Hiroyuki Kanao1, Yoichi Aoki2, Tsuyoshi Hisa2, Nobuhiro Takeshima2. 1. Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koutouku, Tokyo 135-8550, Japan. Electronic address: hiroyuki.kanao@jfcr.or.jp. 2. Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koutouku, Tokyo 135-8550, Japan.
Abstract
OBJECTIVE: Patients in whom laterally recurrent cervical carcinoma develops in the previously irradiated pelvis are usually abandoned because the resectability rate is low, and the 5-year survival rate is close to zero when complete margin-negative resection is not achieved [1]. Höckel described laterally extended endopelvic resection (LEER) as an approach in which the line of resection extends to the pelvic sidewall [2]. Complete margin-negative resection (R0 resection) was achieved in all 100 patients who underwent LEER for laterally recurrent cervical carcinoma, and 5-year survival was very good at 62%. However, two procedure-related deaths occurred, and morbidity was 70% [3]. When cervical carcinoma recurs in the previously irradiated pelvis, fibrosis and adhesion around the recurrent mass increase morbidity and mortality. Because laparoscopy optimizes visualization and thus provides for meticulous dissection, laparoscopic LEER can be advantageous over open LEER for treatment of such recurrent tumors. METHODS: We performed laparoscopic LEER in three cases of previously irradiated laterally recurrent cervical carcinoma under the following criteria: the recurrent tumor was solitary and without distant metastasis; no equally effective alternative treatment existed, preoperative evaluation of the tumor showed R0 resection to be achievable; and the patient provided informed consent for the procedure. RESULTS: In all three cases, R0 resection was achieved without the need for blood transfusion and without intraoperative or postoperative complications. There was no associated morbidity or mortality. One patient died from recurrent disease 24months after the operation, but neither of the other two patients has suffered recurrence during the respective 3 and 4months that have passed since the surgery. CONCLUSION: Laparoscopic LEER is a very complicated procedure; the surgeon must possess detailed knowledge of the pelvic anatomy and high-level technical skill. Our experience indicates that laparoscopic LEER is feasible for cervical carcinoma that recurs laterally after irradiation and that low morbidity and mortality can be expected. Oncologic outcomes of the procedure will become clear with an accumulation of cases and long-term follow-up data.
OBJECTIVE:Patients in whom laterally recurrent cervical carcinoma develops in the previously irradiated pelvis are usually abandoned because the resectability rate is low, and the 5-year survival rate is close to zero when complete margin-negative resection is not achieved [1]. Höckel described laterally extended endopelvic resection (LEER) as an approach in which the line of resection extends to the pelvic sidewall [2]. Complete margin-negative resection (R0 resection) was achieved in all 100 patients who underwent LEER for laterally recurrent cervical carcinoma, and 5-year survival was very good at 62%. However, two procedure-related deaths occurred, and morbidity was 70% [3]. When cervical carcinoma recurs in the previously irradiated pelvis, fibrosis and adhesion around the recurrent mass increase morbidity and mortality. Because laparoscopy optimizes visualization and thus provides for meticulous dissection, laparoscopic LEER can be advantageous over open LEER for treatment of such recurrent tumors. METHODS: We performed laparoscopic LEER in three cases of previously irradiated laterally recurrent cervical carcinoma under the following criteria: the recurrent tumor was solitary and without distant metastasis; no equally effective alternative treatment existed, preoperative evaluation of the tumor showed R0 resection to be achievable; and the patient provided informed consent for the procedure. RESULTS: In all three cases, R0 resection was achieved without the need for blood transfusion and without intraoperative or postoperative complications. There was no associated morbidity or mortality. One patient died from recurrent disease 24months after the operation, but neither of the other two patients has suffered recurrence during the respective 3 and 4months that have passed since the surgery. CONCLUSION: Laparoscopic LEER is a very complicated procedure; the surgeon must possess detailed knowledge of the pelvic anatomy and high-level technical skill. Our experience indicates that laparoscopic LEER is feasible for cervical carcinoma that recurs laterally after irradiation and that low morbidity and mortality can be expected. Oncologic outcomes of the procedure will become clear with an accumulation of cases and long-term follow-up data.