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LiFE re
Literature for ENYGO
Surgical treatment of primary cervical cancer
Editor Mandic Aljosa and Matteo Morotti
Descriptive summary
Narducci et al. retrospectively analysed 29 patients with occult
cervical cancer after inadvertent simple hysterectomy. Patients who
underwent radical parametrectomy with pelvic lymph node dissec-
tion (n=13) dissection resulted in a better clinical outcome (OS and
DFS) than radiotherapy (n=16) with acceptable minimal morbidity
being observed. Although the cohort is quite small to draw conclu-
sions from, minimally invasive surgery can be a good option in the
management of these women.
Papadia et al. compared retrospectively SLN mapping in occult
cervical cancer patients diagnosed after hysterectomy (group 1) with
patients with uterus in situ (group 2). Overall and bilateral detection
rates were higher when uterus was in situ with 66.6 % and 33.3 %
(group 1) and 95.1 % and 87 % (group 2). No false-negative SLNs
were identified in either group.
Benedetti Panici et al. retrospectively evaluated the feasibility and
safety of type B (group 1) compared to type C (Group 2; 36 patients
in each group) radical hysterectomy (RH) after clinical response to
NACT. No differences in clinical outcome were reported between
the two groups, however bladder dysfunction rate was significant-
ly lower in Group 1 compared with Group 2 (13.9 vs. 69.4 %; p <
0.0001). Authors concluded that Type B RH after NACT in well-se-
lected patients is a safe procedure that upholds the results of type
C, reducing operative time and late postoperative morbidity, without
detrimental effect on survival. However, further prospective trials are
warranted to confirm these results.
Johansen et al. investigated the reproductive and oncologic outcome
following robotic radical trachelectomy for early-stage cervical
cancer (IA1-IB1). 56 women with a median age of 29 years (range
23–41) were followed for a median of 24 months (range 1–89). A lo-
cal recurrence was seen in two of the 49 women (4 %), in whom the
procedure was completed as planned. Seventeen of the 21 women
(81 %) in the reproductive follow-up group conceived. 12 women (71
%) in gestational week ≥ 36. One (6 %) second trimester delivery
occurred. According to these results the authors supported the
feasibility of robotic fertility-sparing radical trachelectomy in women
with early-stage cervical cancer.
Köhler et al. reported on the feasibility of surgical vs. clinical staging
followed by chemoradiation in patients with stage IIB-IVA disease
(Uterus-11). 255 patients with advanced cervical cancer (FIGO IIB-
IVA) were randomised to surgical staging and RCTX (arm A) or clini-
Continued on the next page 
International Journal of Gynecological Cancer, Volume 26, Supplement #1
CERVICAL CANCER
cal staging followed by RCTX (arm B). Brachytherapy was mandatory.
The surgical approach was transperitoneal laparoscopy (93.4 %),
with no operative mortality. A mean of 19 pelvic and 17 para-aortic
nodes were removed. Operative staging led to upstaging in 40 of 121
(33 %). RCTX began between 7 and 21 days after surgery. Authors
concluded that surgical staging in patients with locally advanced
cervical cancer is safe and does not delay primary RCTX.
For quality assurance outcomes of this trial, see the report on
“Medical treatment of primary or recurrent cervical cancer” by K.
Lindemann.
Li et al. published on the postoperative recovery in patients with
early cervical cancer. In this randomised trial, authors investigated
the effect of a home-based, nurse-led health program on quality of
life and family function (intervention group) compared to convention-
al nursing education (control). In the intervention group, significant
improvements were found for the quality of life total scores, sexual
function scores, cohesion scores, and adaptability scores compared
to baseline. The change in scores for quality of life, sexual function,
cohesion, and adaptability indicated significant improvement in the
intervention group compared to controls. Authors concluded that
a home-based, nurse-led, health promotion program improves the
quality of life, sexual function, and social relations in these patients.
Jeong In Gab et al. reviewed 7 patients who underwent augmenta-
tion ileocystoplasty with ileal ureter replacement. The majority of
the patients (4 of 7) were previously treated with radical hysterec-
tomy plus radiotherapy. Ileal ureter replacement was performed on
11 renal units, and bilateral ileal ureter substitution was performed
for 4 patients, with the largest ureteral defect being 15 cm. After
the median hospital stay (23 days), 4 of 7 patients experienced
major complications (grade C 3). During a mean follow-up duration
of 38 months, none of the patients experienced deterioration of
renal function after surgery, proving the feasibility of this technique
for bridging long ureteral defects caused by ureteric stenosis from
surgery, radiotherapy, or both, for pelvic tumours.
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