Kanao Hiroyuki, Aoki Yoichi, Hisa Tsuyoshi, Takeshima Nobuhiro
Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koutouku, Tokyo 135-8550, Japan.
Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koutouku, Tokyo 135-8550, Japan.
Gynecol Oncol. 2017 Aug;146(2):438-439. doi: 10.1016/j.ygyno.2017.05.030. Epub 2017 May 30.
For locally advanced cervical carcinoma, concurrent chemoradiotherapy (CCRT) is the standard treatment, however, CCRT can lead to development of a vesicovaginal or rectovaginal fistula [1]. Treatment options are limited for patients with laterally recurrent cervical carcinoma and fistula formation after CCRT. Chemotherapy with bevacizumab is now used for recurrent or advanced cervical carcinoma, but this treatment is associated with fistula formation [2]. When the recurrent mass is confined to the pelvic cavity, complete surgical resection with negative margins offers the most promise; however, the resectability rate is low in cases of laterally recurrent tumor [3], which may include bony structures, and survival outcomes seem to be poor in cases of a laterally recurrent vs. centrally recurrent tumor, even when the primary tumor has been resected in full [4]. Because analyses have shown that laparoscopy optimizes visualization and thus provides for meticulous dissection and that laparoscopic pelvic exenteration, in comparison to open pelvic exenteration results in minimal intraoperative blood loss and complications, fewer postoperative complications, and a shorter hospital stay [5], we perform laparoscopic pelvic exenteration in cases of laterally recurrent cervical carcinoma.
A 52-year-old woman underwent CCRT for a 10-cm stage IVA cervical carcinoma. That involved the bladder and right ureter, causing right hydronephrosis. Seven months after the CCRT, a recurrent mass at the right pelvic sidewall and vesicovaginal fistula were detected. The mass involved the right ureter and bladder and was attached to the rectum. The patient's right renal function was lost.
Total pelvic exenteration and right nephroureterectomy were performed laparoscopically. Operation time was 566min, and the blood loss volume was 250mL. Complete tumor clearance was achieved without any complication. No adjuvant treatment has been performed, and follow-up positron emission tomography-computed tomography has revealed no sign of recurrence during the 5months that have passed since the surgery.
Total laparoscopic pelvic exenteration is technically feasible for a laterally recurrent cervical carcinoma and vesicovaginal fistula that develop after CCRT.
对于局部晚期宫颈癌，同步放化疗（CCRT）是标准治疗方法，然而，CCRT 可导致膀胱阴道瘘或直肠阴道瘘的形成[1]。对于 CCRT 后出现侧方复发宫颈癌并伴有瘘形成的患者，治疗选择有限。贝伐单抗化疗目前用于复发或晚期宫颈癌，但这种治疗与瘘形成有关[2]。当复发肿块局限于盆腔时，切缘阴性的完整手术切除最有希望；然而，侧方复发肿瘤的可切除率较低[3]，其中可能包括骨性结构，并且与中央复发肿瘤相比，侧方复发肿瘤即使在原发肿瘤已完全切除的情况下，生存结果似乎也较差[4]。因为分析表明腹腔镜检查可优化视野，从而实现细致的解剖，并且与开放性盆腔脏器清除术相比，腹腔镜盆腔脏器清除术术中失血和并发症最少，术后并发症更少，住院时间更短[5]，所以我们对侧方复发宫颈癌患者实施腹腔镜盆腔脏器清除术。
一名 52 岁女性因 10cm 的IVA 期宫颈癌接受 CCRT。病变累及膀胱和右侧输尿管，导致右肾积水。CCRT 7 个月后，在右盆腔侧壁发现复发肿块及膀胱阴道瘘。肿块累及右侧输尿管和膀胱，并与直肠相连。患者右侧肾功能丧失。
通过腹腔镜进行了全盆腔脏器清除术和右肾输尿管切除术。手术时间为 566 分钟，失血量为 250mL。实现了肿瘤的完全清除，无任何并发症。未进行辅助治疗，术后 5 个月的随访正电子发射断层扫描 - 计算机断层扫描显示无复发迹象。
对于 CCRT 后发生的侧方复发宫颈癌和膀胱阴道瘘，全腹腔镜盆腔脏器清除术在技术上是可行的。
