positivity, but did not reduce the treatment failure rate of LEEP.
Adult ; Cervical Intraepithelial Neoplasia/pathology/*surgery ; Electrosurgery/*methods ; Female ; Humans ; Hysterectomy ; Medical Records ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis/epidemiology ; Neoplasm, Residual/diagnosis/epidemiology ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Uterine Cervical Neoplasms/pathology/*surgery

To determine whether radical hysterectomy is necessary in the treatment of endometrial cancer patients with cervical involvement, we reviewed the medical records of women who underwent primary surgical treatment for endometrial carcinoma and selected patients with pathologically proven cervical invasion. Among 133 patients, 62 patients underwent extrafascial hysterectomy (EH) and 71 radical or modified radical hysterectomy (RH). The decision regarding EH or RH was made at the discretion of the attending surgeon. The sensitivity of pre-operative magnetic resonance imaging for cervical invasion was 44.7% (38/85). In RH patients, 10/71 (14.1%) patients had frankly histologic parametrial involvement (PMI). All were stage III or over. Eight of 10 patients had pelvic/paraaortic node metastasis and two showed extrauterine spread. In 74 patients with stage II cancer, RH was performed in 41 and PMI was not seen. Sixty-six (89.2%) patients had adjuvant radiation therapy and there were 3 patients who had developed recurrent disease in the RH group and none in the EH group (Mean follow-up: 51 months). Although these findings cannot conclusively refute or support the necessity of radical hysterectomy in patients with cervical extension, it is noteworthy that the risk of PMI seems to be minimal in patients with a tumor confined to the uterus without evidence of extrauterine spread.
Adult ; Aged ; Databases, Factual ; Endometrial Neoplasms/epidemiology/*pathology/*surgery ; Female ; Humans ; *Hysterectomy/methods ; Korea/epidemiology ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/epidemiology/*pathology/*surgery

OBJECTIVE: Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. METHODS: After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. RESULTS: Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. CONCLUSION: NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
Constipation/epidemiology/etiology ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Intraoperative Complications/epidemiology ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Rectum/*innervation/surgery ; Sexual Dysfunction, Physiological/epidemiology/etiology ; Urinary Bladder/*innervation/surgery ; Urinary Retention/epidemiology/etiology ; Uterine Cervical Neoplasms/epidemiology/*surgery ; Uterus/innervation/surgery ; Vagina/innervation/surgery

PURPOSE: To compare surgical outcomes of robotic radical hysterectomy (RRH) using 3 robotic arms with those of conventional laparoscopy in patients with early cervical cancer. MATERIALS AND METHODS: A retrospective cohort study included 102 patients with stage 1A1-IIA2 cervical carcinoma, of whom 60 underwent robotic and 42 underwent laparoscopic radical hysterectomy (LRH) with pelvic lymph node dissection performed between December 2009 and May 2013. Perioperative outcomes were compared between two surgical groups. RESULTS: Robotic approach consisted of 3 robotic arms including the camera arm and 1 conventional assistant port. Laparoscopic approach consisted of four trocar insertions with conventional instruments. There were no conversions to laparotomy. Mean age, body mass index, tumor size, cell type, and clinical stage were not significantly different between two cohorts. RRH showed favorable outcomes over LRH in terms of estimated blood loss (100 mL vs. 145 mL, p=0.037), early postoperative complication rates (16.7% vs. 30.9%, p=0.028), and postoperative complications necessitating intervention by Clavien-Dindo classification. Total operative time (200.5+/-61.1 minutes vs. 215.6+/-83.1 minutes, p=0.319), mean number of lymph node yield (23.3+/-9.3 vs. 21.7+/-9.8, p=0.248), and median length of postoperative hospital stay (11 days vs. 10 days, p=0.129) were comparable between robotic and laparoscopic group, respectively. The median follow-up time was 44 months with 2 recurrences in the robotic and 3 in the laparoscopic cohort. CONCLUSION: Surgical outcomes of RRH and pelvic lymphadenectomy were comparable to that of laparoscopic approach, with significantly less blood loss and early postoperative complications.
Adult ; Blood Loss, Surgical ; Female ; Humans ; Hysterectomy/*adverse effects/methods ; Laparoscopy/*adverse effects ; Length of Stay ; Middle Aged ; Postoperative Complications/*epidemiology ; Retrospective Studies ; Robotic Surgical Procedures/*adverse effects ; Treatment Outcome ; Uterine Cervical Neoplasms/*surgery

PURPOSE: The aim of this study was to evaluate perioperative complications of robot-assisted laparoscopic surgery in gynecology. MATERIALS AND METHODS: Patients who underwent elective robot-assisted laparoscopic surgery between February 2006 and December 2013 were identified. Robotic procedures were performed using the da Vinci robotic system. Patient demographic data and operative outcomes were prospectively collected in a computerized database and extracted for this study. RESULTS: Two hundred and ninety eight patients were identified during the study period. One case was converted to conventional laparoscopy due to mechanical failure of the robot system before the procedure and excluded from review. The median age and body mass index of patients were 48 years and 23.0 kg/m2, respectively. The majority (n=130, 43.6%) of operative procedures was radical hysterectomy, followed by endometrial cancer staging (n=112, 37.6%), total hysterectomy (n=39, 13.1%), and myomectomy (n=17, 5.7%). The median operative time, estimated blood loss, and postoperative hospital stay were 208.5 min, 184.8 mL, and 8.9 days, respectively. The overall complication rate was 18.8% and that for only oncologic cases was 16.1%. Intraoperative complications (n=5, 1.7%) consisted of three vessel injuries, one bowel content leakage during an appendectomy during endometrial cancer staging and one case of bladder injury during radical hysterectomy. Early and late postoperative complications were 14.4% and 2.7%, respectively. Five patients (1.7%) experienced grade 3 complications according to Clavien-Dindo classification and therefore needed further intervention. CONCLUSION: Robot-assisted laparoscopic surgery is a feasible approach in gynecology with acceptable complications.
Adult ; Aged ; Body Mass Index ; Endometrial Neoplasms/surgery ; Female ; Humans ; Hysterectomy ; Laparoscopy/*methods ; Length of Stay ; Lymph Node Excision/methods ; Middle Aged ; Neoplasm Staging ; Pain, Postoperative/epidemiology ; *Perioperative Period ; Postoperative Complications ; Prospective Studies ; Robotics/*methods ; Socioeconomic Factors ; Treatment Outcome ; Uterine Cervical Neoplasms/*surgery

PURPOSE: The aim of this study was to evaluate perioperative complications of robot-assisted laparoscopic surgery in gynecology. MATERIALS AND METHODS: Patients who underwent elective robot-assisted laparoscopic surgery between February 2006 and December 2013 were identified. Robotic procedures were performed using the da Vinci robotic system. Patient demographic data and operative outcomes were prospectively collected in a computerized database and extracted for this study. RESULTS: Two hundred and ninety eight patients were identified during the study period. One case was converted to conventional laparoscopy due to mechanical failure of the robot system before the procedure and excluded from review. The median age and body mass index of patients were 48 years and 23.0 kg/m2, respectively. The majority (n=130, 43.6%) of operative procedures was radical hysterectomy, followed by endometrial cancer staging (n=112, 37.6%), total hysterectomy (n=39, 13.1%), and myomectomy (n=17, 5.7%). The median operative time, estimated blood loss, and postoperative hospital stay were 208.5 min, 184.8 mL, and 8.9 days, respectively. The overall complication rate was 18.8% and that for only oncologic cases was 16.1%. Intraoperative complications (n=5, 1.7%) consisted of three vessel injuries, one bowel content leakage during an appendectomy during endometrial cancer staging and one case of bladder injury during radical hysterectomy. Early and late postoperative complications were 14.4% and 2.7%, respectively. Five patients (1.7%) experienced grade 3 complications according to Clavien-Dindo classification and therefore needed further intervention. CONCLUSION: Robot-assisted laparoscopic surgery is a feasible approach in gynecology with acceptable complications.
Adult ; Aged ; Body Mass Index ; Endometrial Neoplasms/surgery ; Female ; Humans ; Hysterectomy ; Laparoscopy/*methods ; Length of Stay ; Lymph Node Excision/methods ; Middle Aged ; Neoplasm Staging ; Pain, Postoperative/epidemiology ; *Perioperative Period ; Postoperative Complications ; Prospective Studies ; Robotics/*methods ; Socioeconomic Factors ; Treatment Outcome ; Uterine Cervical Neoplasms/*surgery