Benedetti-Panici P, Maneschi F, Cutillo G, Greggi S, Salerno M G, Amoroso M, Scambia G, Mancuso S
Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
Cancer. 1996 Dec 1;78(11):2359-65. doi: 10.1002/(sici)1097-0142(19961201)78:11<2359::aid-cncr14>3.0.co;2-#.
Due to the high prevalence of perioperative major morbidity and the difficulties in achieving surgical disease free margins, surgery has had no role in the treatment of patients with Stage III cervical carcinoma.
Forty-two women with International Federation of Gynecology and Obstetrics (FIGO) Stage III cervical carcinoma responding to platinum-based neoadjuvant chemotherapy underwent the maximum surgical effort, comprised of a modified type IV-V radical hysterectomy (37 patients) or anterior pelvectomy (5 patients) with systematic pelvic and aortic lymphadenectomy. Feasibility, modifications of surgical technique, and pathologic and clinical data were analyzed.
Surgery was feasible in all 42 patients intraoperatively selected. Disease free margins were achieved in all but one patient. The median operating time was 390 minutes, and the median estimated blood loss was 800 mL. In the last series of patients, these figures declined to 320 minutes and 600 mL, respectively. Major morbidity consisted of severe intraoperative hemorrhage in two patients, pulmonary embolism in four, ureteral fistula in three, and laparocele in three. The number of lymph nodes removed ranged from 30 to 117 with a median of 56. The mean lengths of vagina and lateral parametrium resected were 55 and 48 mm, respectively. Despite perioperative chemotherapy, lymph node metastasis was present in 36% of patients, parametrial disease in 38%, and vaginal disease in 45%. After a median follow-up of 53 months, the 5-year overall and disease-free survival rates of radically operated patients were 70% and 58%, respectively.
Thanks to improved surgical technique and perioperative care, extended radical surgery appears to be feasible with acceptable morbidity in chemosensitive women with Stage III cervical carcinoma and may constitute a valid alternative to radiotherapy in these patients.
由于围手术期严重并发症的高发生率以及难以实现手术切缘无癌，手术在Ⅲ期宫颈癌患者的治疗中一直未发挥作用。
42例国际妇产科联盟（FIGO）Ⅲ期宫颈癌患者对铂类新辅助化疗有反应，接受了最大程度的手术，包括改良的Ⅳ - Ⅴ型根治性子宫切除术（37例患者）或前盆腔脏器切除术（5例患者），并进行系统性盆腔和主动脉旁淋巴结清扫。分析手术的可行性、手术技术的改进以及病理和临床数据。
所有42例术中选择的患者手术均可行。除1例患者外，其余患者均实现了切缘无癌。中位手术时间为390分钟，中位估计失血量为800毫升。在最后一组患者中，这些数字分别降至320分钟和600毫升。主要并发症包括2例严重术中出血、4例肺栓塞、3例输尿管瘘和3例切口疝。切除的淋巴结数量在30至117个之间，中位数为56个。切除的阴道和侧方宫旁组织的平均长度分别为55毫米和48毫米。尽管进行了围手术期化疗，36%的患者存在淋巴结转移，38%存在宫旁组织病变，45%存在阴道病变。中位随访53个月后，接受根治性手术患者的5年总生存率和无病生存率分别为70%和58%。
由于手术技术和围手术期护理的改进，扩大根治性手术对于化疗敏感的Ⅲ期宫颈癌女性患者似乎可行，并发症可接受，并且可能成为这些患者放疗的有效替代方案。
