scholarly journals Application of Modified Laparoscopic Radical Hysterectomy in The Treatment of Early Cervical Cancer

2021 ◽  
Author(s):  
Xuqing Li ◽  
Xueting Pei ◽  
Hongyan Li ◽  
Yan Wang ◽  
Youwei Zhou ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Surgical Procedure ◽  
Early Stage ◽  
Disease Free Survival ◽  
Bladder Function ◽  
Laparoscopic Radical Hysterectomy ◽  
Gynecology And Obstetrics ◽  
Normal Bladder ◽  
Early Stage Cervical Cancer

Abstract Background: To investigate the safety and efficacy of modified laparoscopic radical hysterectomy (MLRH) in the treatment of early stage cervical cancer by comparing relevant indices of different surgical procedures in patients with early stage cervical cancer.Methods: Patients with 2014 International Federation of Gynecology and Obstetrics (FIGO) clinical stages IB1 and IIA1 cervical cancer who underwent radical hysterectomy in the Gynecological Department of our hospital from October 2015 to June 2018 were enrolled. Patients were divided into two groups based on the surgical procedure: the open radical hysterectomy (ORH) group (n=336) and MLRH group (n=302). We retrospectively analyzed and compared the clinical characteristics, surgical indices, and survival prognosis between the groups.Results: Compared to the ORH group, the MLRH group exhibited a longer operative time, normal bladder function recovery time, less intraoperative blood loss volume, and more harvested pelvic lymph nodes (P<0.05). No significant differences were observed in postoperative complications, the 2.5-year overall survival (OS) rate, 2.5-year disease-free survival (DFS) rate, and recurrence rate between the groups (P>0.05), but the recurrence pattern was significantly different between the groups (P<0.05). Stratified analysis revealed that OS time was shorter in the ORH group than in the MLRH group in patients with stage IB1 and middle invasion (P<0.05). Pathological type was an independent factor for DFS and OS in early stage cervical cancer.Conclusion: MLRH incorporates a series of measures to prevent tumor spillage. It is a feasible and effective surgical procedure for the treatment of early stage cervical cancer.Trial registration: Present research is a retrospective study. The study had retrospectively registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/) and the registered number is ChiCTR1900026306.

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

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.

scholarly journals Efficacy of different surgical approaches on survival outcomes in patients with early-stage cervical cancer: protocol for a multicentre longitudinal study in China

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038020
Author(s):  
Xiaopei Chao ◽  
Ming Wu ◽  
Shuiqing Ma ◽  
Xianjie Tan ◽  
Sen Zhong ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Disease Free Survival ◽  
Learning Curves ◽  
Surgical Approaches ◽  
Survival Outcomes ◽  
Link Type ◽  
Gynecology And Obstetrics ◽  
Early Stage Cervical Cancer

IntroductionRecent studies have revealed that the oncological survival outcomes of minimally invasive radical hysterectomy (MIRH) are inferior to those of abdominal radical hysterectomy (ARH) in early-stage cervical cancer, but the potential reasons are unclear.Methods and analysisEach expert from 28 study centres participating in a previously reported randomised controlled trial (NCT03739944) will provide successive eligible records of at least 100 patients who accepted radical hysterectomy for early-stage cervical cancer between 1 January 2009 and 31 December 2015. Inclusion criteria consist of a definite pathological evaluation of stages IA1 (with positive lymphovascular space invasion), IA2 and IB1 according to the International Federation of Gynecology and Obstetrics 2009 staging system and a histological subtype of squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma. The primary endpoint is 5-year disease-free survival between the MIRH and ARH groups. The secondary endpoints include the MIRH learning curves of participating surgeons, 5-year overall survival between the MIRH and ARH groups, survival outcomes according to surgical chronology, surgical outcomes and sites of recurrence and potential risk factors that affect survival outcomes. A subgroup analysis in patients with tumour diameter less than 2 cm will follow the similar flow diagram.Ethics and disseminationThis study has been approved by the Institutional Review Board of Peking Union Medical College Hospital (registration no. JS-1711), and is also filed on record by all other 27 centres. The results will be disseminated through community events and peer-reviewed journals.Trial registration numberNCT03738969

Comparison of laparoscopic versus open radical hysterectomy in patients with early-stage cervical cancer: a multicenter study in China

2020 ◽  
Vol 30 (8) ◽  
pp. 1143-1150
Author(s):  
Ting wen yi Hu ◽  
Yue Huang ◽  
Na Li ◽  
Dan Nie ◽  
Zhengyu Li
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Radical Hysterectomy ◽  
Tumor Size ◽  
Early Stage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Laparoscopic Radical Hysterectomy ◽  
Early Stage Cervical Cancer ◽  
Disease Free

IntroductionRecently, the safety of minimally invasive surgery in the treatment of cervical cancer has been questioned. This study was designed to compare the disease-free survival and overall survival of abdominal radical hysterectomy and laparoscopic radical hysterectomy in patients with early-stage cervical cancer.MethodsA total of 1065 patients with early-stage cervical cancer who had undergone abdominal/laparoscopic radical hysterectomy between January 2013 and December 2016 in seven hospitals were retrospectively analyzed. The 1:1 propensity score matching was performed in all patients. Patients with tumor size ≥2 cm and <2 cm were stratified and analyzed separately. Disease-free survival and overall survival were compared between matched groups. After confirming the normality by the Shapiro-Wilks test, the Mann-Whitney U test and the χ2 test were used for the comparison of continuous and categorical variables, respectively. The survival curves were generated by the Kaplan-Meier method and compared by log-rank test.ResultsAfter matching, a total of 812 patients were included in the disease-free survival and overall survival analyses. In the entire cohort, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.65, 95% CI 1.00 to 2.73; p=0.048) but not overall survival (HR 1.60, 95% CI 0.89 to 2.88; p=0.12) when compared with the abdominal radical hysterectomy group. In patients with tumor size ≥2 cm, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.93, 95% CI 1.05 to 3.55; p=0.032) than the abdominal radical hysterectomy group, whereas no significant difference in overall survival (HR 1.90, 95% CI 0.95 to 3.83; p=0.10) was found. Additionally, in patients with tumor size <2 cm, the laparoscopic radical hysterectomy and abdominal radical hysterectomy groups had similar disease-free survival (HR 0.71, 95% CI 0.24 to 2.16; p=0.59) and overall survival (HR 0.59, 95% CI 0.11 to 3.13; p=0.53).ConclusionLaparoscopic radical hysterectomy was associated with inferior disease-free survival compared with abdominal radical hysterectomy in the entire cohort, as well as in patients with tumor size ≥2 cm. For the surgical treatment of patients with early-stage cervical cancer, priority should be given to open abdominal radical hysterectomy.

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

Cancers ◽  
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.

Self-Reported Long-Term Autonomic Function After Laparoscopic Total Mesometrial Resection for Early-Stage Cervical Cancer: A Multicentric Study

2017 ◽  
Vol 27 (7) ◽  
pp. 1501-1507 ◽  
Author(s):  
Alessandro Lucidi ◽  
Swetlana Windemut ◽  
Marco Petrillo ◽  
Margherita Dessole ◽  
Giulio Sozzi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Radical Hysterectomy ◽  
Vaginal Hysterectomy ◽  
Early Stage ◽  
Nerve Sparing ◽  
Laparoscopic Radical Hysterectomy ◽  
Early Stage Cervical Cancer ◽  
Laparoscopic Assisted

ObjectivesThis multicentric retrospective study investigates the early and long-term self-reported urinary, bowel, and sexual dysfunctions in early-stage cervical cancer patients who submitted to laparoscopic total mesometrial resection (L-TMMR), total laparoscopic radical hysterectomy, vaginal-assisted laparoscopic radical hysterectomy, and laparoscopic-assisted radical vaginal hysterectomy.MethodsCervical cancer patients, FIGO (International Federation of Gynecology and Obstetrics) stage IA2–IB1/IIA1 who submitted to nerve-sparing radical hysterectomy were recruited. Pelvic functions were assessed within 30 days (early outcome) and 12 months after surgery (long-term outcome).ResultsTwo hundred thirteen subjects receiving nerve-sparing radical hysterectomy were enrolled. Laparoscopic total mesometrial resection was performed in 46 patients (21.6%), total laparoscopic radical hysterectomy in 65 patients (30.5%), vaginal-assisted laparoscopic radical hysterectomy in 54 patients (25.4%), and laparoscopic-assisted radical vaginal hysterectomy in 48 women (22.5%). Operative time was significantly lower in the L-TMMR group (240 minutes; range, 120–670 minutes; P = 0.001). The overall perioperative complication rate was 11.3%, with no statistically significant differences among the 4 groups. Stress incontinence and sensation of bladder incomplete emptying were detected, respectively, in 54 patients (25.6%) and 65 patients (30.7%) with a significantly lower prevalence among those in the L-TMMR group, which resulted, respectively, in 11.1% (P = 0.022) and 13.3% (P = 0.036). The prevalence rates of constipation, sensation of incomplete bowel emptying, and effort during evacuation were significantly higher among those in the L-TMMR group, resulting in, respectively, 37% (P = 0.001), 42.3% (P = 0.012), and 50% (P = 0.039). One hundred forty-nine patients (70%) were sexually active. Fifty-eight women (38.9%) reported low enjoyment, 83 women (55.7%) medium enjoyment, and 8 women (5.4%) reported high enjoyment, without statistically significant differences among the 4 groups.ConclusionsLaparoscopic total mesometrial resection is associated with improved long-term urinary autonomic functions and worse gastrointestinal autonomic outcome. Further larger prospective trials are needed to evaluate both the oncological and functional outcomes in order to establish the most appropriate surgical approach for early-stage cervical cancer patients.

scholarly journals Updated Opinion of the Uterus Commission of the Gynecological Oncology Working Group (AGO) and the Gynecological Endoscopy Working Group (AGE) of the German Society of Gynecology and Obstetrics (DGGG) on the Randomized Study Comparing Minimally Invasive with Abdominal Radical Hysterectomy for Early-stage Cervical Cancer (LACC)

2019 ◽  
Vol 79 (02) ◽  
pp. 145-147 ◽  
Author(s):  
Peter Hillemanns ◽  
Sara Brucker ◽  
Bernd Holthaus ◽  
Rainer Kimmig ◽  
Björn Lampe ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Working Group ◽  
Early Stage ◽  
Randomized Study ◽  
Published Data ◽  
Gynecological Oncology ◽  
Gynecology And Obstetrics ◽  
Early Stage Cervical Cancer

AbstractIn this opinion on the randomized study comparing minimally invasive with abdominal radical hysterectomy for early-stage cervical cancer (LACC), the Uterus Commission of the Gynecological Oncology Working Group (AGO) and the Gynecological Endoscopy Working Group (AGE) of the Germany Society of Gynecology and Obstetrics (DGGG) state that, based on their examination of the published data, patients with FIGO stage IA1 (with LVSI), IA2 or IB1 cervical cancer must be informed about the results of this LACC study prior to making a decision on the route for radical hysterectomy.

Sign in / Sign up

Export Citation Format

Share Document