about 22 000 women will have been diagnosed with epithelial ovarian cancer in the united states in 2011 . unlike most other cancers , all stages of epithelial ovarian cancer
prospective randomized trials have proven the benefits of laparoscopic gynecologic surgery : decreased pain , decreased surgical - site infection ( decreased relative risk , 80% ) , decreased hospital stay ( 2 fewer days ) , quicker return to activity ( 2 weeks sooner ) , and fewer postoperative adhesions ( decreased by 60% ) .
though originally more costly , with increasing experience , the length of laparoscopic procedures has shortened , resulting in costs similar to laparotomy .
laparoscopic staging of early ovarian cancer and laparoscopic secondary cytoreductive surgery for recurrent ovarian cancer have been described .
we have reported on our experience with laparoscopy - assisted cytoreduction for primary advanced ovarian cancer .
laparoscopic supracervical hysterectomy ( lsch ) has potential benefits compared with total laparoscopic hysterectomy ( tlh ) or laparoscopy - assisted vaginal hysterectomy for ovarian cancer patients who receive postoperative chemotherapy .
lsch may be associated with fewer cases of postoperative vaginal cuff infection , a complication that would delay chemotherapy .
the purpose of our study is to evaluate the incidence of cervical recurrence after lsch for ovarian cancer debulking or staging .
all patients undergoing surgery at our division of gynecologic oncology were entered into a prospective surgical database .
demographic characteristics were obtained and entered into the database preoperatively , surgical outcomes were entered into the database immediately postoperatively , and follow - up data were entered into the database after each office examination .
patients were followed up in the office at 1 and 4 weeks after surgery and every 3 weeks during chemotherapy , as well as every 3 to 6 months thereafter for 5 years .
cervical examination was performed at all 3- to 6-month office visits and during examination of patients under anesthesia if laparoscopic secondary cytoreductive surgery was performed at the time of recurrence .
we identified 122 surgical cases of ovarian cancer , of which 51 included lsch for ovarian cancer primary debulking or staging .
seventy - one cases were deemed ineligible for the following reasons : secondary debulking in 27 , prior hysterectomy in 24 , gastrointestinal primary in 5 , intraperitoneal ports in 5 , laparotomy in 5 , conservative staging ( uterus retained for fertility ) in 3 , and small - bowel obstruction in 2 .
it is our practice to attempt lsch for ovarian cancer debulking or staging in all cases .
we have previously described our technique of laparoscopy - assisted cytoreduction with supracervical hysterectomy ( sch ) . in brief ,
round ligaments were excised with plasmakinetic ( pk ) cutting forceps ( gyrus acmi , southborough , massachusetts ) .
the retroperitoneal spaces were dissected , both ureters were identified , and the infundibulopelvic ligaments were excised with the pk cutting forceps . the anterior and posterior leaf of the broad ligament was dissected , and the bladder was dissected off the cervix with monopolar electrosurgery .
the uterine vessels and cardinal and uterosacral ligaments were then coagulated and cut with the pk cutting forceps .
use of the trendelenburg position was discontinued , and the omentum was retracted toward the pelvis with graspers through the lower - quadrant ports .
the lateral attachments of the infracolic omentum were excised with the pk cutting forceps . if the omental metastasis was not densely adherent to the transverse colon , the entire omentectomy was performed with the pk cutting forceps .
a 6-cm periumbilical maylard incision was performed , and the omentum , uterus , and ovaries were manually delivered .
when an adherent omental metastasis was present , the omentum was delivered through the incision and the remainder of the omentectomy was performed by a traditional approach .
the transverse colon was delivered through the incision , inspected , and oversewn as necessary .
when a bulky pelvic tumor was encountered , manual resection of the cul - de - sac tumor was performed through the periumbilical maylard incision .
when small - bowel resection was necessary , lysis of adhesions was performed laparoscopically and the segment of small bowel was delivered through the incision and stapled resection and reanastomosis were performed .
the periumbilical maylard incision was closed with a running mass closure with a delayed absorbable monofilament suture .
a laparoscopic 5-mm argon - beam coagulator ( abc ) ( valleylab , boulder , colorado ) was used to coagulate residual tumor in the pelvis , abdominal peritoneum , intestinal mesentery , and diaphragm .
we ablated residual tumor using the abc rather than performing resections such as partial colectomy and diaphragm stripping .
the abc was used at a setting of 50 to 70 w and an argon gas flow setting of 4 l / min .
patients with stage iii / iv tumors , a cytoreductive status of < 1 cm , and minimal adhesions were treated with postoperative intraperitoneal chemotherapy .
penn state milton s. hershey medical center institutional review board approval was obtained for this study .
the median age was 62 years ( range , 3283 years ) , and the median body mass index was 29 kg / m ( range , 1641 kg / m ) .
medical comorbidities were present in 40 patients ( 78% ) , and 53% had prior abdominal surgery .
the median operative time was 2 hours ( range , 13.5 hours ) , and the median blood loss was 200 ml ( range , 50900 ml ) .
the stage was i in 12 , ii in 6 , iii in 32 , and iv in 1 .
the cytoreductive status was microscopic in 61% , < 1 cm in 37% , and > 1 cm in 2% .
serous histology was present in 59% of tumors . at a median follow - up time of 1.7 years ( range , 0.32.6 years ) , 20 patients ( 39% ) had recurrence of cancer , with a medium time of recurrence of 1.1 years ( range , 0.32.3 years ) ( table 2 ) .
of the 20 recurrences , 17 ( 85% ) were in patients with stage iii / iv tumors .
all recurrences were in the abdomen or pelvis except for 1 axillary node recurrence and 1 recurrence in the distal vagina .
awd = alive with disease ; dod = dead of disease ; ned = no evidence of disease . of the patients ,
four patients ( 2 of whom had small - bowel resection during debulking ) had ileus , which resolved without nasogastric tube decompression . a skin infection developed in 1 patient .
urinary retention developed in 1 patient . among the 104 cycles of intraperitoneal chemotherapy , there was no vaginal leakage of intraperitoneal chemotherapy .
the benefits of laparoscopic gynecologic surgery versus laparotomy have been documented in prospective randomized trials : decreased pain , decreased surgical - site infection , decreased hospital stay , quicker return to activity , and fewer postoperative adhesions .
we have reported on our experience with laparoscopic staging of early ovarian cancer , laparoscopic secondary cytoreductive surgery for recurrent ovarian cancer , and laparoscopy - assisted cytoreduction for primary advanced ovarian cancer .
lsch has potential benefits compared with tlh or laparoscopy - assisted vaginal hysterectomy for ovarian cancer patients who receive postoperative chemotherapy .
however , a potential risk of lsch is ovarian cancer recurrence in the remaining cervical stump .
because ovarian cancer spreads primarily in the peritoneal cavity and the cervical stump is extraperitoneal ( in the vagina ) , involvement of the cervical stump by ovarian cancer should be rare . in our study , of the 51 patients who underwent lsch , 20 have had recurrences , but none in the cervix . a pubmed literature search of cervical metastases from primary ovarian cancer yielded case reports and small case series with the majority describing cervical metastases diagnosed concurrently or before the ovarian cancer .
we were unable to locate any similar studies of lsch for ovarian cancer and recurrence in the remaining cervical stump .
we were able to locate a single study of abdominal sch compared with total abdominal hysterectomy ( tah ) . in this
study the vaginal / cervical recurrence rate was 11% in the sch group and 12% in the tah group .
regarding the patients with recurrence , there was a higher rate of vaginal tumor erosion in the patients who underwent tah .
lsch may be associated with fewer cases of postoperative vaginal cuff infection , a complication that would delay chemotherapy . in our study
we were unable to locate any similar studies of lsch for ovarian cancer and postoperative vaginal cuff infections .
however , in a national commercial claims database review of 20 379 patients with benign disease , lsch was associated with a significantly lower infection rate than laparoscopy - assisted vaginal hysterectomy .
hoffman et al compared the surgical outcomes of 614 patients undergoing lsch or tlh for benign disease and found a statistically significant difference in the development of pelvic cellulitis : 3% of lsch patients versus 7% of tlh patients ( p = .01 ) .
similarly , a comparative analysis of perioperative outcomes of 566 lsch and 450 tlh procedures for benign disease conducted by harmanli et al showed decreased vaginal cuff cellulitis with lsch , with an adjusted odds ratio of 1.29
. lsch may prevent vaginal leakage of intraperitoneal chemotherapy . in our study , among the 104 cycles of intraperitoneal chemotherapy , there was no vaginal leakage of intraperitoneal chemotherapy .
we were unable to locate any similar studies of lsch for ovarian cancer and vaginal leakage of intraperitoneal chemotherapy . in a meta - analyses of patients treated with tah ,
leakage of intraperitoneal chemotherapy can lead to failure to complete chemotherapy , as was shown in a large phase iii multicenter clinical trial of intraperitoneal versus intravenous chemotherapy in ovarian cancer ( gynecologic oncology group 172 ) .
interestingly , in a review of intraperitoneal chemotherapy , markman and walker recommended sch to prevent vaginal leakage of intraperitoneal chemotherapy but supplied no data to support their opinion .
we present a study of lsch for ovarian cancer debulking or staging that resulted in no recurrence in the remaining cervical stump , no postoperative vaginal cuff infections , and no vaginal leakage of intraperitoneal chemotherapy .
 background and objectives : the purpose of our study is to evaluate the incidence of cervical recurrence after laparoscopic supracervical hysterectomy for ovarian cancer debulking or staging.methods:from a prospective surgical database , we identified 51 cases of laparoscopic supracervical hysterectomy for ovarian cancer debulking or staging . 
 no cases were excluded.results:from 2009 to 2012 , 51 patients were identified . 
 the median age was 62 years ( range , 3283 years ) , and the median body mass index was 29 kg / m2 ( range , 1641 kg / m2 ) . 
 medical comorbidities were present in 40 patients ( 78% ) , and 53% had prior abdominal surgery . 
 the median operative time was 2 hours ( range , 13.5 hours ) , and the median blood loss was 200 ml ( range , 50900 ml ) . 
 the median length of stay was 1 day ( range , 012 days ) . 
 the stage was i in 12 patients , ii in 6 , and iii / iv in 33 . at a median follow - up time of 1.7 years ( range , 0.32.6 years ) 
 , 20 patients ( 39% ) had recurrence of cancer , with a median time of recurrence of 1.1 years ( range , 0.32.3 years ) . 
 all recurrences were in the abdomen or pelvis except for 1 axillary node recurrence and 1 recurrence in the distal vagina . 
 there were no recurrences in the remaining cervical stump . 
 no patient had a postoperative vaginal cuff infection . among the 104 cycles of intraperitoneal chemotherapy , there was no vaginal leakage of intraperitoneal chemotherapy.conclusion:laparoscopic supracervical hysterectomy for ovarian cancer debulking or staging does not result in cervical recurrence . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
CONCLUSION