Factors Affecting Spontaneous Voiding Recovery After Radical Hysterectomy
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Background: The impairment of spontaneous voiding is the most prominent type of morbidity in the early postoperative period after radical hysterectomy. The aim of our work was to evaluate the parameters affecting the recovery of spontaneous voiding. Methods: Enrolled were women in whom radical procedure for early-stage cervical cancer was performed in the period from 2006 to 2008. Satisfactory spontaneous voiding was characterized by the reduction of postvoiding urine residuum to 50 mL or less in the course of a whole day. Results: Data from 85 patients were evaluated retrospectively (radical hysterectomy 67, radical parametrectomy 6, and radical trachelectomy 12), of which 35 underwent nerve-sparing modification, 19 underwent type C radicality of procedure, and 31 underwent type D radicality of procedure. Radicality of parametrectomy was the most significant parameter influencing the interval to spontaneous voiding recovery ( P < 0.05); significant differences were observed between nerve-sparing and type D procedures. Multivariate analysis revealed 3 significant parameters: procedure radicality ( P < 0.001), type of procedure (radical hysterectomy vs radical trachelectomy; P < 0.05), and a negative correlation with body mass index ( P < 0.05). Long-term spontaneous voiding impairment lasting more than 6 weeks was observed in 7 patients, of whom 5 had undergone type D procedure. Conclusions: The radicality of parametrial resection is the most prominent factor determining the interval to spontaneous voiding, with significantly poorer outcomes after type D procedure. Interestingly, another significant parameter in our study was the type of parametrectomy, with better outcomes achieved after radical trachelectomy. Delayed voiding recovery was observed in patients with lower body mass index.Keywords:
Trachelectomy
Nerve sparing
Radical hysterectomy has been the standard surgical treatment for cervical cancer, achieving a good survival outcome. However, it is a major operation that has considerable potential long-term morbidity. With good prognosis achieved in most early cervical cancers, there is a trend towards more emphasis on maintaining good quality of life post-treatment. Many women diagnosed with cervical cancer are young, and fertility-sparing surgery such as trachelectomy would preserve their reproductive potential. Minimally invasive surgery, such as laparoscopic radical hysterectomy, can potentially improve post-operative recovery and cosmetic results while maintaining oncological safety. Sentinel lymph nodes assessment can minimize unnecessary systematic pelvic lymphadenectomy. Radicality of the hysterectomy may also be reduced in selected individuals with good prognostic factors, thus minimizing long-term pelvic floor dysfunction. This review aims to give a broad overview of the current status of these new trends in surgical management for cervical cancer.
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In the Centenary year of Wertheim's hysterectomy for the treatment of invasive cervical cancer, it is appropriate to look at less radical methods of managing early stage disease. Radical trachelectomy with pelvic lymphadenectomy is a conservative but locally radical procedure, preserving the corpus uteri and therefore fertility potential. The first 10 cases in a pilot study are presented. One patient has required post-operative radiotherapy and another a completion radical hysterectomy. Three live births by caesarean section and three other pregnancies have resulted. Careful selection within strict criteria may allow this more conservative approach without compromising cure. These procedures should be carried out in referral centres with continuing follow up and review.
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Cervical cancer is the third most common female cancer worldwide. Radical hysterectomy with lymph node dissection has become a standard method for treating early stage cervical cancer. Laparoscopic radical hysterectomy for early stage cervical cancer can provide a good survival outcome, fewer complications and a faster recovery time than open surgery. For patients who wish to retain their fertility, fertility-sparing surgery is considered. Laparoscopic radical trachelectomy is a good example of such surgery. Several series have shown that it is feasible, safe and has an acceptable overall survival rate compared with radical hysterectomy. It also provides the benefits of minimally-invasive surgery. It is a good choice for fertility-sparing surgery in cervical cancer. There are currently several methods of approach to radical trachelectomy, with different fertility and oncological results.
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To compare Piver III radical hysterectomy (RH) with nerve-sparing radical hysterectomy (NSRH) for cervical cancer patients in terms of postoperative physiology of pelvic autonomic nerves and perioperative complications.Seventy-three consecutive patients with invasive cervical cancer underwent RH (53 cases) or NSRH (20 cases) from 2001 to 2012 at the Department of Gynecology and Gynecologic Oncology of Polish Mother's Memorial Hospital - Research Institute in Łódź.Compared with patients treated with RH, patients who underwent NSRH presented no significant difference in terms of operative time (146 vs. 143 minutes, p > 0.05), blood loss and hospital stay (9.2 vs. 7.5 days, p > 0.05). A positive surgical margin was found in 6 cases of RH. No serious surgical complications were found in the NSRH group, while there were 4 cases in the RH group.Nerve-sparing radical hysterectomy is safe and feasible surgical management for cervical cancer patients, which should improve the physiology of the pelvic autonomic nerve system postoperatively. The technique is relatively new and its oncologic efficiency has not been fully established yet, moreover it requires sophisticated anatomical knowledge and high operative skills.
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The management of early stage cervical cancer often includes surgery in the form of radical hysterectomy, radical trachelectomy, or radical parametrectomy. Surgical techniques have evolved to include minimal invasive approaches, and more recently, to include robotic assisted techniques. This review highlights the evolution of surgical management of early cervical cancer and specifically explores robotic assisted radical hysterectomy, radical trachelectomy, radical parametrectomy, and the role of neoadjuvant chemotherapy. J. Surg. Oncol. 2015;112:772–781 . © 2015 Wiley Periodicals, Inc.
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