100% 5-Year survival rate in laparoscopic radical hysterectomy for early-stage cervical cancer is an achievable task
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Robotic radical hysterectomy is increasingly being utilized in the treatment of cervical cancer and initial studies are promising. Compared to open radical hysterectomy, robotic radical hysterectomy is expected to result in decreased pain, infection, length of stay, and adhesions and quicker return to activity. Prospective randomized controlled trials are needed to compare robotic, laparoscopic and open radical hysterectomy for the treatment of cervical cancer.
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The authors made an exact investigation of the treatment of patients suffering from cervical cancer during one year period. Out of the data of 101 gynecological wards 1700 cases were evaluated. The authors evaluated the different ways of treatment with respect to the international requirements on the base of hystological results. They elaborated the operative methods in every stage of cervical cancers, with more details on radical hysterectomy and regional lymphadenectomy. The authors suggest that patients suffering from cervical cancer should be treated by standardized principles based on international scientific experiences.
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To study the feasibility of the nerve-sparing radical hysterectomy (NSRHT) stage by stage in cervical cancer and its impact on the blood loss, the duration of RH as well as on bladder dysfunction in irradiated and non-irradiated patients.Between XI.2002 and IX.2011 294 consecutive patients with invasive cervical cancer (IB1, IB2, IIB) were operated on. The performed surgery was radical hysterectomy class III and pelvic lymphadenectomy 77 patients were submitted to NSRH (26.19%)--56 patients--non-irradiated (gr. 1) and 21--after preoperative radiotherapy (gr.2) CONCLUSIONS: NSRH is feasible technique in stages IB1, I82, IIB before or after radiotherapy. NSRH doesn't compromise the radically of the RH. Preoperative radiotherapy doesn't change the benefits of NSRH. The latter is associated with minimal blood loss during RH (280 ml vs 600, p < 0.005), fast recovery to spontaneous voiding (16th day vs 24, p < 0.005) and is little more time--consumpting procedure (75 min. vs 60 min., NS).
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The study compares survival and complications during two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa. Group A included 128 patients operated during the years 1983-87. In that period 5 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Group B included 135 patients operated during the years 1988-91. In that period 7 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Considering stage 1b separately, the frequency of operation was raised from 52 (123/237) to 87% (128/148). A 5-years crude survival rate of 85% and 88% was observed in the two groups. The mortality rate was zero in both periods and no fistulae occurred. There were no significant increase in morbidity or length of hospitalization. In the elderly patients over sixty years a significant increase in minor postoperative complications and hospitalization more than 2 weeks were seen. The conclusion is that the frequency of radical hysterectomy as treatment of cervical cancer stage Ib can be raised from 52% to 87% without any noticeable influence on survival or complication rate.
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地方性甲状腺腫は臨床, 病理学的に複雑な経過を示し, 疫学的, 病理学的発生論や治療の選択に多くの難題が残されている. 著者は本症の病期検討および妥当な病期分類がこれらの検索, 解明にきわめて有用であると着目し, 甲状腺剔出を行なった地方性甲状腺腫336例を臨床, 病理学的に精査し下記の結果をえた. 1) 地方性甲状腺腫は臨床的, 病理学的経過からStage 1;過形成期, Stage 2;腫大期, Stage 3;結節形成期と分類できた. 2) 本症は病期の進行に伴い病悩期間は長くなり, 甲状腺腫は増大し種々の局所圧迫症状をみるが, 合併症がなければ全身的, 臨床生化学的所見はほぼ正常である. 3) 臨床, 病理学的に本症はStage 1からStage 2さらにStage 3に進行し, Stage 3は終末期である. 4) 病変の占居部位はStage 1では両葉性, Stage 2では両葉性と単葉性がほぼ等しく, Stage 3では単葉性が多い点からもStageの進行度を裏付けられる. 5) 336例のうち男性39例, 女性297例, 男女比1:7.6で, 発生のピークは女性では20才から30才代, 男性は30才から40才代であった. 6) 手術適応例は若年者より成人に多く, 女性は男性より著しく多い. ヨード治療の効果が若年者ほど良好で, 男性は女性よりもヨード感受性が高いためである. 7) Stage 3の9.4%に甲状腺機能亢進症 (4.03%), 腺腫 (1.34%), 甲状腺癌 (4.03%) などの共存疾患がみられた. 8) ヨード治療はStage 1では効果的であるがStage 2では無効でStage 3に進行し, 種々の合併症を起こすこともあり, Stage 2における手術が望ましい.
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Invasive surgery
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