Table Of ContentSURGERY IN GYNECOLOGICAL ONCOLOGY
DEVELOPMENTS IN ONCOLOGY
F.l. Cleton and 1.W.I.M. Simons, eds., Genetic Origins of Tumour Cells
ISBN 90-247-2272-1
1. Aisner and P. Chang, eds., Cancer Treatment Research
ISBN 90-247-2358-2
B.W. Ongerboer de Visser, D.A. Bosch and W.M.H. van Woerkom-Eykenbook, eds.,
Neuro-oncology: Clinical and Experimental Aspects
ISBN 90-247-2421-X
K. Hellmann, P. Hilgard and S. Eccles, eds., Metastasis: Clinical and Experimental Aspects
ISBN 90-247-2424-4
H.F. Seigler, ed., Clinical Management of Melanoma
ISBN 90-247-2584-4
P. Correa and W. Haenszel, eds., Epidemiology of Cancer of the Digestive Tract
ISBN 90-247-2601-8
L.A. Liotta and I.R. Hart, eds., Tumour Invasion and Metastasis
ISBN 90-247-2611-5
1. Banoczy, ed., Oral Leukoplakia
ISBN 90-247-2655-7
C. Tijssen, M. Halprin and L. Endtz, eds., Familial Brain Tumours
ISBN 90-247-2691-3
F.M. Muggia, C.W. Young and S.K. Carter, eds., Anthracycline Antibiotics in Cancer
ISBN 90-247-2711-1
B.W. Hancock, ed., Assessment of Tumour Response
ISBN 90-247-2712-X
D.E. Peterson, ed., Oral Complications of Cancer Chemotherapy
ISBN 0-89838-563-6
R. Mastrangelo, D.G. Poplack and R. Riccardi, eds., Central Nervous System Leukemia.
Prevention and Treatment
ISBN 0-89838-570-9
SURGERYIN
GYNECOLOGICAL
ONCOLOGY
edited by
A. PETER M. HEINTZ, MD
University of Leiden Medical Centre, Leiden
C. THOMAS GRIFFITHS, MD
Brigham and Womens Hospital
Harvard Medical School, Boston
J. BAPTIST TRIMBOS, MD
University of Leiden Medical Centre, Leiden
1984 MARTINUS NIJHOFF PUBLISHERS ....
1111
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
BOSTON / THE HAGUE / DORDRECHT / LANCASTER .~
This publication is based upon a Boerhaave course organized by
the Faculty of Medicine, University of Leiden
Distributors
for the United States and Canada: Kluwer Boston, Inc., 190 Old Derby Street,
Hingham, MA 02043, USA
for all other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O.Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
Main entry under title:
Surgery in gynecological oncology.
(Developments in oncology)
Includes index.
1. Generative organs, Female--Cancer--Surgery.
2. Gynecology, Operative. I. Heintz, A. Peter M.
II. Griffiths, C. Thomas. III. Trimbos, J. Baptist.
IV. Series. [DNLM: 1. Genital neoplasms, Female-
Surgery. Wl DE998N v. 16 I WP 145 8961)
RG104.6.S9 1983 616.99'465059 83-17424
ISBN -13 :978-94-009-6752-6 e-I SBN-13: 978-94-009-6750-2
001: 10.10071978-94-009-6750-2
ISBN-13 :978-94-009-6752-6
Copyright
© 1984 by Martinus Nijhoff Publishers, The Hague.
Softcover reprint of the hardcover tst edition 1984
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Martinus Nijhoff Publishers, P.O. Box 566, 2501 CN The Hague,
The Netherlands.
v
INTRODUCTION
Gynecological oncology surgery has shown substantial progress
in recent years. Most of the advances come from gynecologists
with full time commitments to gynecological oncology.
Jt is important for the general obstetrician-gynecologist to
be informed about the possibilities offered by modern gyneco
logical oncology. Thus he or she may acquire new techniques
which can be used in general gynecological practice. On the
other hand it is essential to know what his or her colleagues,
specialised in gynecological oncology can offer in oncology
centres.
The chapters in this book are based on a post-graduate course
organised by the Boerhaave Committee for post-graduate medical
education of the medical faculty of the University of Leiden,
in the Netherlands. In view of the considerable interest shown
by many highly qualified specialists we are extremely grateful
to our contributors who were prepared to lucidly present their
knowledge and expertise within the covers of the present book.
One of the conclusion of this book must be that the special
surgical skills needed for adequate treatment of gynecological
cancer cannot be developed within general residency programs.
Thus European gynecologists should examine whether and to what
extent additional training as usual in the U.S.A. is necessary.
The editors want to thank the Royal College of Obstericians
and Gynecologists for their kind permission to reproduce the
contribution of J.A. Jordan (chapter 7 from "pre-clinical
neoplasia of the cervix" (London, 1982).
A.P.M. Heintz, M.D.
C.Th.G~i66ith~,M.D.
J.B. , M.D.
T~imbo~
VI
CONTRIBUTORS
M. MmM<,>eYl M. V. , Gynecologist, ~rhus Amtssygehus, Tage Hansen
gade 234, 8000 ~rhus C, Danmark
G.P. B.teek.eJt M.V. , Gynecologist, University of Amsterdam, Womens
Department, 1e Helmerstraat 104, 1054 EG Amsterdam, The Ne
therlands
G. Bo<,>, Psychologist, Psychotherapist, Department of Obstetrics
and Gynecology, State University of Leiden, Rijnsburgerweg 10,
2333 AA Leiden, The Netherlands
LV. Vu.Ylc.aYl M.V. , Gynecologist, Senior Lecturer, Department of
Obstetrics and Gynecology, University of Dundee, Medical School,
Ninewells Hospital, Dundee, Scotland
H. Fox M.V. , F.R.C. Path., Professor of Reproductive Pathology,
Department of Pathology, University of Manchester, Oxford Road,
M13 9PT Manchester, England
C.T. Gfli66dh6 M.V., Ass. Professor of Gynecology, Harvard Medi
cal School, Ass. Chief on Gynecologic Oncology, Brigham and
Womens Hospital and Sydney Farber Cancer Institute, 75 Francis
Street, Boston, Massachusetts 02115, U.S.A.
A.P.M. Hu.u:z M.D., Gynecologist, Section of Gynecologic Oncology,
Department of Obstetrics and Gynecology, State University of
Leiden, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
J.A. JOfLdaYl M.D. , F.R. C.O.G., Gynecologist, The Birmingham Ma
ternity Hospital, Queen Elisabeth Medical Centre, Edgbaston
Birmingham, B15 2TG England
B.W. KeX;tiYlg M.V., Gynecologist, University of Amsterdam, Womens
Department, 1e Helmerstraat 104, 1054 EG Amsterdam, The Ne
therlands
E. vaYl K.tee6, Social Worker, University of Amsterdam, Womens
Department, 1e Helmerstraat 104, 1054 EG Amsterdam, The Ne
therlands
VII
R.C. KVtapp M.V. , Professor of Gynecology, Director of Gyneco
logical Oncology, Harvard Medical School, Brigham and Woman's
Hospital, 75 Francis Street, Boston, Massachusetts 02115,
U.S.A.
K.E. Kj¢Mtad IvI.V., The Norwegian Radium Hospital, Department
of Gynecological Oncology, Montebello - Oslo 3, Norway
Tj. Kuipvu., M.V., Executive gynecologic therapist, the Rotterdam
Radiation Therapy Institute, Dr. Daniel den Hoed Clinic, Groe
ne Hilledijk 301, 3075 EA Rotterdam, The Netherlands
L.V. LagMM IvI.V., Director Gynecologic Oncology, U.C.L.A. Center
for Health Sciences, Los Angeles, California 90024, U.S.A.
F.B. Lamm~ M.V. , Director of Obstetrics and Gynecology, Zuider
ziekenhuis, Groene Hilledijk 315, 3075 EA Rott8rdam, Director
of Gynecologic Oncology, Dr. Daniel den Hoed Clinic, Groene
Hilledijk 301, 3075 EA Rotterdam, The Netherlands
M. vavt Levtt M. V. , Gynecologist, Department of Obstetrics and
Gynecology, Zuiderziekenhuis, Rotterdam, Dr. Daniel den Hoed
Clinic, Groene Hilledijk 301, 3075 EA Rotterdam, The Nether
lands
A. C.M. vavt LivtdW 1vI. V. , Gynecologist, Department of Gynecologic
Oncology, State University of Utrecht, Catharijnesingel 101,
3583 CP Utrecht, The Netherlands
K.J. Lohe, Professor of Gynecology, University of Munich Womens
Department and School of Midwifery, Maistrasse 11, 8000 Munich
2, West Germany
G.W. lvIouey 1vI. V. , Director of Gynecology Oncology, Uni versi ty
of Michigan Medical School, Ann Arbor, Michigan 48104, U.S.A.
J. Myiotie 1vI. V. , Gynecologist, Department of Obstetrics and Gy
necology, Regional Hospital, Galway, Irish Republic
N. B. ROhevt~huvt M. V., Director of Gynecologic Oncology, The John
Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland
21205, U.S.A.
VIII
K. SelUba M.D., Professor of Gynecology, Okayama University Me
dical School, Okayama, Japan
J.B. TurnbO'-> M.D. , Gynecologist, Department of Obstetrics and
Gynecology, State University of Leiden, Rijnsburgerweg 10,
2333 AA Leiden, The Netherlands
J.A. WijYleYl M.D. , Gynecologist, Department of Gynecological
Oncology, University of Rotterdam, Dr. Molewaterplein 40,
3015 GO Rotterdam, The Netherlands
IX
TABLE OF CONTENTS
Part I Surgery in cancer of vulva and vagina
Conservative management of vaginal and vulval intraepithelial
neoplasia
J.A. Jordan
2 Surgical treatment of cancer of the vulva: Superficially
invasive vulvar cancer with nodal metastases
L.D. Lagasse 12
3 Surgical treatment of cancer of the vulva: Radical vulvec
tomy and bilateral lymphadenectomy through separate groin
incisions
L.D. Lagasse 21
4 Carcinoma of the vagina
Robert C. Knapp 30
Part II The surgical treatment of cervical intraepithelial
neoplasia
5 eIN - Definition, epidemiology and diagnosis
J.A. Jordan 43
6 The treatment of cervical intra-epithelial neoplasia by
surgical cone biopsy
J.A. Wijnen 49
7 Treatment of eIN by destruction - laser
J.A. Jordan and J. Mylotte 59
8 Destruction of cervical intraepithelial neoplasia at 1000C
with the Semm coagula tor
I. Duncan 71
x
9 The treatment of eIN by cryotherapy
M. van Lent 86
Part III Surgery in cervical cancer
10 Diagnosis and treatment of microinvasive cervical cancer
K.J. Lohe 94
11 Surgical treatment of cervical cancer by the Wertheim
Okabayashi procedure
F.B. Lammes, K. Sekiba 111
12 Surgical treatment of cervical cancer by the A.V.R.U.E.L.
procedure
B.W. Ketting and o.P. Bleeker 116
13 Urodynamics after radical surgery for carcinoma of the
uterine cervix
Mogens Asmussen 143
14 Radiotherapy in conjunction with surgery in the treatment
of patients with early cervical cancer
Kjell E. Kj¢rstad 165
15 Pelvic exenteration in the treatment of recurrent cervical
cancer
George W. Moreley 174
16 Pelvic reconstruction
L.D. Lagasse 182
Part IV Surgery in endometrial cancer
17 The morphological basis for the treatment of endometrial
carcihoma in situ
H. Fox 190
