Association of preoperative cone biopsy with recurrences after radical hysterectomy

Abstract Objective To evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer. Methods This is a retrospective single-center study. Patients with cervical cancer stage IA1 with LVSI to IIA2 and squamous, adenosquamous and adenocarcinoma subtype were included. Patients were analyzed for general characteristics and recurrence-free survival (RFS). Results In total, of 480 patients with cervical cancer, 183 patients met the inclusion criteria (117 with laparoscopic and 66 with open surgery). The median tumor diameter was 25.0 mm (range 4.6–70.0 mm) with 66 (36.2%) patients having tumors smaller than 2 cm. During median follow-up of 54.0 months (range 0–166.0 months), the RFS for the laparoscopic cohort was 93.2% and 87.5% at 3 and 4.5 years, and 79.3% for the open cohort after 3 and 4.5 years, respectively. In total, 17 (9.3%) patients developed recurrent disease, 9 (7.3%) after laparoscopic, and 8 (12.1%) after open surgery. No preoperative cone biopsy (OR 9.60, 95% CI 2.14–43.09) as well as tumor diameter > 2 cm (OR 5.39, 95% CI 1.20–24.25) were significantly associated with increased risk for recurrence. In multivariate analysis, only missing preoperative cone biopsy was significantly associated with increased risk for recurrence (OR 5.90, 95% CI 1.11–31.29) Conclusion There appears to be a subgroup of patients (preoperative cone biopsy, tumor diameter < 2 cm) with excellent survival and low risk for recurrence after radical hysterectomy which might benefit from the advantages of laparoscopic surgery.

Download Full-text

Association of Preoperative Cone Biopsy With Recurrences After Radical Hysterectomy

10.21203/rs.3.rs-420135/v1 ◽

2021 ◽

Author(s):

Rüdiger Klapdor ◽

Hermann Hertel ◽

Laura Delebinski ◽

Peter Hillemanns

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Open Surgery ◽

Recurrent Disease ◽

Tumor Diameter ◽

Free Survival ◽

Increased Risk ◽

Single Center Study ◽

Cone Biopsy

Abstract ObjectiveTo evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer.MethodsThis is a retrospective single-center study. Patients with cervical cancer stage IA1 with LVSI to IIA2 and squamous, adenosquamous and adenocarcinoma subtype were included. Patients were analyzed for general characteristics and recurrence-free survival (RFS). ResultsIn total, of 480 patients with cervical cancer 183 patients met the inclusion criteria (117 with laparoscopic and 66 with open surgery). The median tumor diameter was 25.0 mm (range 4.6-70.0 mm) with 66 (36.2%) patients having tumors smaller than 2 cm. During median follow-up of 54.0 months (range 0-166.0 months) the RFS for the laparoscopic cohort was 93.2% and 87.5% at 3 and 4.5 years, and 79.3% for the open cohort after 3 and 4.5 years, respectively. In total, 17 (9.3%) patients developed recurrent disease, 9 (7.3%) after laparoscopic, and 8 (12.1%) after open surgery. No preoperative cone biopsy (OR 9.60, 95%CI 2.14-43.09) as well as tumor diameter >2cm (OR 5.39, 95%CI 1.20-24.25) were significantly associated with increased risk for recurrence. In multivariate analysis only missing preoperative cone biopsy was significantly associated with increased risk for recurrence (OR 5.90, 95% CI 1.11-31.29)ConclusionThere appears to be a subgroup of patients (preoperative cone biopsy, tumor diameter <2cm) with excellent survival and low risk for recurrence after radical hysterectomy which might benefit from the advantages of laparoscopic surgery.

Download Full-text

Patterns of recurrence after laparoscopic versus open abdominal radical hysterectomy in patients with cervical cancer: a propensity-matched analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001381 ◽

2020 ◽

Vol 30 (7) ◽

pp. 987-992 ◽

Cited By ~ 2

Author(s):

Giorgio Bogani ◽

Fabio Ghezzi ◽

Luis Chiva ◽

Baldo Gisone ◽

Ciro Pinelli ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Open Surgery ◽

Survival Outcomes ◽

Recurrent Cervical Cancer ◽

Free Survival ◽

Laparoscopic Radical Hysterectomy ◽

Open Abdominal Surgery ◽

Patterns Of Recurrence

ObjectiveRecent evidence has suggested that laparoscopic radical hysterectomy is associated with an increased risk of recurrence in comparison with open abdominal radical hysterectomy. The aim of our study was to identify patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer.MethodsThis a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery performed between January 1990 and December 2018. Inclusion criteria were: age ≥18 years old, radical hysterectomy (type B or type C), no recurrent disease, and clinical follow-up >30 days. The primary endpoint was to evaluate patterns of first recurrence following laparoscopic and open abdominal radical hysterectomy. The secondary endpoint was to estimate the effect of the primary surgical approach (laparoscopy and open surgery) in post-recurrence survival outcomes (event-free survival and overall survival). In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Survival outcomes were estimated using the Kaplan-Meier model.ResultsA total of 1058 patients were included in the analysis (823 underwent open abdominal radical hysterectomy and 235 patients underwent laparoscopic radical hysterectomy). The study included 117 (14.2%) and 35 (14.9%) patients who developed recurrent cervical cancer after open or laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2), we reduced the population to 105 patients (35 vs 70 patients with recurrence after laparoscopic and open radical hysterectomy). Median follow-up time was 39.1 (range 4–221) months and 32.3 (range 4–124) months for patients undergoing open and laparoscopic surgery, respectively. Patients undergoing laparoscopic radical hysterectomy had shorter progression-free survival than patients undergoing open abdominal surgery (HR 1.98, 95% CI 1.32 to 2.97; p=0.005). Patients undergoing laparoscopic radical hysterectomy were more likely to develop intrapelvic recurrences (74% vs 34%; p<0.001) and peritoneal carcinomatosis (17% vs 1%; p=0.005) than patients undergoing open surgery.ConclusionsPatients undergoing laparoscopic radical hysterectomy are at higher risk of developing intrapelvic recurrences and peritoneal carcinomatosis. Further evidence is needed in order to corroborate our findings.

Download Full-text

Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000994 ◽

2020 ◽

Vol 30 (5) ◽

pp. 564-571 ◽

Cited By ~ 4

Author(s):

Xu Chen ◽

Na Zhao ◽

Piaopiao Ye ◽

Jiahua Chen ◽

Xingwei Nan ◽

...

Keyword(s):

Cervical Cancer ◽

Laparoscopic Surgery ◽

Cancer Patients ◽

Radical Hysterectomy ◽

Tumor Size ◽

Open Surgery ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free

ObjectiveThere is recent evidence that demonstrates worse oncologic outcomes associated with minimally invasive radical hysterectomy when compared with open radical hysterectomy, particularly in patients with tumors >2 cm. The aim of our study was to retrospectively evaluate the oncological outcomes between laparoscopic and open radical hysterectomy in International Federation of Gynecology and Obstetrics(FIGO) 2009 stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm.MethodsA retrospective review of medical records was performed to identify patients who underwent either laparoscopic or open radical hysterectomy during January 2010 and December 2018. Inclusion criteria were: (1) histologically confirmed cervical cancer including all histological types; (2) FIGO 2009 stage IB1; (3) tumor size ≤2 cm (determined by pelvic examination, magnetic resonance imaging or transvaginal ultrasound); (4) had undergone radical hysterectomy (type II or III) with pelvic and/or para-aortic lymphadenectomy as primary surgical treatment; (5) had follow-up information. Patients with FIGO 2009 stage IA1 or IA2, tumor size >2 cm, or who received neo-adjuvant chemotherapy before surgery, those with cervical cancer incidentally found after simple hysterectomy, or with insufficient data were excluded. Concurrent comparison between the laparoscopic and open cohorts was made for disease-free survival and overall survival.ResultsA total of 325 cervical cancer patients were included; of these, 129 patients underwent laparoscopic surgery and 196 patients had open surgery. The median follow-up times were 51.8 months (range 2–115) for laparoscopic surgery and 49.5 months (range 3–108) for open surgery. Patients in the laparoscopic group had significantly worse 5 year disease-free survival than those in the open group (90.4% vs 97.7%; p=0.02). There was no significant difference in 5 year overall survival between groups (96.9% vs 99.4%, p=0.33). The Cox proportional hazards regression analysis indicated that laparoscopic surgery was associated with lower disease-free survival compared with open surgery (adjusted hazard ratio 4.64, 95% CI 1.26 to 17.06; p=0.02). In patients with non-squamous cell carcinoma or with grade II–III, laparoscopic surgery had a significantly worse 5 year disease-free survival compared with the open surgery group (74% vs 100%, p=0.01, and 88.8% vs 98.0%, p=0.02, respectively).ConclusionLaparoscopic radical hysterectomy was associated with worse disease-free survival for stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm compared with open radical hysterectomy. Further studies may shed additional light on the impact of minimally invasive surgery in this low-risk patient population.

Download Full-text

Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002587 ◽

2021 ◽

pp. ijgc-2021-002587

Author(s):

Felix Boria ◽

Luis Chiva ◽

Vanna Zanagnolo ◽

Denis Querleu ◽

Nerea Martin-Calvo ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Quality Indicators ◽

Radical Hysterectomy ◽

Disease Free Survival ◽

Free Survival ◽

Operative Complications ◽

Early Cervical Cancer ◽

Disease Free

IntroductionComprehensive updated information on cervical cancer surgical treatment in Europe is scarce.ObjectiveTo evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database.MethodsThe SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified.ResultsThe mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0–84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation.ConclusionsIn this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.

Download Full-text

Minimally invasive radical hysterectomy: an analysis of oncologic outcomes from Hospital Italiano (Argentina)

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000323 ◽

2019 ◽

Vol 29 (5) ◽

pp. 863-868 ◽

Cited By ~ 7

Author(s):

Diego Odetto ◽

Maria Celeste Puga ◽

Jose Saadi ◽

Florencia Noll ◽

Myriam Perrotta

Keyword(s):

Cervical Cancer ◽

Recurrence Rate ◽

Radical Hysterectomy ◽

Adenosquamous Carcinoma ◽

Disease Free Survival ◽

Laparoscopic Approach ◽

Free Survival ◽

Laparoscopic Radical Hysterectomy ◽

Disease Free

BackgroundThe Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated a higher rate of disease recurrence and worse disease-free survival in patients who underwent minimally invasive radical hysterectomy.ObjectivesTo evaluate surgical and oncological outcome of laparoscopic radical hysterectomy performed at Hospital Italiano in Buenos Aires, Argentina.MethodsThis retrospective study included all patients with cervical cancer, 2009 FIGO stage IA1, with lymphovascular invasion to IB1 (<4 cm) who underwent a laparoscopic radical hysterectomy between June 2010 and June 2015. Patients were eligible if they had squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, and no lymph node involvement by imaging. Patients must have undergone a type C1 radical hysterectomy. Only patients who were treated by a laparoscopic approach were included. Patients were excluded if histopathology showed a component of neuroendocrine carcinoma before or after surgery; if they had synchronous primary tumors, history of abdominal or pelvic radiotherapy, or were operated on at an outside institution; and if they had only surgery and no follow-up in our institution. Relapse rate and disease-free survival were evaluated using the Kaplan-Meier method.ResultsA total of 108 patients were evaluated. The median age was 41 years (range 27–70). Distribution of histologic sub-types was squamous carcinoma in 77 patients (71%), adenocarcinoma in 27 patients (25%), and adenosquamous carcinoma in four patients (4%). Ninety-nine patients (92%) had stage IB1 tumors and 58 (54%) patients had tumors ≤2 cm. The median surgical time was 240 min (range 190–290), the median estimated blood loss was 140 mL (range 50–500) and the transfusion rate was 3.7%. The median length of hospital stay was 2 days (range 1–11). The median follow-up time was 39 months (range 11–83). The global recurrence rate after laparoscopic radical hysterectomy was 15% (16/108). According to tumor size, the recurrence rate was 12% in patients with tumors ≤2 cm (7/58) and 18% in patients with tumors >2 cm (9/50) (OR=0.76; 95% CI 0.26 to 2.22; p=0.62) The 3- and 5-year relapse rate was 17% (95% CI 11% to 27%). The 3- and 5-year disease-free survival was 81% (95% CI 71% to 88%) and 70% (95% CI 43% to 86%), respectively. Overall survival at 3 years was 87% (95% CI 76% to 93%).ConclusionThe recurrence rate after laparoscopic radical hysterectomy was 15%, and in tumors ≤2 cm it was 12%. The 3-year disease-free survival was 81%. Given these results our hospital has changed the approach to open radical hysterectomy.

Download Full-text

Comparison of laparoscopic and abdominal radical hysterectomy for early stage cervical cancer: oncologic outcomes based on tumor diameter

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001504 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1308-1316

Author(s):

Junshen He ◽

Min Hao ◽

Ping Liu ◽

Zhihua Liu ◽

Jinghe Lang ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Radical Hysterectomy ◽

Early Stage ◽

Disease Free Survival ◽

Oncologic Outcomes ◽

Tumor Diameter ◽

Free Survival ◽

Early Stage Cervical Cancer ◽

Disease Free

BackgroundEarly stage cervical cancer is prevalent in China and remains a major public health burden in developing countries. We aimed to determine the long term oncologic outcomes between laparoscopic and abdominal radical hysterectomy in patients with early cervical cancer.MethodsWe conducted a multicenter, retrospective, case-control study of 37 hospitals. All consecutive early stage cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1 with lymphovascular space invasion to IB1, who underwent laparoscopic or abdominal radical hysterectomy between January 2004 and December 2016, were included. We compared the disease free survival and overall survival of the two approaches in 1:1 case-control matched settings based on prognosis related factors.ResultsWe selected 8470 of 46 313 patients. After matching (n=1601/1601), we found that laparoscopic surgery was associated with significantly worse 5 year disease free survival (89.5% vs 93.1%, p=0.001; hazard ratio (HR) 1.60, p=0.001), but not 5 year overall survival (94.3% vs 96.0%, HR=1.48, p=0.058). In the subgroup analysis, in patients with a tumor diameter <2 cm (n=739/739), both 5 year disease free survival and overall survival were similar between the laparoscopic and abdominal radical hysterectomy groups. However, when tumor diameter was 2–4 cm (n=898/898), laparoscopic surgery was a poor prognosis risk factor for 5 year disease free survival (84.7% vs 90.8%, p=0.001; HR=1.81, p<0.001), but not 5 year overall survival (90.9% vs 93.8%, p=0.077; HR=1.53, p=0.059).ConclusionsIn patients with early cervical cancer, laparoscopic radical hysterectomy was associated with significantly poorer long term oncologic outcome, although in patients with tumors <2 cm, the 5 year overall survival and 5 year disease free survival were similar.

Download Full-text

Abdominal Scar Recurrences of Cervical Cancer: Incidence and Characteristics: A Case-Control Study

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181db5153 ◽

2010 ◽

Vol 20 (6) ◽

pp. 1031-1040 ◽

Cited By ~ 4

Author(s):

Sabrina A. H. M. van den Tillaart ◽

Annelies Schoneveld ◽

Inge T. Peters ◽

J. Baptist M. Trimbos ◽

Astrid Van Hylckama Vlieg ◽

...

Keyword(s):

Cervical Cancer ◽

Recurrent Disease ◽

Figo Stage ◽

Resection Margins ◽

Control Group ◽

Case Group ◽

Tumor Diameter ◽

Gynecology And Obstetrics ◽

Mean Time

Background:Tumor recurrence in the surgical scar after radical hysterectomy for cervical cancer has been reported, but the incidence is unknown. Facts about patient and tumor characteristics and follow-up are lacking. The objective of this study was to analyze the incidence and characteristics of cervical cancer scar recurrences.Methods:All patients who were surgically treated for cervical cancer in our center between 1984 and 2007 were reviewed for scar recurrences. For each case, 5 random controls were selected. Clinical characteristics were compared between the cases and controls.Results:Eleven (1.3%) of 842 patients developed a scar recurrence. Mean time between surgery and scar recurrence was 16 months (range, 2-45 months). For 8 patients (73%), the scar recurrence was the first disease recurrence. Five patients (45%) died, and 2 (18%) were lost to follow-up. Mean time between scar recurrence and death was 9 months. Ninety-one percent of the cases had recurrent disease besides the scar recurrence during follow-up. The case group had a higher percentage of advanced FIGO (International Federation of Gynecology and Obstetrics) stage and postoperatively found involvement of parametria or resection margins and tumor diameter greater than 4 cm, whereas lymph nodes were more often involved in the control group.Conclusions:The incidence of scar recurrences after primary surgery for cervical cancer was 1.3%. Time to development was variable, and prognosis was poor. Besides higher FIGO stage and concurrent unfavorable pathological characteristics, we found no outstanding characteristics of patients with scar recurrence. Scar recurrences go hand in hand with recurrent disease at other locations and seem a manifestation of tumors with extensive metastatic potential.

Download Full-text

The Effect of Neoadjuvant Chemotherapy Combined With Brachytherapy Before Radical Hysterectomy on Stage IB2 and IIA Cervical Cancer: A Retrospective Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.618612 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yun Dang ◽

Qing Liu ◽

Lixia Long ◽

Hua Luan ◽

Qingfang Shi ◽

...

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Radical Hysterectomy ◽

Progression Free Survival ◽

Positive Margin ◽

Pelvic Radiotherapy ◽

Free Survival ◽

Hospital Patients ◽

And Child Health

ObjectiveThis study aims to retrospectively evaluate and compare the clinical efficacy in patients with stage IB2 and IIA cervical cancer, who treated with neoadjuvant chemotherapy combined with brachytherapy or not before radical hysterectomy.MethodsThe data of patients who have diagnosed with stage IB2 and IIA cervical cancer between January 2010 and December 2013 were retrieved through the Hospital Information System (HIS) of Gansu Provincial Maternal and Child Health Hospital. Patients were divided into two groups: neoadjuvant chemotherapy combined with brachytherapy followed by radical hysterectomy group (NACT+BT Group) and direct radical hysterectomy group (RH Group). The rate of adjuvant radiotherapy, progression-free survival (PFS), and overall survival (OS) were compared between the two groups.ResultsA total of 183 patients were included in this study with 82 in the NACT+BT group and 101 in the RH group. The median follow up duration was 44.9 months for the NACT+BT group and 38.1 months for the RH group. The 5-year PFS for NACT+BT Group was 93.8%, which was significantly higher compared to the RH group (77.2%, P= 0.0202). The rate of postoperative adjuvant pelvic radiotherapy was significantly lower in the NACT+BT group compared to the RH group (30.49% vs 79.21%; P <0.05). COX multivariate analysis showed that NACT+BT increased PFS by 29% compared with RH treatment, and Positive margin decreased PFS and OS by by 4.7 and 6.87 times, respectively.ConclusionNeoadjuvant chemotherapy combined with brachytherapy followed by radical hysterectomy (NACT+BT) can extend PFS, reduce postoperative pathological risk, and postoperative adjuvant pelvic radiotherapy compared to the direct radical hysterectomy (RH).

Download Full-text