Plante M, Roy M
L'Hôtel-Dieu de Québec, Laval University, 11 Côte du Palais, Quebec City, G1R-2J6, Canada.
Gynecol Oncol. 1998 May;69(2):94-9. doi: 10.1006/gyno.1998.4978.
Selecting out the true candidates for a pelvic exenteration frequently poses a difficult clinical dilemma in patients with recurrent cervical cancer after radiation therapy. Despite very thorough preoperative investigation, inoperable disease is discovered at the time of laparotomy in up to 60% of cases.
In this retrospective analysis, we report the use of operative laparoscopy in 13 patients with either biopsy proven locally recurrent cervical cancer (N = 9) or with clinically suspected tumor recurrence (N = 4). All have previously received radical radiation therapy.
Patients' ages ranged from 36 to 79 years (median, 43). The median duration of the procedure was 150 min (range,50-200) and median blood loss was 50 cc (range, 50-200). The procedure was well tolerated in all patients. There was no intraoperative complication. One deep thrombophlebitis occurred postoperatively. The laparoscopic evaluation could not be completed in one case because of a large nonmobile uterine fibroid filling the whole pelvis. At laparoscopy, metastatic tumor was identified in 9 of 12 patients (75%). An unnecessary laparotomy was avoided in 8 of those 9 cases (one had a palliative exenteration). The most common site of metastasis was in the previously radiated pelvis (7/9). Three patients had a negative laparoscopy. Two had an exenteration and one had a transureteroureterostomy. At the time of laparotomy, none were found to have disease that would have been missed at laparoscopy.
We conclude that operative laparoscopy may be a valuable additional step in the work-up and management of patients with locally recurrent cervical cancer. With experience in retroperitoneal surgery, the procedure can be carried out safely in previously radiated patients. We believe this approach can lower the number of unnecessary laparotomies, reduce the morbidity, and shorten the length of the postoperative recovery.
对于接受过放射治疗的复发性宫颈癌患者，挑选出真正适合盆腔脏器清除术的患者常常构成一个棘手的临床难题。尽管术前进行了非常全面的检查，但在剖腹手术时仍有高达60%的病例发现存在无法手术切除的疾病。
在这项回顾性分析中，我们报告了13例经活检证实为局部复发性宫颈癌（9例）或临床怀疑肿瘤复发（4例）患者的手术腹腔镜检查应用情况。所有患者此前均接受过根治性放射治疗。
患者年龄在36至79岁之间（中位数为43岁）。手术的中位时长为150分钟（范围为50 - 200分钟），中位失血量为50毫升（范围为50 - 200毫升）。所有患者对该手术耐受性良好。术中无并发症发生。术后发生1例深部血栓性静脉炎。1例因巨大且固定不动的子宫肌瘤占据整个盆腔，无法完成腹腔镜评估。在腹腔镜检查时，12例患者中有9例（75%）发现有转移性肿瘤。这9例中的8例避免了不必要的剖腹手术（1例进行了姑息性盆腔脏器清除术）。最常见的转移部位是先前接受过放疗的盆腔（7/9）。3例患者腹腔镜检查结果为阴性。2例进行了盆腔脏器清除术，1例进行了输尿管-输尿管吻合术。在剖腹手术时，未发现有腹腔镜检查会遗漏的疾病。
我们得出结论，手术腹腔镜检查可能是局部复发性宫颈癌患者检查和治疗中的一个有价值的额外步骤。有腹膜后手术经验的话，该手术可在先前接受过放疗的患者中安全进行。我们认为这种方法可以减少不必要的剖腹手术数量，降低发病率，并缩短术后恢复时间。
