Sardain H, Lavoue V, Redpath M, Bertheuil N, Foucher F, Levêque J
CHU de Rennes, Gynecology Department, Tertiary Surgery Center, Teaching Hospital of Rennes, Hôpital Sud, 16, Bd de Bulgarie, 35000 Rennes, France; Université de Rennes, Faculty of Medicine, 2 Henry Guilloux, 35000 Rennes, France.
CHU de Rennes, Gynecology Department, Tertiary Surgery Center, Teaching Hospital of Rennes, Hôpital Sud, 16, Bd de Bulgarie, 35000 Rennes, France; Université de Rennes, Faculty of Medicine, 2 Henry Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Rennes, France.
Eur J Surg Oncol. 2015 Aug;41(8):975-85. doi: 10.1016/j.ejso.2015.03.235. Epub 2015 Apr 14.
Pelvic exenteration requires complete resection of the tumor with negative margins to be considered a curative surgery. The purpose of this review is to assess the optimal preoperative evaluation and surgical approach in patients with recurrent cervical cancer to increase the chances of achieving a curative surgery with decreased morbidity and mortality in the era of concurrent chemoradiotherapy.
Review of English publications pertaining to cervical cancer within the last 25 years were included using PubMed and Cochrane Library searches.
Modern imaging (MRI and PET-CT) does not accurately identify local extension of microscopic disease and is inadequate for preoperative planning of extent of resection. Today, only half of pelvic exenteration procedures obtain uninvolved surgical margins.
Clear margins are required for curative pelvic exenterations, but are poorly predictable by pre-operative assessment. More extensive surgery, i.e. the infra-elevator exenteration with vulvectomy, is a logical surgical choice to increase the rate of clear margins and to improve patient survival following surgery for recurrent cervical carcinoma.
盆腔脏器清除术需要完整切除肿瘤且切缘阴性才能被视为根治性手术。本综述的目的是评估复发性宫颈癌患者的最佳术前评估和手术方法，以增加在同步放化疗时代实现根治性手术的机会，同时降低发病率和死亡率。
通过PubMed和Cochrane图书馆检索，纳入过去25年内有关宫颈癌的英文出版物进行综述。
现代影像学检查（MRI和PET-CT）不能准确识别微小病灶的局部扩展，不足以用于术前切除范围的规划。目前，只有一半的盆腔脏器清除术能获得无肿瘤累及的手术切缘。
根治性盆腔脏器清除术需要切缘清晰，但术前评估很难预测。更广泛的手术，即低位盆腔脏器清除术联合外阴切除术，是提高切缘阴性率和改善复发性宫颈癌患者术后生存率的合理手术选择。
