2018 Volume 34 Issue 1 Pages 143-147
OBJECTIVE: The National Comprehensive Cancer Network guidelines recommend that in patients presenting with an incidental finding of an invasive cancer (The International Federation of Gynecology and Obstetrics stage IA2-IIA) during a simple hysterectomy, the management strategy includes observation, radiation and/or concurrent chemoradiation therapy, or a radical parametrectomy (RP). However, an RP procedure is difficult to perform; therefore, it is not widely used in Japan. We report a patient who underwent laparoscopic RP (LRP) to treat stage IB1 cervical cancer after a simple vaginal hysterectomy, and we additionally present a literature review.
METHODS: Case report.
RESULTS: A 66-year-old woman, diagnosed with CIN3, was treated with a simple total vaginal hysterectomy. Histopathological findings revealed cervical cancer stage IB1 (squamous cell carcinoma, nonkeratinizing type, measuring 7 mm each in diameter and depth, with a negative surgical margin). All investigative tests were negative for residual tumor or metastasis. After the treatment options were explained to her, she opted for RP, and we performed LRP on the 58th day after her first operation. Intraoperatively, the tumor demonstrated fibrous adhesions with the vesicouterine ligament. The operation time was 5.5 hours, estimated blood loss was 173 mL, and 45 pelvic lymph nodes were removed. Because she showed no histopathological evidence of malignant cells in the studied specimens, we decided to follow her up as an outpatient. No recurrence has been observed for 15 months since the LRP.
CONCLUSION: Reportedly, performing RP is considered a difficult procedure due to adhesions resulting from prior surgery. However, recent reports indicate that RP can be safely and effectively performed. We conclude that this operation might serve as an alternative treatment strategy for the management of Japanese patients showing this presentation.
