Kanao Hiroyuki, Kurita Tomoko, Tanaka Yuji, Fusegi Atsushi, Aoki Yoichi, Nomura Hidetaka
Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koutouku, Tokyo 135-8550, Japan.
Gynecol Oncol Rep. 2021 Feb 13;36:100728. doi: 10.1016/j.gore.2021.100728. eCollection 2021 May.
In 2003, Höckel described the laterally extended endopelvic resection (LEER), which may be an effective surgical technique for patients with laterally recurrent cervical cancer (Höckel, 2003). Super-radical hysterectomy, which was introduced by Ryukichi Mibayashi in 1941, is the traditional surgical approach for cervical cancer patients (Kim et al., 2017). These two procedures are similar and belong to the same group (type D) in the Querleu-Morrow classification (Querleu et al., 2017). Until now, no surgical video clearly demonstrated their differences, because technical complexities and concern for procedural safety are still being debated. The present video demonstrated total pelvic exenteration (TPE) for laterally recurrent, previously irradiated cervical cancer that involved both the bladder and rectum. In this case, the recurrent tumor infiltrated the parametrium, reached the left pelvic sidewall, and invaded the left piriform muscle, sacrospinous ligament, and spine segment S2. To completely clear the tumor, we used TPE with super-radical hysterectomy on the right side and LEER on the left. We performed this procedure laparoscopically because improved visualization allows for meticulous dissection and a higher possibility of achieving R0. Surgery time was 9 h 45 min including the time for creation of the ileal conduit and colostomy, and blood loss was 230 ml with no blood transfusion needed. Pathological R0 resection was achieved without any intraoperative and postoperative complications. Compared to super-radical hysterectomy, LEER ensured additional surgical margins. Without any adjuvant treatment, there has been no sign of recurrence during the 12 months that have passed since the surgery. Laparoscopic TPE with super-radical hysterectomy and LEER for laterally recurrent, previously irradiated cervical cancer is a technically feasible and safe surgical option. LEER can ensure more surgical margins than super-radical hysterectomy, and it may be a treatment of choice for more advanced lateral recurrence.
2003年，赫克尔描述了盆腔内扩大切除术（LEER），这可能是治疗侧方复发宫颈癌患者的一种有效手术技术（赫克尔，2003年）。1941年由三林隆吉引入的超根治性子宫切除术是宫颈癌患者的传统手术方法（金等人，2017年）。这两种手术相似，在奎勒-莫罗分类法（奎勒等人，2017年）中属于同一组（D型）。到目前为止，没有手术视频能清楚地展示它们的差异，因为技术复杂性和对手术安全性的担忧仍在争论中。本视频展示了对侧方复发、先前接受过放疗且累及膀胱和直肠的宫颈癌进行全盆腔脏器切除术（TPE）的过程。在这个病例中，复发肿瘤浸润了子宫旁组织，到达左盆腔侧壁，并侵犯了左梨状肌、骶棘韧带和S2椎体节段。为了完全清除肿瘤，我们在右侧采用超根治性子宫切除术、在左侧采用LEER进行TPE。我们采用腹腔镜进行该手术，因为改善的视野有助于精细解剖，且更有可能实现R0切除。手术时间为9小时45分钟，包括创建回肠造口和结肠造口的时间，失血量为230毫升，无需输血。实现了病理R0切除，无任何术中及术后并发症。与超根治性子宫切除术相比，LEER确保了额外的手术切缘。术后12个月来，未进行任何辅助治疗，也没有复发迹象。对于侧方复发、先前接受过放疗的宫颈癌，采用超根治性子宫切除术和LEER的腹腔镜TPE是一种技术上可行且安全的手术选择。与超根治性子宫切除术相比，LEER能确保更多的手术切缘，对于更晚期的侧方复发可能是一种首选治疗方法。
