Inmaculada Alonso

Bio: Inmaculada Alonso is an academic researcher from University of Barcelona. The author has contributed to research in topics: Medicine & Breast cancer. The author has an hindex of 4, co-authored 8 publications receiving 112 citations.

Comparative study of laparoscopically assisted radical vaginal hysterectomy and open Wertheim-Meigs in patients with early-stage cervical cancer: eleven years of experience.

Abstract: Introduction: The aim of this study was to compare the feasibility, safety, and survival outcomes of Coelio-Schauta (CS) procedure versus open Wertheim-Meigs (WM) as primary surgical treatment of early-stage cervical cancer. Methods: Observational study on the consecutive cases of cervical cancer undergoing CS during the last 11 years at our institution was performed. Data on clinical characteristics of patients, surgical performance, long-term morbidity, and survival were prospectively analyzed and compared with a historical series of 23 consecutive WM performed at the same hospital in the immediate previous period. Results: Sixty-seven patients were included in the study group (CS). Cases and controls were comparable in age, body mass index, stage, tumor size, and histological diagnosis. The number of pelvic nodes, disease-free margin, and complications rate were similar in both groups, but blood loss and blood transfusion rate were marginally less in the CS group. Operating time was longer in the first 20 CS patients, but it became comparable to WM once the learning curve was overcome. Hospital stay was significantly shorter in the CS group as well as the bladder function recovery time. However, no differences were seen regarding long-term urinary and bowel function between groups. Four patients (5.9%) from the CS group and 3 (13%) in the WM group had recurrence. Mortality rates were 3% and 8.7%, respectively (P = not significant). Conclusions: The CS procedure is a suitable alternative to WM for small-volume, early-stage cervical cancer, showing a good safety profile, shorter postoperative recovery time, and similar survival outcomes.

Oncogenic human papillomavirus-infected immature metaplastic cells and cervical neoplasia.

Abstract: Persistent cervical high-risk human papillomavirus (HR-HPV) infection results in high-grade cervical intraepithelial neoplasia (CIN2/3) and cervical carcinoma. The susceptibility of the cervix to HPV carcinogenesis and the importance of HPV18 in cervical carcinoma despite relative infrequency in CIN2/3 could be linked to HR-HPV infection of immature metaplasia (IM) at the squamocolumnar junction. Atypical IM (AIM) is an equivocal category used to describe changes in IM suggestive of high-grade neoplasia, which causes diagnostic and management problems. We used laser capture microscopy combined with polymerase chain reaction in 24 women with HPV18, HPV16, or other HPV infections on cytologic analysis and a cervical loop electrosurgical excision procedure to locate HR-HPV in cervical tissue. HPV18-positive AIM and CIN2/3 were present in 7/12 cases with HPV18 on cytologic analysis. In 2 cases with HPV18 and other HPV types, HPV18 was only present in AIM and not in CIN2/3. HPV16-positive AIM was present in 3/7 and HPV16-positive CIN2/3 in 5/7 cases with HPV16. No cases had HPV16 AIM without CIN2/3. Other HR-HPV-positive AIM and CIN2/3 cases were present, respectively, in 1/6 and 5/6 cases positive for HR-HPV types other than HPV16/18. In a subset, 94% HPV18 AIM regions showed CK17 and p16 positivity, and 41% were CK7 positive. CIN2/3 and AIM with other HR-HPVs showed similar patterns. AIM was a particular feature of HPV18 infection in women with CIN2/3. HR-HPV infection of CK7/17-positive AIM expressing p16 was particularly seen for HPV18 with and without classical CIN2/3 and should be regarded as a high-grade precancer.

Fertility-sparing surgery in patients with cervical cancer

Abstract: There are several types of fertility saving procedures that can be done in patients with cervical cancer, which differ in terms of surgical approach and extent of paracervical resection. This review assesses oncological and pregnancy results after different procedures. The oncological results of vaginal radical trachelectomies (VRT) and abdominal radical trachelectomies (ART) are similar for tumours less than 2 cm in size, and are now considered safe surgical procedures. Oncological outcomes of VRT and ART in tumours larger than 2 cm are also identical, but the results cannot be considered satisfactory. Preliminary findings of less radical procedures (ie, deep cone and simple trachelectomy) in patients with tumours less than 2 cm, and negative sentinel and other pelvic lymph nodes, are comparable with the results of VRT and ART. Downstaging tumours larger than 2 cm by neoadjuvant chemotherapy is still an experimental procedure and will need multicentre cooperation to verify its oncological safety. Pregnancy results vary statistically with the different methods.

Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer.

Abstract: Aim This study investigates the pattern of disease recurrence and identifies the clinicopathologic prognostic factors for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB and IIA cervical carcinoma treated with laparoscopic/robotic radical hysterectomy (LRH/RRH). Methods We conducted a retrospective analysis of 128 patients with FIGO stage IB and IIA cervical cancer. Preoperative examination did not uncover definitive evidence of parametrial invasion or lymph node metastasis in any of the patients; therefore, all patients underwent LRH/RRH with retroperitoneal lymphadenectomy between April 2006 and December 2013. Sites of disease recurrence and all possible clinicopathologic factors related to the risk of disease recurrence were determined. Results Multivariate analysis demonstrated that laparoscopic intracorporeal colpotomy (P < 0.041, odds ratio 7.038, 95% confidence interval 1.059–15.183) represented a strong prognostic factor related to disease recurrence. We categorized the minimally invasive surgery group into LRH through vaginal colpotomy (LRH-VC; 79 patients) and LRH/RRH through intracorporeal colpotomy (LRH/RRH-IC; 49 patients) according to the colpotomic approaches. Disease recurrence was higher in the LRH/RRH-IC group than in the LRH-VC group (16.3% vs 5.1%, P = 0.057), with five patients in the LRH/RRH-IC group experiencing intraperitoneal spreads. Conclusions Total laparoscopic/robotic intracorporeal colpotomy under CO2 pneumoperitoneum may carry a risk of positive vaginal cuff margin, as well as intraperitoneal tumor spreads in patients with early-stage cervical cancer treated with LRH/RRH.

Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or dargent's operation) : A comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH)

Abstract: Conventional treatment of early cervical cancer (<4 cm) is radical hysterectomy, but laparoscopic-assisted vaginal radical trachelectomy (LARVT), also known as Dargent's Operation, offers a means of radically removing the cervix, proximal parametrium, and upper vaginal cuff while preserving the body of the uterus, and thereby fertility. Retrospective studies have confirmed this procedure's oncological safety. The present study is a case-control comparison of LARVT with laparoscopic-assisted radical vaginal hysterectomy (LARVH) in women having FIGO stage I-IIA cervical cancer. LARVT was carried out in 118 patients, and LARVH in 139, in the years 1986-2003. Both procedures were accompanied by laparoscopic pelvic lymph node dissection. Women in the LARVT group were younger and fewer of them had tumors larger than 2 cm, but major prognostic factors were similar in the 2 groups. Both operations took roughly 3 hours to perform, LARVH slightly longer. Nearly half the patients underwent laparoscopic lymphadenectomy via a preperitoneal approach. Intraoperative and postoperative complications were comparably frequent in the 2 groups. Three intestinal lesions occurred in the LARVH group and 6% of women in this group were reoperated on, a majority of them because of pelvic bleeding. In the LARVT group, 11% of women were reoperated on, 9 because of bleeding. During a median follow-up of 95 months after LARVT and 113 months following LARVH, recurrences were observed in 16 women, 6% of those treated. The rate was 5.9% in the LARVT group and 3.5% in the LARVH group, not a statistically significant difference. The 5-year recurrence-free survival rate and overall survival rate approximated 95% in both surgical groups. On multivariate analysis, only tumor size and the presence or absence of lymph-vascular space invasion independently predicted recurrence; the type of operation did not. In women of reproductive age who have early cervical cancer, Dargent's operation appears to be as effective and as safe as LARVH.