The Study Of Systematic Review And Feasibility Analysis In The Laterally Extended Parametrectomy In The Treatment Of Cervical Cancer

Radical hysterectomy (RH) was the standard surgical treatment for early stage cervical cancer. Radical hysterectomy cannot removed all lymph nodes to the true pelvic side wall and the effect not satisfactory in locally advanced cervical cancer. Lymph node metastasis is an important factor to the prognosis of cervical cancer, local recurrence was the main cause of treatment failure. Therefore, some gynecologists proposed laterally extended parametrectomy (LEP), aimed at improving the local control in pelvic and survival of locally advanced cervical cancer.This paper is divided into two parts:(1). Safety and efficacy of laterally extended parametrectomy in the treatment of cervical cancer:a systematic review.(2). Laterally extended parametrectomy (LEP) in the treatment of cervical cancer:technique and feasibility analysis. Objective:To evaluate the efficacy and safety of surgery laterally extended parametrectomy in treatment of cervical cancer.Methods:Searching literatures had been published related with the laterally extended parametrectomy in the treatment of cervical cancer at home and abroad, the safety of surgery and the clinical value were discussed.Results:3literatures including563cases met the inclusion criteria. The most common complications related with operation were blood lost, ureter stricture、postoperative bleeding and lymphedema.Conclusions:Laterally extended parametrectomy is safe and feasible for patients with cervical cancer, It providing an alternative choice of surgical approach to cervical cancer. As the current researches are mainly with small-sized samples and retrospective, outcomes reported by only one center. Therefore, the above conclusions not yet been confirmed, more high-quality and large-scale prospective randomized controlled trials are needed to demonstrate this conclusion. Objective To study the feasibility of laterally extended parametrectomy technique and its effect on removing the lymphatic connective tissue in pelvic side wall.Method From November2012to March2014,13cases in our hospital FIGO stage ⅠB-ⅡB cervical cancer patients accept surgical treatment laterally extended parametrectomy on the basis of Wertheim radical hysterectomy, analysis the operative time, blood loss, short-term postoperative complications and postoperative recovery.Results13patients were successfully completed the LEP procedure, the mean operation time was321.5(180-485) min, mean intraoperative bleeding was738.5(300-1500) ml, red blood cell transfusion was need in9cases, the average blood transfusion3.0(2-6) U; the first exhaust time was2.5(2-5) d, and the first stool time was3.7(2-6) d, the duration of postoperative hospital stay was22.0(14-32)d.Conclusion LEP surgical procedure technical was feasible and safe, with an acceptable risk of complications, removing all the lymphatic tissue from the pelvic side wall.This procedure removes parametrial tissue not removed by conventional class Ⅲ-Ⅳ Wertheim hysterectomy by extending the lateral limits of the dissection to the true boundaries of the pelvic side wall rather than the medial surface of the internal iliac vessels. The extensive surgical procedure can be an alternative choice for pelvic lymph node metastasis in early stay patients or locally advanced cervical.