Surgical Endoscopy

, Volume 28, Issue 9, pp 2713–2718 | Cite as

A new laparoscopic method of bowel radio-protection before pelvic chemoradiation of locally advanced cervix cancers

  • E. Leblanc
  • F. Narducci
  • L. Bresson
  • J. Durand-Labrunie
  • S. Taieb
  • E. Vanlerenberghe
  • I. Farre
  • P. Nickers



Chemoradiation therapy (CRT) has become the mainstay of locally advanced cervical carcinomas (LACC). However, the price to pay is a significant rate of both early and late colo-rectal toxicities, which may impact on survivors’ quality of life. To reduce the incidence of such complications, we suggest a simple technique of pelvic radioprotection.

Materials and methods

An omental flap is created which is placed to fill the Douglas pouch to both increase the space between rectum and uterine cervix and prevent small bowel to fall in and to be exposed to radiation. In addition, a long sigmoid loop is retracted and fixed in the left paracolic gutter to prevent its irradiation as well.


From May 2011 to May 2012, 51 successive LACC patients were offered this procedure in addition of a laparoscopic staging. All but 2 with too small an omentum benefitted from omentoplasty, while sigmoidopexy was performed in all but one patient with a long and free sigmoid loop. No immediate adverse effect was observed. The volume of retro-uterine omental flap averaged 7.17 ± 3.79 cm3. Sequential measurements of the utero-rectal space throughout CRT duration showed a real and durable increase in the distance between these organs, resulting in a drop in the dose of irradiation to recto-sigmoid. With 10 ± 4.5-month median follow-up, we did not observe any rectal or small bowel early or late adverse effects of CRT.


Although this series is preliminary, this simple procedure, feasible by laparoscopy (or laparotomy), seems effective to prevent recto-sigmoid as well as small bowel from radio-induced complications due to pelvic CRT.


Cervix cancer Radiation therapy Radioprotection Laparoscopic surgery 



There are no conflicts of interests to disclose.


  1. 1.
    Green J et al (2005) Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database Syst Rev 20(3):CD002225Google Scholar
  2. 2.
    Parker K et al (2009) Five years’ experience treating locally advanced cervical cancer with concurrent chemoradiotherapy and high-dose-rate brachytherapy: results from a single institution. Int J Radiat Oncol Biol Phys 74(1):140–146PubMedCrossRefGoogle Scholar
  3. 3.
    Chung YL et al (2005) Extended-field radiotherapy and high-dose-rate brachytherapy with concurrent and adjuvant cisplatin-based chemotherapy for locally advanced cervical cancer: a phase I/II study. Gynecol Oncol 97(1):126–135PubMedCrossRefGoogle Scholar
  4. 4.
    Tan LT, Zahra M (2008) Long-term survival and late toxicity after chemoradiotherapy for cervical cancer: the Addenbrooke’s experience. Clin Oncol 20(5):358–364CrossRefGoogle Scholar
  5. 5.
    Rose PG et al (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. New Engl J Med 340(15):1144–1153PubMedCrossRefGoogle Scholar
  6. 6.
    Pearcey R et al (2002) Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 20(4):966–972PubMedCrossRefGoogle Scholar
  7. 7.
    Morris M et al (1999) Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. New Engl J Med 340(15):1137–1143PubMedCrossRefGoogle Scholar
  8. 8.
    Potter R et al (2011) Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 100(1):116–123PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Leblanc E et al (2007) Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol Oncol 105(2):304–311PubMedCrossRefGoogle Scholar
  10. 10.
    Bifulco G et al (2008) Multiple bowel stenosis and perforation as long-term complications of chemoradiotherapy for advanced cervical cancer in a young woman: case report. Tumori 94(4):592–595PubMedGoogle Scholar
  11. 11.
    Hsieh CH et al (2009) Whole pelvic helical tomotherapy for locally advanced cervical cancer: technical implementation of IMRT with helical tomotherapy. Radiat Oncol 4:62PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Potter R et al (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 78(1):67–77PubMedCrossRefGoogle Scholar
  13. 13.
    Adli M et al (2003) Does prone positioning reduce small bowel dose in pelvic radiation with intensity-modulated radiotherapy for gynecologic cancer? Int J Radiat Oncol Biol Phys 57(1):230–238PubMedCrossRefGoogle Scholar
  14. 14.
    Huh SJ, Kang MK, Han Y (2004) Small bowel displacement system-assisted intensity-modulated radiotherapy for cervical cancer. Gynecol Oncol 93(2):400–406PubMedCrossRefGoogle Scholar
  15. 15.
    Niles B, Sugarbaker PH (1989) Use of the bladder as an abdominopelvic partition. Am Surg 55(9):533–535PubMedGoogle Scholar
  16. 16.
    Mazeron R et al (2013) Adaptive 3D image-guided brachytherapy: a strong argument in the debate on systematic radical hysterectomy for locally advanced cervical cancer. Oncologist 18(4):415–422PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Rodier JF et al (1991) Prevention of radiation enteritis by an absorbable polyglycolic acid mesh sling. A 60-case multicentric study. Cancer 68(12):2545–2549PubMedCrossRefGoogle Scholar
  18. 18.
    Tuech JJ et al (2004) Prevention of radiation enteritis by intrapelvic breast prosthesis. Eur J Surg Oncol 30(8):900–904PubMedCrossRefGoogle Scholar
  19. 19.
    Sugarbaker PH (1983) Intrapelvic prosthesis to prevent injury of the small intestine with high dosage pelvic irradiation. Surg Gynecol Obstet 157(3):269–271PubMedGoogle Scholar
  20. 20.
    Marnitz S et al (2012) Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation. Radiat Oncol 7(1):109PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Prada PJ et al (2007) Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 69(1):95–102PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • E. Leblanc
    • 1
  • F. Narducci
    • 1
  • L. Bresson
    • 1
  • J. Durand-Labrunie
    • 2
  • S. Taieb
    • 3
  • E. Vanlerenberghe
    • 1
  • I. Farre
    • 4
  • P. Nickers
    • 2
  1. 1.Department of Gynecologic OncologyCentre Oscar LambretLilleFrance
  2. 2.Department of Radiation TherapyCentre Oscar LambretLilleFrance
  3. 3.Department of ImagingCentre Oscar LambretLilleFrance
  4. 4.Department of PathologyCentre Oscar LambretLilleFrance

Personalised recommendations