SURGERY 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