Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan.
J Gynecol Oncol. 2023 Nov;34(6):e80. doi: 10.3802/jgo.2023.34.e80. Epub 2023 Jul 6.
This study evaluated the feasibility and outcomes of pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fascia-oriented and nerve-sparing surgical approach.
This retrospective observational cohort study examined the operative outcomes and prognoses of patients who underwent PVRH (n=59) for up to stage IIA cervical cancer. The basic procedure was Kyoto B2 (Viper Type II nerve-sparing) radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal (open or laparoscopic) approaches. In all cases, pneumovaginoscopy (PV) was used to create a vaginal cuff and dissect the paracolpium and paracervical endopelvic fascia to minimize nerve damage.
Thirty-eight (64.4%) patients had stage IB1 cancer. Seven (11.9%) had vaginal invasion (stage IIA1, n=4; IIA2, n=3). The abdominal approach was open in 38 cases and laparoscopic in 21. Adjuvant therapy was administered to 24 patients (41%); one patient received concurrent chemoradiotherapy for gastric-type adenocarcinoma. There were three (6.1%) intraoperative complications (CO gas embolism [n=1], sigmoid colon musculosa injury [n=1], and ureteral injury [n=1]) and 8 (14%) postoperative complications (lymphedema with cellulitis [n=4], vaginal cuff dehiscence [n=1], sub-ileus [n=1], symptomatic lymphocyst [n=l], and ureterovaginal fistula [n=1]). The median urination recovery period was 3 days. Microscopic R0 was achieved in all cases. The median follow-up was 44.5 (2-122) months, and no recurrence occurred.
PVRH is a new fascia-oriented and nerve-sparing surgery for early-stage cervical cancer. Further, it has favorable operative outcomes and good prognoses, similar to those of adjacent pelvic surgery such as trans-anal total mesorectal excision and radical prostatectomy.
本研究评估了采用双向筋膜导向和神经保护手术方法的经阴道镜辅助根治性子宫切除术（PVRH）治疗宫颈癌至 IIA 期的可行性和结果。
本回顾性观察性队列研究检查了 59 例接受 PVRH（n=59）治疗宫颈癌至 IIA 期的患者的手术结果和预后。基本程序是京都 B2（Viper 型 II 神经保护）根治性子宫切除术和盆腔淋巴结切除术，通过同时经阴道和腹部（开放或腹腔镜）途径进行。在所有情况下，均使用经阴道镜检查（PV）来创建阴道袖口，并解剖副阴道和副宫颈盆内筋膜，以最大程度地减少神经损伤。
38 例（64.4%）患者患有 IB1 期癌症。7 例（11.9%）有阴道侵犯（IIA1 期，n=4；IIA2 期，n=3）。腹部入路开放 38 例，腹腔镜 21 例。24 例患者（41%）接受了辅助治疗；1 例患者因胃型腺癌接受了同期放化疗。有 3 例（6.1%）术中并发症（CO 气体栓塞[n=1]，乙状结肠肌层损伤[n=1]，输尿管损伤[n=1]）和 8 例（14%）术后并发症（淋巴水肿伴蜂窝织炎[n=4]，阴道袖口裂开[n=1]，亚性肠梗阻[n=1]，症状性淋巴囊肿[n=1]，输尿管阴道瘘[n=1]）。排尿恢复的中位时间为 3 天。所有病例均达到显微镜下 R0。中位随访时间为 44.5（2-122）个月，无复发。
PVRH 是一种新的筋膜导向和神经保护手术，适用于早期宫颈癌。此外，它具有与相邻盆腔手术（如经肛门全直肠系膜切除术和根治性前列腺切除术）相似的良好手术结果和预后。
