Comparison of Survival Outcomes between Minimally Invasive Surgery and Open Radical Hysterectomy in Early-Stage Cervical Cancer.

OBJECTIVES: To compare the survival outcomes between minimally invasive surgery (MIS) and laparotomy radical hysterectomy in patients with early-stage cervical cancer. METHODS: We conducted a retrospective study involving women who received a radical hysterectomy for cervical cancer, stage IA1 with lymphovascular invasion, IA2, IB1, IB2, or IIA from 2008 to 2016. Clinicopathologic and perioperative outcomes were compared using appropriate statistical methodologies. RESULTS: Oncologic survival outcomes were analyzed using the Kaplan-Meier method. Among the 105 cases identified, 58 (55.2%) and 47 (44.8%) women underwent MIS and open radical hysterectomy, respectively. Over a median follow-up period of 62 months, women who underwent MIS and open radical hysterectomy had a 5-year overall survival rate of 87.9% and 89.4% (p = 0.845) and a 5-year disease-free survival rate of 82.5% and 86.7% (p = 0.624), respectively. CONCLUSIONS: For early-stage cervical cancer, patients who underwent MIS radical hysterectomy had survival outcomes that were comparable to those who underwent open surgery at our institute.

Primary peritoneal carcinosarcoma: A report of two cases.

OBJECTIVE: Carcinosarcomas also known as malignant mixed mullerian tumors (MMMTs) contain both carcinomatous and sarcomatous elements. Most MMMTs are arising from female genital tract, including ovaries, uterus and fallopian tubes. Extragenital carcinosarcomas are extremely rare, with an estimation less than 40 cases so far. CASE REPORT: We report two cases of primary peritoneal carcinosarcomas. An 81-year-old woman with pelvic peritoneal carcinosarcoma, heterologous type, was treated with incomplete surgery without further chemotherapy, and died of disease soon. The other one was a 76 year-old woman with abdominal peritoneal carcinosarcoma, homologous type. After optimal debulking surgery and subsequent 6 cycles of combination of paclitaxel and carboplatin chemotherapy, the patient is free of tumor half of year. CONCLUSION: Active therapy, including complete cytoreduction surgery and carboplatin-paclitaxel chemotherapy might offer a chance of disease control for these unusual primary peritoneal carcinosarcomas.

Uterine rupture secondary to placenta percreta in a near-term pregnant woman with a history of hysterotomy.

Uterine rupture during near-term pregnancy is a life-threatening condition. A 31-year-old pregnant woman with a breech presentation at the gestation age of 35(+2) weeks had complained of a dull abdominal pain for days. She was treated 2 years ago with bilateral uterine artery ligation and hysterotomy for removal of the retained placenta. An aggravation of abdominal pain occurred suddenly 4 h after hospitalization. The cardiotocogram showed a fetal heart beat with loss of variability, but increasing deceleration. An urgent cesarean section was performed because of suspected placenta abruption. After successful delivery of the fetus, a protruding placental tissue was found on the fundal uterine wall. We performed wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, an intramuscular injection of 0.2 mg methylergonovine, and primary repair of the defect, but in vain. Cesarean hysterectomy was used to control the intractable bleeding. The accumulated blood loss was more than 10,000 mL. The final pathology confirmed placenta percreta with uterine rupture. Luckily, both mother and fetus recovered well and were discharged 7 days later. We concluded that women with retained placenta and/or postpartum hemorrhage managed by previous hysterotomy and uterine artery ligation still need careful prenatal care, since the possibility of re-occurrence of the placenta percreta is easily overlooked and may result in a further life-threatening situation, such as the uterine rupture in this case.