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Complete Laparoscopic Type C2 Radical Surgery for Cervical Stump Cancer: No-Look and No-Touch Techniques

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Due to previous surgical history and subsequent adhesions between pelvic organs, surgery for cervical stump cancer (CSC) is technically more challenging than surgery for cervical cancer with an intact uterus.1 We aimed to illustrate the related anatomy, surgical steps and techniques of complete laparoscopic type C2 radical surgery (CLRS) for early-stage CSC.

Methods

CLRS for six patients with CSC was performed from January 2021 to January 2022. We demonstrated the detailed skills of parametrial management during CLRS for CSC in case 5 by means of a video. A 58-year-old woman diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIA1 CSC received CLRS through five operative ports (Fig. 1).

Results

The magnetic resonance imaging (MRI) scans and gross appearance of the specimen are shown in Fig. 2. The median age and body mass index (BMI) of the six patients were 53 years and 23.8, respectively. The median blood loss was 275 mL; the median time of operation was 218 min; the median length of hospitalization was 15 days; and the median time to recover urinary function was 12 days. One patient underwent postoperative radiation for pathologically proven adenocarcinoma with deep stromal invasion,2 while the other five did not. After a median follow-up of 24 months, no patients experienced complications, recurrence, or death (Table 1).

Conclusions

This study details the skills of CLRS for CSC, especially space development and the ‘no-look, no-touch’ tumor-free principle. It is helpful for clinicians to perform safe and standardized surgery on patients with early-stage CSC.

Trocar placement of complete laparoscopic type C2 radical surgery for early-stage CSC. CSC cervical stump cancer, S superior, I inferior, R right, L left, U umbilicus

MRI scans and gross appearance of the specimen for case 5 with CSC at FIGO 2018 stage IIA1. The tumor lesion on the cervical stump is indicated by yellow arrows. a Axial T2-weighted image; b DKI image; c ADC map; d sagittal T2-weighted image; e sagittal T1-weighted image; f gross appearance of the surgical specimen. MRI magnetic resonance imaging, CSC cervical stump cancer, FIGO International Federation of Gynecology and Obstetrics, DKI diffusional kurtosis imaging, ADC apparent diffusion coefficient

Table 1 Clinicopathological characteristics, operative details, and outcomes of patients with cervical stump cancer
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References

  1. Mendez LE, Penalver M, McCreath W, Bejarano P, Angioli R. Radical vaginal trachelectomy after supracervical hysterectomy. Gynecol Oncol. 2002;85(3):545–7. https://doi.org/10.1006/gyno.2002.6660.

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Funding

The study was supported by the Project of Maternal and Child Health of Jiangsu, China (grant/award number F202118) [CL]. The funders had no role in the design of the study; data collection, analysis, and interpretation; or preparation of the manuscript.

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Author notes

  1. Keyi Zhang, Yue Zhang and Huiyun Wu have contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Gynecology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China

    Keyi Zhang MM, Yue Zhang MM, Huiyun Wu MM, Shan Wu MM, Wenjun Cheng MD & Chengyan Luo MD

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  1. Keyi Zhang MM
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  2. Yue Zhang MM
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  3. Huiyun Wu MM
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  4. Shan Wu MM
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Corresponding author

Correspondence to Chengyan Luo MD.

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Disclosure

Keyi Zhang, Yue Zhang, Huiyun Wu, Shan Wu, Wenjun Cheng, and Chengyan Luo declare they have no conflicts of interest in relation to this study.

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki (revised 2013). Informed consent was obtained from patients prior to the utilization of clinical data, surgery video, and images in this study.

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Zhang, K., Zhang, Y., Wu, H. et al. Complete Laparoscopic Type C2 Radical Surgery for Cervical Stump Cancer: No-Look and No-Touch Techniques. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15380-z

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