Extraperitoneal versus transperitoneal selective paraaortic lymphadenectomy in the pretreatment surgical staging of advanced cervical carcinoma (A Gynecologic Oncology Group study)
Identifieur interne : 00DF40 ( Main/Exploration ); précédent : 00DF39; suivant : 00DF41Extraperitoneal versus transperitoneal selective paraaortic lymphadenectomy in the pretreatment surgical staging of advanced cervical carcinoma (A Gynecologic Oncology Group study)
Auteurs : Edward B. Weiser [États-Unis] ; Brian N. Bundy [États-Unis] ; William J. Hoskins [États-Unis] ; Paul B. Heller [États-Unis] ; Richard R. Whittington [États-Unis] ; Philip J. Disaia [États-Unis] ; Stephen L. Curry [États-Unis] ; John Schlaerth [États-Unis] ; J. Tate Thigpen [États-Unis]Source :
- Gynecologic Oncology [ 0090-8258 ] ; 1989.
Abstract
Two-hundred and eighty-eight patients with predominately stage IIB or IIIB cervical carcinoma underwent pretreatment surgical staging including selective paraaortic lymphadenectomy (SPAL), followed by pelvic irradiation with or without paraaortic irradiation (RT). Four patients were excluded from analysis (two received no RT and two were insufficiently documented). Of the remaining 284 patients, 128 underwent extraperitoneal (EP) SPAL and 156 transperitoneal (TP) SPAL procedures. Age, race, and stage (clinical and surgical), cell type, paraaortic nodal status, and peritoneal cytology findings were similar in both groups. Complications presumed to arise from operative staging were infection, which was similar for both groups, and vascular injury, which was higher in the TP group, although not statistically significant. Complications subsequent to RT fell into two categories: local—pelvic necrosis, vesicovaginal and rectovaginal fistulas, proctitis, etc., and regional—enterovaginal fistula, bowel obstruction, enteritis, bowel perforation, etc. The frequency of local complications was similar for both EP and TP patients. Utilizing univariant analysis, among regional complications, both bowel obstruction and nonobstructive enteric injuries were observed significantly more often in TP patients than in EP patients (11.5% vs 3.9%, P = 0.03, for both types). Multivariant analysis confirmed these observations. This report supports the conclusions that in advanced cervical carcinoma (1) EP- and TP-SPAL are of similar sensitivity in detecting nodal spread, (2) no significant differences in the frequency of surgical complications could be detected between EP- and TP-SPAL groups, and (3) TP-SPAL is associated with a higher frequency of certain postirradiation regional enteric complications.
Url:
DOI: 10.1016/0090-8258(89)90513-1
Affiliations:
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Weiser</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gynecologic Oncology Division, Obstetrics and Gynecology Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Bundy, Brian N" sort="Bundy, Brian N" uniqKey="Bundy B" first="Brian N." last="Bundy">Brian N. Bundy</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gynecologic Oncology Group, Roswell Park Memorial Institute, Buffalo, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Hoskins, William J" sort="Hoskins, William J" uniqKey="Hoskins W" first="William J." last="Hoskins">William J. Hoskins</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Heller, Paul B" sort="Heller, Paul B" uniqKey="Heller P" first="Paul B." last="Heller">Paul B. Heller</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gynecologic Oncology Division, Obstetrics and Gynecology Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Whittington, Richard R" sort="Whittington, Richard R" uniqKey="Whittington R" first="Richard R." last="Whittington">Richard R. Whittington</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Radiation Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author><author><name sortKey="Disaia, Philip J" sort="Disaia, Philip J" uniqKey="Disaia P" first="Philip J." last="Disaia">Philip J. Disaia</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Obstetrics and Gynecology, Irvine Cancer Center, Orange, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Curry, Stephen L" sort="Curry, Stephen L" uniqKey="Curry S" first="Stephen L." last="Curry">Stephen L. Curry</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Obstetrics and Gynecology, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Schlaerth, John" sort="Schlaerth, John" uniqKey="Schlaerth J" first="John" last="Schlaerth">John Schlaerth</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Women's Hospital, LA/USC Medical Center, Los Angeles, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Thigpen, J Tate" sort="Thigpen, J Tate" uniqKey="Thigpen J" first="J. Tate" last="Thigpen">J. Tate Thigpen</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Medical Oncology, Departments of Medicine and Obstetrics and Gynecology, University of Mississippi School of Medicine, Jackson, Mississippi</wicri:regionArea><placeName><region type="state">État du Mississippi</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="ISSN">0090-8258</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1989">1989</date><biblScope unit="volume">33</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="283">283</biblScope><biblScope unit="page" to="289">289</biblScope></imprint><idno type="ISSN">0090-8258</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0090-8258</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Two-hundred and eighty-eight patients with predominately stage IIB or IIIB cervical carcinoma underwent pretreatment surgical staging including selective paraaortic lymphadenectomy (SPAL), followed by pelvic irradiation with or without paraaortic irradiation (RT). Four patients were excluded from analysis (two received no RT and two were insufficiently documented). Of the remaining 284 patients, 128 underwent extraperitoneal (EP) SPAL and 156 transperitoneal (TP) SPAL procedures. Age, race, and stage (clinical and surgical), cell type, paraaortic nodal status, and peritoneal cytology findings were similar in both groups. Complications presumed to arise from operative staging were infection, which was similar for both groups, and vascular injury, which was higher in the TP group, although not statistically significant. Complications subsequent to RT fell into two categories: local—pelvic necrosis, vesicovaginal and rectovaginal fistulas, proctitis, etc., and regional—enterovaginal fistula, bowel obstruction, enteritis, bowel perforation, etc. The frequency of local complications was similar for both EP and TP patients. Utilizing univariant analysis, among regional complications, both bowel obstruction and nonobstructive enteric injuries were observed significantly more often in TP patients than in EP patients (11.5% vs 3.9%, P = 0.03, for both types). Multivariant analysis confirmed these observations. This report supports the conclusions that in advanced cervical carcinoma (1) EP- and TP-SPAL are of similar sensitivity in detecting nodal spread, (2) no significant differences in the frequency of surgical complications could be detected between EP- and TP-SPAL groups, and (3) TP-SPAL is associated with a higher frequency of certain postirradiation regional enteric complications.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li><li>Maryland</li><li>Massachusetts</li><li>Pennsylvanie</li><li>État de New York</li><li>État du Mississippi</li></region></list><tree><country name="États-Unis"><region name="Maryland"><name sortKey="Weiser, Edward B" sort="Weiser, Edward B" uniqKey="Weiser E" first="Edward B." last="Weiser">Edward B. Weiser</name></region><name sortKey="Bundy, Brian N" sort="Bundy, Brian N" uniqKey="Bundy B" first="Brian N." last="Bundy">Brian N. Bundy</name><name sortKey="Curry, Stephen L" sort="Curry, Stephen L" uniqKey="Curry S" first="Stephen L." last="Curry">Stephen L. Curry</name><name sortKey="Disaia, Philip J" sort="Disaia, Philip J" uniqKey="Disaia P" first="Philip J." last="Disaia">Philip J. Disaia</name><name sortKey="Heller, Paul B" sort="Heller, Paul B" uniqKey="Heller P" first="Paul B." last="Heller">Paul B. Heller</name><name sortKey="Hoskins, William J" sort="Hoskins, William J" uniqKey="Hoskins W" first="William J." last="Hoskins">William J. Hoskins</name><name sortKey="Schlaerth, John" sort="Schlaerth, John" uniqKey="Schlaerth J" first="John" last="Schlaerth">John Schlaerth</name><name sortKey="Thigpen, J Tate" sort="Thigpen, J Tate" uniqKey="Thigpen J" first="J. Tate" last="Thigpen">J. Tate Thigpen</name><name sortKey="Whittington, Richard R" sort="Whittington, Richard R" uniqKey="Whittington R" first="Richard R." last="Whittington">Richard R. Whittington</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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