Improve The Quality Of Life Of Cervical Cancer Surgery, Clinical And Evidence-based Medical Research

THE IMPACT ON PROGNOSIS AND QUALITY OF LIFE OF LAPAROSCOPIC RADICAL HYSTERECTOMY WITH PELVIC LYMPHADENECTOMY IN TREATMENT EARLY CERVICAL CANCEROBJECTIVE:To evaluate the clinical effect of laparoscopic-assisted radical hysterectomy (LARH) and pelvic lymphadenectomy in management of early invasive cervical carcinomaMETHODS:Retrospective the consecutive cases with FIGO Ib-IIa cervical cancer from February 2002 to December 2008 were documented, including 31 patients underwent LRH+LPL, and 85 patients underwent ARH+APL as control group. The clinic data of perioperative periods,survival rate and quality of life were compared between groups.RESULTS:All laparoscopic procedures were completed successfully except 2 cases converted to laparotomy. In laparoscopy group the operating time increased significantly (260.07±76.67min VS 215.33±51.12min P=0.007), and the recovery time of bowel decreased significantly (42.88±18.66h VS 68.99±66.7h P=0.0001). No significant difference was found between groups on the blood loss during operation and numbers of the pelvic lymph nodes resected.The median follow-up was 42 months (range 6 to 84 months). Three and ten cases lost to follow-up in laparoscopy and laparotomy group, respectively. The recurrence rate (24.86% VS 21.55%,P>0.05) and the mortality rate (10.34% VS 11.58%, P>0.05) between groups was similar.There was no significant difference between groups in the five-year overall survival rate and the 5-year disease free survival rate.The quality of life between groups was similar. CONCLUSION:Our data demonstrated that cervical cancer could be treated successfully with LRH+LPL with similar clinical effect to ARH+APL. LRH+LPL is a safe and effective alternative to conventional abdominal surgery for stage Ib-IIa cervical cancer, and should be used if the surgeon is sufficiently trained. Its clinical value should be confirmed by multicenter randomized clinic trials. THE IMPACT ON PROGNOSIS AND QUALITY OF LIFE OF LAPAROSCOPIC RADICAL HYSTERECTOMY WITH PELVIC LYMPHADENECTOMY IN TREATMENT EARLY CERVICAL CANCER:A META ANALYSISOBJECTIVE:To evaluate the clinical effects of laparoscopic-assisted radical hysterectomy(LARH) and pelvic lymphadenectomy(LPL) METHODS:The following electronic databases were searched:CBMdisc,Medline,Pubmed,EMBASE,Cochrane Library.All eligible documents were assessed for quality.All data were performed by a Meta-analysis. RESULTS:There were 8 documents met the inclusion criteria. There were no RCTS,three prospective non-randomized controlled trials and five retrospective case-control studies. Comparing to ARH+APL, LARH+LPL has several advantages.Such as decreasing the recovery time of bowel, the blood loss during operation, postoperative hospital stays and complications of postoperation. But the recurrence rate and complications of intraoperation between LARH+LPL and ARH+APL was similar. CONCLUSION:LRH+LPL is a safe and effective alternative to conventional abdominal surgery for stage Ib-Ⅱa cervical cancer.Beause the quality of all the included documents are low, the conclusion is needed to further assessed by rigorously designeds, randomed, double-blind,controlled trialsTHE CLINICAL EFFECT OF RADICAL TRACHELECTOMY IN TREATMENT EARLY SATAGE CERVICAL CARCINOMAOBJECTIVE:To investigate the feassibility and effect of radical trachelectomy in treating women with early cervical cancer who desired to maintain fertility. METHODS: Retrospective The consecutive cases with early stage cervical cancer from December 2002 to February 2009 were documented, including 10 patients underwent radical trachelectomy.Subjects were selected for this treatment on the basis of favorable cervical tumors and a desire to maintain fertility. RESULTS:9 women underwent this procedure successfully. One patients converted to radical hysterectomy,because lymph nodes are positive.Mean age was 30years(range 25 to 38 years),Mean operative time was 200 mins(range 150 to365 mins), with a mean blood loss of 330 ml(range 250 to 800 ml). There were one intra-operative and one post-operative complication. With an average following up of 24 months(range 2 to 84 months), there have been no recurrences and no deaths. One woman has becomed pregnant with the help of artificial fertilization CONCLUSIONS: Radical trachelectomy is possible to preserve fertility in the treatment of patients with early cervical cancer, but treatment indication should be considered carefully.THE CLINICAL EFFECT OF RADICAL TRACHELECTOMY IN TREATMENT EARLY SATAGE CERVICAL CARCINOMA: A SYSTEMATIC REVIEWOBJECTIVE:To evaluate the feassibility and effect of radical trachelectomy in treating women with early cervical cancer who desired to maintain fertility. METHODS:The following electronic databases were searched:CBMdis,Medline,Pubmed,EMBASE,Cochrane Library. RESULTS:There were 19 documents met the inclusion criteria.The recurrence rate was 0%-9.8%,the mean recurrence rate was 4.7%. The death rate was 0%-4.2%, the mean death rate was 1%. The pregnancy rate was 46.1%,while 40.6% of these pregnancies were lost during the first and second trimesters. The rate of first trimester loss was60.6%, while second trimester loss was 39.4%. Furthermore, overall preterm deliveries (<37 weeks) occurred in 21% of these pregnancies. CONCLUSIONS:Radical trachelectomy appears safe when performed by sufficient surgery.lt can satisfy the patients' needs to preserve the fertility. The conclusion is needed to further assessed by rigorously designeds, randomed, double-blind,controlled trialsTHE IMPACT ON PROGNOSIS AND LIFE QUALITY ALL KINDS OF TREATMENTS IN TREATING CERVICAL CANCER (STAGEⅡB)OBJECTIVE:To investigate the clinical effect of all kinds of treatments treated for FIGO stageⅡb cervical cancer.METHODS:Retrospective The consecutive 158 cases with FIGO stageⅡb cervical cancer from Janurarye 2000 to December 2007were documented, including 33patients underwent exclusive radiotherapy,28patients underwent concurrent chemoradiation,28 patients underwent neoadjuvant chemotherapy (NACT) and radical surgery(RS),24 patients underwent neoadjuvant concurrent chemoradiation and radical surgery,45 patients underwent neoadjuvant chemotherapy or neoadjuvant concurrent chemoradiation and radical surgery and adjuvant chemoradiation. The 5-year over-all survival rate,5-year disease free survival rate and quality of life were compared among groups.RESULTS:There was significant difference among groups in the five-year overall survival rate,the 5-year disease free survival rate and quality of life. The overall 5-year survival rate of neoadjuvant chemotherapy or neoadjuvant concurrent chemoradiation and radical surgery and adjuvant chemoradiation group is the lowest.The quality of life of both exclusive radiotherapy and concurrent chemoradiation groups are the lowest.CONCLUSIONS:Neoadjuvant chemotherapy (NACT) and radical surgery(RS) could be useded to treat the FIGO stageⅡb cervical cancer.Although it didn't improve the survival rate,yet it improved the quality of life. NEOADJUVANT CHEMOTHERAPY AND RADICAL SURGERY TREATMENT THE LOCALLY ADVANCED CANCER:A MATA ANALYSISOBJECTIVE:To evaluate the clinical effects of neoadjuvant chemotherapy (NACT) and radical surgery(RS) in locally advanced cervical cancer METHODS:The following electronic databases were searched:CBMdisc,Medline,Pubmed,EMBASE,Cochrane Library.All eligible documents were assessed for quality.All data were performed by a Meta-analysis.Neoadjuvant chemotherapy (NACT) and radical surgery(RS) didn't increase the 5-year survival rate,but increased the 5-year disease-free survival rate and decreased lymph node metastasis and parameter metastasis. CONCLUSION:Neoadjuvant chemotherapy (NACT) and radical surgery could be chosen to treat the locally advanced cervical cancer.It increased the 5-year disease-free survival rate and decreased lymph node metastasis and parameter metastasis. But the conclusion is needed to further assessed by rigorously designeds, randomed, double-blind,controlled trials.