Comparative effectiveness of laparoscopic radical hysterectomy for cervical cancer.

e17015 Background: Despite the benefits of minimally invasive surgery for cervical cancer, population-level data describing the surgery’s effectiveness in unselected patients are lacking. We compared morbidity, cost, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Methods: We used the Korean Health Insurance Review and Assessment Service database to identify women with cervical cancer who underwent radical hysterectomy from 2011 to 2014. Patient who underwent abdominal radical hysterectomy were compared with those who had minimally invasive hysterectomy. Perioperative morbidity, use of adjuvant therapy, and survival were evaluated. Results: We identified 6,335 patients including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. Uptake of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger and treated at larger hospital were more likely to undergo laparoscopic procedure (P<0.001). Laparoscopic radical hysterectomy had lower rates of complication, less transfusion requirement, shorter hospital stays, and reduced total medical costs (P<0.001). There was no significant association between use of laparoscopic approach and recurrence-free survival (P=0.194). Conclusions: Laparoscopic radical hysterectomy was associated with lower risk of perioperative complication and have comparable outcomes with abdominal radical hysterectomy.

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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.

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Robotic radical hysterectomy for early-stage cervical cancer: A systematic literature review

Gynecologic Robotic Surgery ◽

10.36637/grs.2021.00038 ◽

2021 ◽

Vol 2 (2) ◽

pp. 33-42

Author(s):

Gun Oh Chong

Keyword(s):

Cervical Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Radical Hysterectomy ◽

Open Surgery ◽

Early Stage ◽

Laparoscopic Approach ◽

Robotic Radical Hysterectomy ◽

Early Stage Cervical Cancer

Robotic technology has recently come into widespread use to overcome the limitations of laparoscopic radical hysterectomy in the treatment of early-stage cervical cancer. Most comparative studies showed that blood loss and hospital stays for patients undergoing minimally invasive surgery, including robotic procedures, were superior compared to open surgery. Moreover, the survival outcomes of robotic radical hysterectomy were not inferior to open radical hysterectomy. Unexpectedly, the Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized, open-label, noninferiority study that compared minimally invasive radical hysterectomy with open radical hysterectomy, revealed that minimally invasive surgery was associated with a higher risk of recurrence and death compared with open surgery. Strict guidelines for robotic radical hysterectomy for the treatment of early-stage cervical cancer should be established in accordance with objective Korean data. In addition, it is recommended that further studies should be performed on how to avoid the use of uterine manipulators and the dissemination of cancer cells by ensuring a more effective vaginal closure using a standardized approach.

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Survival after Laparoscopic Radical Surgery for Early-stage Cervical Cancer in 1316 Consecutive Cases from a National Laparoscopic Training Center in China

10.21203/rs.3.rs-915547/v1 ◽

2021 ◽

Author(s):

Yuhui Huang ◽

Jing Cai ◽

Hongbo Wang ◽

Weihong Dong ◽

Yuan Zhang ◽

...

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Radical Hysterectomy ◽

Laparoscopic Training ◽

Oncologic Outcomes ◽

Consecutive Series ◽

Training Center ◽

Cancer Trial ◽

Laparoscopic Radical Hysterectomy ◽

Stage Ia

Abstract Background: A major concern about the Laparoscopy Approach to Cervical Cancer trial is the disparities in laparoscopic radical hysterectomy experience between the participating centers and the potential effects of the learning curve of minimally invasive surgery on the oncologic outcomes of patients. Thus, it is necessary to assess the survival of cervical cancer patients undergoing laparoscopy in a minimally invasive gynecology center.Methods: A consecutive series of patients undergoing first laparoscopic radical hysterectomy (LRH) for cervical cancer from May 2008 to December 2017 at a national laparoscopic training center were retrospectively analyzed. The overall survival (OS) and progression-free survival (PFS) were compared between groups.Results: In total, 1316 women with FIGO (2009) stage IA-IIB cervical cancer received LRH. Among them, 1114 (84.7%) were followed-up for 3 months or longer; the median follow-up period was 48 months (range, 3-144 months). In patients with stage IA, IB1 (≤ 2 cm), IB1 (> 2 cm), IB2, IIA1 and IIA2-IIB tumors, the 4-year PFS rates were 98.6%, 94.5%, 87.4%, 65.6%, 80.0% and 67.4%, respectively, and the 4-year OS rates were 98.6%, 96.8%, 91.1%, 77.4%, 85.6% and 76.2%, respectively. The 4-year PFS and OS were as high as 96.2% and 97.5%, respectively, in patients with squamous cell carcinoma of 2 cm or smaller in diameter. A stable high 4-year OS and PFS was achieved after completing 100 LRHs. In patients operated on by the same surgeon, an improvement in survival was observed after 40 LRHs. Conclusion: Favorable oncologic outcomes can be achieved in patients with IA-IB1 cervical cancer after LRH in a center with a high surgery volume.

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Application of Novel Tumor-free Techniques in Laparoscopic Radical Hysterectomy for Early Cervical Cancer.

10.21203/rs.3.rs-149355/v1 ◽

2021 ◽

Author(s):

Huining Jing ◽

Junying Zhou ◽

Xuting Ran ◽

Wenjiao Min ◽

Zhengyu Li

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Radical Hysterectomy ◽

Surgical Techniques ◽

Open Approach ◽

Initial Experience ◽

Invasive Approach ◽

Laparoscopic Radical Hysterectomy ◽

Uterine Manipulator ◽

Early Cervical Cancer

Abstract Objective: Minimally invasive radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, it was recently reported to be significantly inferior in long-term outcomes of the minimally invasive approach to open approach. The underlying causes of this finding arouse great concern and remain controversial. Here we would like to share some initial experience of tumor-free techniques in laparoscopic procedures for early cervical cancer, including uterine manipulator-free manipulation and enclosed colpotomy. Methods: Between December 2019 and May 2020, we performed manipulator-free laparoscopic radical hysterectomy in 26 cases with early cervical cancer. The modified tumor-free techniques, including uterine manipulator-free manipulation and enclosed colpotomy, was described in detail with illustrations.Results: The procedures went well in all patients. In our initial experience, these modifications do not increase the difficulty of surgical techniques, and can be well performed by the experienced surgeons.Conclusions: These techniques are safe and feasible, and the effects on oncological outcomes deserve follow-up and further clinical studies.

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Total Laparoscopic Nerve-Sparing Radical Hysterectomy Using the No-look No-touch Technique

The Surgery Journal ◽

10.1055/s-0041-1736178 ◽

2021 ◽

Author(s):

Atsushi Fusegi ◽

Hiroyuki Kanao

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Radical Hysterectomy ◽

Poor Prognosis ◽

Early Stage ◽

Laparoscopic Approach ◽

Nerve Sparing ◽

Cancer Trial ◽

Early Stage Cervical Cancer ◽

Tumor Spillage

AbstractRadical hysterectomy is a standard operation for patients with early-stage cervical cancer. Over the recent decades, laparoscopic radical hysterectomy has been considered an alternative treatment. In 2018, the results of the laparoscopic approach to cervical cancer trial suggested that women with early-stage cervical cancer who underwent minimally invasive surgery for radical hysterectomy had poorer prognosis than those who underwent open surgery. This finding was unexpected, and direct evidence supporting poor prognosis related to minimally invasive radical hysterectomy was not available because the trial was not designed to evaluate the cause of the inferior outcomes. Tumor spillage caused by surgeon-related factors, including squeezing of the uterine cervix and tumor exposure to circulating CO2 gas, is considered to be associated with the poor prognosis of patients who underwent minimally invasive radical hysterectomy. We believe that protective maneuver to avoid tumor spillage is the key to improve oncologic outcomes of cervical cancer. Here, we present a procedure of total laparoscopic nerve-sparing radical hysterectomy for early-stage cervical cancer in which techniques, such as the “no-look no-touch technique,” were used to prevent tumor spillage.

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Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000388 ◽

2019 ◽

Vol 29 (5) ◽

pp. 845-850 ◽

Cited By ~ 47

Author(s):

Christhardt Köhler ◽

Hermann Hertel ◽

Jörg Herrmann ◽

Simone Marnitz ◽

Peter Mallmann ◽

...

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Lymph Nodes ◽

Radical Hysterectomy ◽

Invasive Cervical Cancer ◽

Survival Rates ◽

Disease Free Survival ◽

Laparoscopic Approach ◽

Invasive Approach ◽

Early Cervical Cancer

ObjectiveLaparoscopic/robotic radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC) has demonstrated significant inferiority of the minimally invasive approach. The aim of this study is to evaluate the oncologic outcomes of combined laparoscopic-vaginal radical hysterectomy.MethodsBetween August 1994 and December 2018, patients with invasive cervical cancer were treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to the LACC trial were identified. In contrast to the laparoscopic/robotic technique used in the LACC trial, all patients in our cohort underwent a combined transvaginal-laparoscopic approach without the use of any uterine manipulator.ResultsA total of 1952 consecutive patients with cervical cancer were included in the analysis. Initial International Federation of Gynecology and Obstetrics (FIGO) stage was IA1 lymphovascular space invasion (LVSI+), IA2 and IB1/IIA1 in 32 (8%), 43 (11%), and 314 (81%) patients, respectively, and histology was squamous cell in 263 (68%), adenocarcinoma in 117 (30%), and adenosquamous in 9 (2%) patients. Lymphovascular invasion was confirmed in 106 (27%) patients. The median number of lymph nodes was 24 (range 2–86). Lymph nodes were tumor-free in 379 (97%) patients. Following radical hysterectomy, 71 (18%) patients underwent adjuvant chemoradiation or radiation. After a median follow-up of 99 (range 1–288) months, the 3-, 4.5-, and 10-year disease-free survival rates were 96.8%, 95.8%, and 93.1 %, and the 3-, 4.5-, and 10-year overall survival rates were 98.5%, 97.8%, and 95.8%, respectively. Recurrence location was loco-regional in 50% of cases with recurrence (n=10). Interestingly, 9/20 recurrences occurred more than 39 months after surgery.ConclusionThe combined laparoscopic-vaginal technique for radical hysterectomy with avoidance of spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery may be oncologically safe and should be validated in further randomized trials.

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Oncologic Outcomes of Laparoscopic Radical Hysterectomy Using the No-Look No-Touch Technique for Early Stage Cervical Cancer: A Propensity Score-Adjusted Analysis

Cancers ◽

10.3390/cancers13236097 ◽

2021 ◽

Vol 13 (23) ◽

pp. 6097

Author(s):

Atsushi Fusegi ◽

Hiroyuki Kanao ◽

Naoki Ishizuka ◽

Hidetaka Nomura ◽

Yuji Tanaka ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Cox Model ◽

Disease Free Survival ◽

Laparoscopic Approach ◽

Oncologic Outcomes ◽

Significant Heterogeneity ◽

Laparoscopic Radical Hysterectomy ◽

Early Stage Cervical Cancer

We evaluated oncologic outcomes of laparoscopic radical hysterectomy using the no-look no-touch technique (NLNT). We analyzed patients with early stage (IA2, IB1, and IIA1, FIGO2008) cervical cancer treated between December 2014 and December 2019. The primary endpoint was disease-free survival (DFS). We compared the outcomes of the abdominal radical hysterectomy (ARH) and NLNT groups using a Cox model with inverse probability of treatment weighting (IPTW), according to propensity scores. We also evaluated NLNT’s non-inferiority to ARH using an evaluation of heterogeneity between the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial and our study. ARH and NLNT were performed in 118 and 113 patients, respectively. The median follow-up duration was 3.2 years. After IPTW adjustment, the 3-year DFS rates (NLNT 92.4%; ARH 94.0%) and overall survival rates did not differ significantly between the groups. Furthermore, the 3-year DFS rates for patients with tumor sizes ≥ 2 cm in the NLNT (85.0%) and ARH (90.3%) groups did not differ significantly. No significant heterogeneity was observed between the LACC trial and our study (I2 = 60.5%, p = 0.111), although there was a trend toward a lower hazard ratio in our study. Laparoscopic radical hysterectomy using NLNT provides a favorable prognosis for early stage cervical cancer.

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ROBOTIC VERSUS LAPAROSCOPIC RADICAL HYSTERECTOMY FOR EARLY CERVICAL CANCER: A CASE MATCHED CONTROL STUDY

10.26226/morressier.599bdc7bd462b80296ca0ad9 ◽

2017 ◽

Author(s):

Conte Carmine

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Matched Control ◽

Laparoscopic Radical Hysterectomy ◽

Early Cervical Cancer ◽

Control Study

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Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-002086 ◽

2021 ◽

pp. ijgc-2020-002086

Author(s):

Juliana Rodriguez ◽

Jose Alejandro Rauh-Hain ◽

James Saenz ◽

David Ortiz Isla ◽

Gabriel Jaime Rendon Pereira ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Laparoscopic Radical Hysterectomy ◽

Oncological Outcomes ◽

Early Stage Cervical Cancer ◽

Laparotomy Group ◽

Disease Free

IntroductionRecent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.MethodsWe performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.ResultsA total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8–201.2) in the laparoscopic group and 52.6 months (range, 0.4–166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09–2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05–4.37; P=0.03).ConclusionIn this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

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