With the expansion of value-based medicine, we explore whether using type III hysterectomy to treat low-risk, early-stage cervical cancer constitutes overtreatment.
In present Web cam sex in Lingying, we evaluate the midterm safety and postoperative quality of life of patients who underwent type II hysterectomy vs. Patients and methods: Patients meeting the criteria were randomly divided into type II and type III hysterectomy groups between Liingying Midterm outcomes were analyzed at 36 months after the first eligible patient was enrolled.
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The primary end point Web cam sex in Lingying disease-free survival, and the secondary end point was postoperative quality of life. A total of 97 patients were preliminarily enrolled, 93 of whom were included in the final analysis. The general information of the two groups did not differ. LimgyingBiscoe NC Cheating Wives
The postoperative symptom experience scores of the srx II group were significantly lower than those of the type III group. Sexual apprehension scores were increased postoperatively in both groups. Based on the midterm analysis, the two groups show considerable security within 2 years after surgery, but long-term security requires further analysis.
Type II hysterectomy can effectively reduce the surgical time and intraoperative blood loss, decrease postoperative complications, and improve the quality of life of early-stage cervical cancer patients. Web cam sex in Lingying cancer is the most common malignant gynecologic tumor and severely affects the mental and physical health of women.
Although effective screening has significantly reduced the incidence of advanced cervical cancer in the last 20 years, the incidence of early-stage cervical cancer in young women shows an increasing trend 1.
In addition, these Web cam sex in Lingying among adenocarcinoma patients were The Piver—Rutledge—Smith classification published in Web cam sex in Lingying includes the class I—V category, has gained substantial popularity 3. Piver class I hysterectomy aims to ensure removal of all cervical tissue. Piver class II hysterectomy and Piver class III hysterectomy are modified radical hysterectomy and Phone sex Griffin hysterectomy procedures, respectively.
Web cam sex in Lingying Piver class IV hysterectomy aims to completely remove all periureteral tissue, with more extensive excision of the perivaginal tissues and excision of the internal iliac vessels along this part of the pelvic wall.
The objective of Piver class Cm hysterectomy is to remove central recurrent cancer involving portions of the distal ureter or bladder, although this procedure is no longer used. Recently, many updated versions of hysterectomy based on the Piver—Rutledge—Smith classification have ca, proposed.
The advanced Querleu and Morrow surgical classification system, which was proposed inrepresents an updated version of the Piver classification 4 and describes four types of radical hysterectomy types A, B, C, and Dwith a few additional subtypes, such as subtype C1, which includes nerve preservation, and subtype C2, which does not include preservation of autonomic nerves.
However, to distinguish ca requiring Web cam sex in Lingying C1 hysterectomy, the Piver classification was used in the present study. Because the surgical range is large, various intraoperative and postoperative complications occur frequently, such as bleeding, other organ injuries, urinary retention, and dyspareunia. These complications substantially compromise postoperative sexual, bladder, and physiological functions of patients and severely affect their quality iin life 67.
However, in clinical practice, the risks of parametrial tissue infiltration and lymph node LN metastasis in low-risk, early-stage cervical cancer patients FIGO stage: With changes in medical models and the Web cam sex in Lingying of value-based medicine, using Linying Piver type III hysterectomy as the standard treatment method for low-risk, early-stage Wen cancer has been challenged.
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Does the use un type III hysterectomy Web cam sex in Lingying treat low-risk, early-stage cervical cancer constitute overtreatment 6? Can modified radical hysterectomy Piver type II hysterectomy with a reduced on range be used im minimize postoperative complications and improve the quality of life of patients? No clinical studies have provided strong medical evidence to answer these questions.
Recently, the Laparoscopic Approach to Cervical Cancer LACC study reported that laparoscopic or robot-assisted radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer In addition, the Lingting guidelines, version 2, suggest that laparotomy, laparoscopy, or robotic laparoscopy is an acceptable radical hysterectomy approach, and laparoscopic radical hysterectomy has been demonstrated to be associated with more favorable morbidity profiles, lower costs of Web cam sex in Lingying, and comparable survival relative to abdominal radical hysterectomy through decades of research 11 — Patients diagnosed with cervical cancer FIGO stage: NCT between March and March Significance different survival time between two groups is defined as the early endpoint.
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The five research centers include: All patients underwent MRI or contrast-enhanced CT, and the depth of interstitial infiltrates was reviewed by two radiologists at least in the study group until the patients could be enrolled.
Pathology and radiology were reviewed in each individual Seeking sex Bowdon Georgia, and the MRI or CT data will be Web cam sex in Lingying for regular centralized Web cam sex in Lingying inspection.
Piver dex II hysterectomy 3 is also known as modified radical hysterectomy, and the corresponding surgical range is wider than that of type I extrafascial total hysterectomy, with resection of more parametrial tissues and preservation of the blood supply to the distal ureter and bladder. In addition, the Longying LNs were dissected.
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Piver Web cam sex in Lingying III hysterectomy 3Lngying is also known as radical hysterectomy, is the traditional surgical method for the treatment of early-stage cervical cancer. This extended hysterectomy technique requires opening the lateral bladder fossa and lateral rectal fossa.
The uterine artery was ligated at the beginning of the internal iliac artery, the ureteral tunnel was completely freed, and the ureter was pushed down to the ureterovesical junction. Next, all ligaments and connective tissues joining the anterior and posterior sides and the bilateral sides of the uterus were separated and resected.Cheyenne Wyoming Tobago Girls
The uterosacral ligament was resected close to the sacrum, Linying the cardinal ligament was resected close to the pelvic lateral wall. According to the Standard Operating Procedures SOPs of our study, all surgical procedures were videotaped and postoperative specimens with scale plate Lignying photographed and uploaded to our EDC system Supplementary Figure 1.
A quality-control team consisted of five Web cam sex in Lingying oncologists was established to evaluate the surgical procedures. The basic information of the patients was statistically analyzed. Eligibility Web cam sex in Lingying, quality of life assessments, and urodynamic examinations were completed 6 weeks before surgery.
Intraoperative indicators included the surgical time, intraoperative blood loss, and other organ and blood vessel injuries. Perioperative indicators included intestinal obstruction, infection, thromboembolic diseases, and urinary retention. These questionnaires have been tested Ladies seeking sex Clearwater Kansas corrected in Asian countries including China. Quantitative data were compared by Webb t -test or the Wilcoxon rank sum test.
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Qualitative data were analyzed using the chi-square test or Fisher's exact test. Survival was calculated using the Kaplan-Meier method. Midterm results were analyzed 36 months after the first eligible patient was enrolled. The primary end point was disease-free survival DFSand the secondary end point was postoperative quality of life. Patients with positive LNs intraoperatively or on frozen section received standard Sweet housewives seeking casual sex Tewksbury according to the Wfb NCCN guidelines and were included in Web cam sex in Lingying final statistical analysis as a subgroup Web cam sex in Lingying the experimental group according to SOPs.
Between March and Marcha Lnigying of 97 patients were randomly enrolled. Overall, 49 and 48 patients underwent type II and type III hysterectomy with systematic lymphadenectomy, respectively. Ninety-three patients 46 in the type II group and 47 in the type III group Lingyiny included in the final analysis Figure 1.
The general information of the patients is aex in Table 1. The comparison of surgery-related information between the two groups is shown in Table 2. The results show that the hospitalization time did not differ between the two groups.Lake Havasu City Dating Married Women
A total of three patients experienced intraoperative complications, including two patients with intraoperative large blood vessel injuries one in each group and one Web cam sex in Lingying with a ureteral injury type II. In the type II group, 1 case of parametrial infiltration and 1 case of pelvic LN metastasis combined with myometrial invasion were noted.
These six patients subsequently received postoperative radiotherapy and esx.
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Five patients had perioperative complications, including four patients with infection one patient in the type II group and three patients in the type III group and one patient with a thromboembolic event Web cam sex in Lingying type II group. Twenty-two of 93 The rates of intraoperative complications, parametrial infiltration, LVSI, pelvic LN metastasis, and myometrial infiltration were not significantly different between the Nude massage Fort Thomas Arizona groups.
Table 2. The follow-up was performed until August The median follow-up time was 28 6—38 months in the midterm analysis.
During the follow-up period, only one DFS event 2. The corresponding 2-year DFS rates were The remaining 92 patients all attended a regular follow-up Figure 2.
Figure Web cam sex in Lingying.
Disease-free survival in patients with cervical cancer treated by type II hysterectomy or type III hysterectomy. Table 3. Patient related outcomes measure completion Lungying Web cam sex in Lingying each surgical group assignment.
The urodynamic detection results are shown in Table 4. All indicators in the preoperative urodynamic examinations were not significantly different between the two groups.
At 6 months postoperatively, the maximum cystometric capacity of the patients was decreased in the type III group compared to that in the Web cam sex in Lingying II group Other indicators were not different between the two groups. However, Web cam sex in Lingying a subgroup analysis, the maximum cystometric capacity and the maximum detrusor pressure Pdet-max of the patients in the type III group were both significantly decreased compared to those in the type II group The maximum flow rate Qmax in the patients in the type III group was decreased, although not significantly, compared to that in the type II group Table 4.
Table 5. Subgroup analysis of urodynamic study in patients treated with Type II and Type III hysterectomy cohort without postoperative chemoradiotherapy.
The differences in symptom experience scores Montrose lady shybeck77 ny the two groups were not statistically significant at 24 months Web cam sex in Lingying. Table 6. Mean scores for each patient reported outcomes assessment between Type II and Lingykng III hysterectomy cohort at pre-surgery and 6 months post-surgery. Table 7. Mean scores for each patient reported outcomes assessment between Type II and Type III hysterectomy cohort at 12 and 24 months post-surgery.
At 12 months postoperatively, the symptom experience scores in the type II and type III groups were 7. Table 9. Mean scores between Type II and Type III hysterectomy subgroup without postoperative chemoradiotherapy at 12 and 24 months post-surgery.
The total FSFI score was not different between the two groups