Document Detail


Uterus-conserving surgery for invasive cervical cancer.
MedLine Citation:
PMID:  15955744     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Standard treatment for cervical cancer is either radical hysterectomy or radiotherapy to the pelvis. Either will inevitably compromise fertility, rendering future childbearing impossible. Precise staging and magnetic resonance imaging can indicate the site and location of the tumour. Radical wide local excision of early-stage small tumours can allow conservation of the uterine corpus and the potential for fertility preservation. An isthmic vaginal anastomosis restores continuity of the vaginal canal after insertion of an isthmic cerclage. This will keep the isthmus competent but still allow menstruation. Pelvic lymphadenectomy is performed laparoscopically. This new approach combines current developing minimal access techniques with laparoscopic pelvic sidewall dissection and lymphadenectomy. The bottom or inferior part of a traditional radical vaginal hysterectomy is performed simultaneously. Over 400 cases have been reported with 100 live births. Premature rupture of the membranes is a risk. Delivery is by classical Caesarean section. Fertility rates are good and recurrence rates are low at 4%. This technique appears to be safe in well-selected cases and when performed in centres with suitable experience of radical vaginal surgery and laparoscopic techniques. Obstetric management in high-risk feto-maternal units is necessary in view of the risk of prematurity.
Authors:
J H Shepherd
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Best practice & research. Clinical obstetrics & gynaecology     Volume:  19     ISSN:  1521-6934     ISO Abbreviation:  Best Pract Res Clin Obstet Gynaecol     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-09-09     Completed Date:  2006-03-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101121582     Medline TA:  Best Pract Res Clin Obstet Gynaecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  577-90     Citation Subset:  IM    
Affiliation:
St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary Westfield College, and Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK. john.shepherd@rmh.nthames.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Cervix Uteri / surgery
Female
Gynecologic Surgical Procedures / methods
Humans
Infertility, Female / prevention & control
Lymph Node Excision / methods*
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Pelvis
Pregnancy
Pregnancy Complications, Neoplastic / pathology
Pregnancy Outcome
Uterine Cervical Neoplasms / epidemiology,  pathology,  surgery*
Uterus / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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