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Marc Possover

Publications and source records attributed to Marc Possover.

11 recordsLinked to original sources
PubMed2006

Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: prospective multicenter study of 100 patients with early cervical cancer.

OBJECTIVE: The aim of this prospective clinical multicenter study "Uterus 6" of the German Association of Gynecologic Oncologists (AGO) was to prove the recurrence rate of patients treated with pelvic lymphadenectomy and radical vaginal trachelectomy (RVT). We also wanted to prove the surgical safety of RVT. METHODS: Between March 1995 and November 2005, we intend to treat 108 patients with cervical cancer (TNM stage 1A1, L1 n = 18, 1A2 n = 21, 1B1 n = 69) by RVT. Eight patients were excluded since the study criteria were not met after RVT (tumor size >2 cm, neuroendocrine tumor type, tumor-involved resection margins, or positive pelvic lymph nodes). Thus, 100 patients were treated by RVT according to protocol. With 4 recurrences in a sample size of 100 patients, an upper limit of the 95% confidence interval (including continuity correction) of 10.5% was calculated. Recruitment had to be stopped if five or more recurrences occurred. RESULTS: The median follow-up time was 29 (1-128) months. Three (3%) recurrences occurred in 100 patients treated with RVT according to protocol. Thus, the upper confidence limit was 9.2%. The projected 5-year recurrence-free and overall survival rates were 97% and 98%. The average duration of surgery was 253 (115-402) min. Perioperative complications were: postoperative bleeding, embolism of the external iliac artery, retroperitoneal lymphocele, or paralytic ileus in one patient, respectively. CONCLUSIONS: RVT combined with laparoscopic pelvic and parametric lymphadenectomy for treatment of patients with early stage cervical cancer < or =2 cm results in a recurrence-free survival of more than 90.8%.

Adult↗
PubMed2005

The LANN technique to reduce postoperative functional morbidity in laparoscopic radical pelvic surgery.

BACKGROUND: We investigated the feasibility and advantages of introducing Laparoscopic Neuro-Navigation (LANN) into the field of laparoscopic gynecologic radical pelvic surgery. STUDY DESIGN: In a prospective pilot study, 261 consecutive patients underwent laparoscopic radical pelvic surgery for cervical cancer or deep infiltrating endometriosis of the parametria. During the procedure, dissection and electrostimulation, and consequently, sparing of the pelvic parasympathetic nerves by transection of the parametria, were performed. Postoperative bladder dysfunction was documented. RESULTS: Laparoscopic dissection and electrostimulation of the pelvic splanchnic nerves were feasible in all patients without any complications, and the rate of postoperative bladder dysfunction was considerably reduced, to less than 1% of the patients. CONCLUSIONS: The parasympathetic nerve-sparing method using the Laparoscopic Neuro-Navigation technique in laparoscopic radical pelvic gynecologic surgery is a feasible and reproducible technique that preserves postoperative bladder function.

Adult↗
PubMed2004

Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies.

OBJECTIVE: Lymphadenectomy is an integral part of staging and treatment of gynecologic malignancies. We evaluated the feasibility and oncologic value of laparoscopic transperitoneal pelvic and paraaortic lymphadenectomy in correlation to complication rate and body mass index. METHODS: Between August 1994 and September 2003, pelvic and/or paraaortic transperitoneal laparoscopic lymphadenectomy was performed in 650 patients at the Department of Gynecology of the Friedrich-Schiller University of Jena. Retrospective and prospective data collection and evaluation of videotapes were possible in 606 patients. Laparoscopic lymphadenectomy was part of the following surgical procedures: staging laparoscopy in patients with advanced cervical cancer (n = 133) or early ovarian cancer (n = 44), trachelectomy in patients with early cervical cancer (n = 42), laparoscopic-assisted radical vaginal hysterectomy in patients with cervical cancer (n = 221), laparoscopy before exenteration in patients with pelvic recurrence (n = 20), laparoscopic-assisted vaginal hysterectomy or laparoscopic-assisted radical vaginal hysterectomy in patients with endometrial cancer (n = 112), and operative procedures for other indications (n = 34). RESULTS: After a learning period of approximately 20 procedures, a constant number of pelvic lymph nodes (16.9-21.9) was removed over the years. Pelvic lymphadenectomy took 28 min, and parametric lymphadenectomy took 18 min for each side. The number of removed paraaortic lymph nodes increased continuously over the years from 5.5 to 18.5. Right-sided paraaortic, left-sided inframesenteric and left-sided infrarenal lymphadenectomy took an average of 36, 28, and 62 min, respectively. The number of removed lymph nodes was independent from the body mass index of the patient. Duration of pelvic lymphadenectomy was independent of body mass index, but right-sided paraaortic lymphadenectomy lasted significantly longer in obese women (35 vs. 41 min, P = 0,011). The overall complication rate was 8.7% with 2.9% intraoperative (vessel or bowel injury) and 5.8% postoperative complications. No major intraoperative complication was encountered during the last 5 years of the study. CONCLUSION: By transperitoneal laparoscopic lymphadenectomy, an adequate number of lymph nodes can be removed in an adequate time and independent from body mass index. The complication rate is low and can be minimized by standardization of the procedure.

Adolescent↗
PubMed2003

Technical modification of the nerve-sparing laparoscopy-assisted vaginal radical hysterectomy type 3 for better reproducibility of this procedure.

OBJECTIVE: The goal of this work is to make the technique of nerve-sparing laparoscopy-assisted vaginal radical hysterectomy (LAVRH) type 3 easier and less time consuming. METHODS: Compared with the original LAVRH type 3, laparoscopic preparation of the cardinal ligament is extended to the transection of the upper part of the rectovaginal ligament. In vaginal approach, the preparation begins not as originally with the bladder pillar and ureter, but with transection of the rest of the rectovaginal ligament followed by dorsal eversion of the uterus and, lastly, transection of the bladder pillar with preparation of the ureters. RESULTS: Thirty-two consecutive patients underwent the modified nerve-sparing LAVRH type 3. The mean operative time for the vaginal part of the procedure was 54.3 min, whereas for the original technique for LAVRH type 3, the mean operative time was 143.6 min. CONCLUSION: Prior transection of the rectovaginal ligament in the vaginal approach with dorsal eversion of the uterine fundus makes preparation of the ureter and transection of the bladder pillar easier and significantly less time consuming than in the original LAVRH type 3.

Female↗
PubMed2003

Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer.

OBJECTIVE: The purpose of this study was to determine the survival of cervical cancer patients treated with laparoscopically assisted radical vaginal hysterectomy (LARVH). We quantify morbidity and correlate survival with known risk factors. METHODS: Between August 1994 and June 2002, 200 patients with cervical cancer (TNM stage 1a1, L1 n = 6, 1a2 n = 21, 1b1 n = 89, 1b2 n = 26, 2a n = 11, 2b n = 45, 3a n = 1, 4 n = 1; squamous cell carcinoma 76.5%, adenocarcinoma 23.5%) were treated with LARVH (type II n = 102, type III n = 98). RESULTS: Paraaortic lymphadenectomy was performed in 170 (85%) patients and pelvic lymphadenectomy was performed in all 200 patients. In 26 (13%) patients positive lymph nodes were found. Major intraoperative injuries occurred in 6% of patients. Postoperative complications occurred in 8% of patients. Incidence of complications decreased significantly when comparing the first half with the second half of patients. After a median follow-up time of 40 months, overall 5-year survival could be projected to 83%; 18.5% of patients experienced recurrence with 35% exclusively extrapelvic and 11% of patients died of recurrence. Independent prognostic factors for recurrence-free survival were tumor stage, lymph node status, and combined involvement of lymphovascular and angiovascular space. In the absence of these risk factors projected 5-year survival was 98%. CONCLUSION: Patients with tumor <4 cm, negative lymph nodes, and the absence of the combination of angio- and lymphovascular space involvement can be identified by laparoscopic staging and are ideal candidates for LARVH.

Adenocarcinoma↗
PubMed2003

Chemopersistent early recurrence in the perineal tear scar of an intrapartally diagnosed cervical cancer.

BACKGROUND: Cervical cancer is the most frequent cancer occurring in pregnancy. Apart from some general recommendations, there is no standardized consensus for the management of this cancer during pregnancy. Individual case reports do exist on intrapartal cancer diagnosis and risks. CASE: We describe the case of an early recurrence in the perineal tear scar of an intrapartally diagnosed cervical cancer, which had developed despite combined neoadjuvant and adjuvant chemotherapy. CONCLUSIONS: Although iatrogenic tumor cell spreading in the vagina is rare, this oncological risk is easy to avoid. It should be considered in the peripartal management of patients suffering from cervical cancer. Our case report underlines the limits of chemotherapy in the treatment of tumor residue and points out the problem of cervical cancer cell spreading during invasive procedures.

Adult↗
PubMed2002

Detection of disseminated tumor cells in patients with cervical cancer.

PURPOSE: Detection of disseminated tumor cells in a cohort of patients presenting the entire spectrum of invasive cervical cancer. METHODS: Disseminated tumor cells were detected in blood samples taken at different times during surgery or in bone marrow aspirates by a HPV type-specific nested PCR enzyme immunoassay (n-PCR-EIA). A group of 24 patients with HPV-positive cervical cancers representing early and late stages were evaluated, and 15 patients with breast cancer and without HPV-related genital disease served as controls. RESULTS: Disseminated tumor cells were detected in blood samples and/or bone marrow aspirates of 6 of 24 patients. A significant association was found between detectable disseminated tumor cells and recurrent disease ( P=0.013) and between disseminated tumor cells and survival of the patients ( P=0.0054). There was also a clear association between the presence of disseminated tumor cells and tumor size and/or positive lymph node status which, however, was not statistically significant. There was no evidence of increased shedding of tumor cells during surgery. CONCLUSION: Detection of disseminated tumor cells in blood or bone marrow may prove to be of prognostic value, particularly for early-stage cervical cancers.

DNA, Viral↗
PubMed2002

Laparoscopic staging compared with imaging techniques in the staging of advanced cervical cancer.

OBJECTIVE: We evaluated the evidence of laparoscopy for decision regarding treatment options in advanced cervical cancer patients. METHODS: One hundred nine consecutive patients with cervical cancer FIGO stage Ib2 and higher underwent laparoscopic staging of the extent of disease. Laparoscopic and histopathologic evaluation of tumor involvement of the paraaortic and pelvic lymph nodes, wall of the bladder, and rectal pillar was compared with preoperative findings of MRI and/or CT. RESULTS: Paraaortic lymphadenectomy was performed in 101 (92.7%) patients and 21 (19.3%) patients had positive paraaortic lymph nodes. Pelvic lymphadenectomy was performed in 75 (68.8%) patients and 20 (26.7%) patients had positive pelvic lymph nodes. In 11 patients (11.5%) infiltration of the bladder and in 6 patients (6.25%) infiltration of the rectal pillar or cul-de-sac was found. Intraoperative complications associated with laparoscopic staging occurred in 3.7% of patients. The negative predictive value for the evaluation of paraaortic or pelvic lymph nodes, the bladder wall, rectal pillar, and cul-de-sac ranged from 73% (CT for pelvic lymph nodes) to 96% (MRI for bladder wall). Lack of information about the extent of disease was adjusted on the basis of laparoscopic findings in 24 (22%) patients and improved treatment plans. CONCLUSION: Laparoscopic staging of patients with advanced cervical cancer is accurate, associated with low morbidity, and helps to adjust treatment according to extent of disease.

Adult↗
PubMed2002

Explorative laparoscopy prior to exenterative surgery.

OBJECTIVE: The objective of this study was to identify the advantages and limits of laparoscopy for assessment of eligibility for exenterative procedures in patients with gynecologic malignancies. METHODS: Between April 1998 and April 2001, 41 consecutive patients with primary or recurrent gynecologic malignancy underwent explorative laparoscopy to detect eligibility for exenteration. RESULTS: Mean age of patients was 54 years (range, 31-80 years). Twenty out of 41 (48.7%) patients underwent exclusively explorative laparoscopy due to unresectable disease or intraabdominal spread of disease. Median operative time for this cohort of patients was 69.1 min (range, 10-278), median blood loss was 30 cc (range 10-60) and no complications occurred. Based on findings of explorative laparoscopy 21 out of 41 (51.2%) patients were eligible for exenteration. Evaluation of extension of disease was correctly done by laparoscopy and was not corrected at laparotomy. One patient out of 21 (4.76%) had extension of disease missed at both laparoscopy and laparotomy and discovered only at an advanced phase of exenteration. Histology of exenterative specimens confirmed laparoscopic evaluation in 20 out of 21 patients (95.25%). CONCLUSIONS: Laparoscopy proved effective for evaluation of patients who were candidates for exenteration and helped to avoid unnecessary laparotomy in half of the candidate patients.

Adult↗
PubMedDate not supplied

Heterotopic triplet pregnancy with bilateral tubal and intrauterine pregnancy after IVF.

Heterotopic pregnancy in a spontaneous cycle is rare, but the incidence increases with the introduction of assisted reproductive technologies. This report describes a case of combined bilateral tubal and intrauterine pregnancy after IVF and embryo transfer. The diagnostic and therapeutic problems will be discussed both in terms of the case report and the literature. Heterotopic pregnancies after IVF and resulting problems are further reasons to encourage the transfer of only one embryo. This could be difficult to achieve without simultaneously decreasing pregnancy rates, as embryo selection is not permitted in Germany.

Adult↗