scholarly journals Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Juan Guo ◽  
Qingwei Hu ◽  
Zaixing Deng ◽  
Xiaotian Jin
Keyword(s):  
Cervical Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Early Stage ◽  
Meta Analysis ◽  
Radical Trachelectomy ◽  
Risk Of Recurrence ◽  
Early Stage Cervical Cancer

Objective: To provide updated evidence on comparative efficacy for clinical outcomes of radical trachelectomy and radical hysterectomy in patients with early-stage cervical cancer.Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews, and Google scholar databases. Studies were done in patients with early-stage cervical cancer that compared the outcomes between radical trachelectomy (RT) and hysterectomy (RH) were considered for inclusion in the review. The outcomes of interest were operative time, the volume of blood loss, need for blood transfusion, any complications, length of hospital stay, risk of recurrence, and survival. The strength of association was presented in the form of pooled relative risk (RR), hazards risk (HR), and weighted mean difference (WMD). Statistical analysis was done using STATA version 16.0.Results: A total of 12 articles were included in the meta-analysis. The majority were retrospective cohort-based studies. Compared to RH, the operative time (in min) was comparatively higher in RT (WMD 23.43, 95% CI: 5.63, 41.24). Patients undergoing RT had blood loss (in ml) similar to those undergoing RT (WMD −81.34, 95% CI: −170.36, 7.68). There were no significant differences in the risk of intra-operative (RR 1.61, 95% CI: 0.49, 5.28) and post-operative complications (RR 1.13, 95% CI: 0.54, 2.40) between the two groups. Patients in the RT group had lesser duration of post-operative hospital stay (in days) (WMD −1.65, 95% CI: −3.22, −0.09). There was no statistically significant difference in the risk of recurrence (HR 1.21, 95% CI: 0.68, 2.18), 5-year overall survival (HR 1.00, 95% CI: 0.99, 1.02), and recurrence-free survival (HR 0.99, 95% CI: 0.96, 1.01) between the two groups.Conclusion: Among the patients with early-stage cervical cancer, RT is similar to RH in safety and clinical outcomes. Future studies with a randomized design and larger sample sizes are needed to further substantiate these findings.

Laparoscopically Assisted Radical Vaginal Hysterectomy for Early-Stage Cervical Cancer: A Systemic Review and Meta-Analysis

2016 ◽  
Vol 26 (8) ◽  
pp. 1497-1502 ◽  
Author(s):  
Sichen Zhang ◽  
Shaowei Wang ◽  
Aiming Lv ◽  
Shuai Huang
Keyword(s):  
Cervical Cancer ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Hospital Stay ◽  
Radical Hysterectomy ◽  
Vaginal Hysterectomy ◽  
Operative Time ◽  
Early Stage ◽  
Rectal Injury ◽  
Early Stage Cervical Cancer

ObjectiveThe aim of this study was to compare intraoperative and short-term postoperative outcomes and recurrence of laparoscopically assisted radical vaginal hysterectomy (LARVH) to abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer.MethodsA search of PubMed, EMBASE, and Cochrane library search trial (central) databases was conducted from database inception through December 2015. We included studies comparing surgical approaches with radical hysterectomy (LARVH vs ARH) in women with stages IA1 to IIB cervical cancer. Outcomes included blood loss, operative time, number of lymph nodes retrieved, intraoperative complications, hospital stay, and prognosis.ResultSeven studies were included (4 prospective cohort studies and 3 case control studies) enrolling 794 women; 349 women were treated by LARVH, and 445 were treated by ARH. Laparoscopically assisted radical vaginal hysterectomy was associated with less blood loss (weight mean difference [WMD], −237.45; 95% confidence interval [CI], −453.42 to −21.47), wound-related complications (odds ratio, 0.17; 95% CI, 0.05–0.61), shorter hospital stay (WMD, −2.01; 95% CI, −2.52 to −1.51), and longer operative time (WMD, 48.95; 95% CI, 42.08 to 55.82) versus ARH. Laparoscopically assisted radical vaginal hysterectomy was comparable with ARH in number of lymph nodes retrieved, urinary-related complications, rectal injury, lymphedema, and all prognosis indicators.ConclusionsThe evidence suggests that LARVH is superior to ARH with lower blood loss, less wound-related complications, and shorter hospital stay. Laparoscopically assisted radical vaginal hysterectomy and ARH seem equivalent in number of lymph nodes retrieved, urinary-related complications, rectal injury, lymphedema, and prognosis.

Robotic Uterine Artery Preservation and Nerve-Sparing Radical Trachelectomy With Bilateral Pelvic Lymphadenectomy in Early-Stage Cervical Cancer

2011 ◽  
Vol 21 (2) ◽  
pp. 391-396 ◽  
Author(s):  
Dae Gy Hong ◽  
Yoon Soon Lee ◽  
Nae Yoon Park ◽  
Gun Oh Chong ◽  
Il Soo Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Blood Loss ◽  
Uterine Artery ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Nerve Sparing ◽  
Radical Trachelectomy ◽  
Estimated Blood Loss ◽  
Early Stage Cervical Cancer ◽  
The Mean

Objective:The aim of the study was to evaluate the safety and feasibility of robotic uterine artery preservation and nerve-sparing radical trachelectomy with pelvic lymphadenectomy using the da Vinci surgical system.Methods:Three patients who were diagnosed with early-stage cervical cancer underwent robotic uterine artery preservation and nerve-sparing radical trachelectomy with bilateral lymphadenectomy from January 2010 to March 2010. The data were compared with those of 4 cases of total laparoscopic nerve-sparing radical trachelectomy that were performed from July 2004 to May 2005 and were previously reported.Results:In the robotic group, the mean console time was 275 minutes (range, 240-305 minutes). The mean postoperative hemoglobin change was 0.4 g/dL (range, 0.2-0.6 g/dL). The mean estimated blood loss was 23 mL (range, 15-40 mL), which is less than that of the laparoscopic group. There were no metastases detected in any of the cases, and the resection margins were negative in both groups.Conclusions:The robotic uterine artery preservation and nerve-sparing radical trachelectomy with pelvic lymphadenectomy were efficient in reducing blood loss and feasible methods such as other approaches.

scholarly journals Cervical Cancer and Fertility-Sparing Treatment

2021 ◽  
Vol 10 (21) ◽  
pp. 4825
Author(s):  
François Zaccarini ◽  
Claire Sanson ◽  
Amandine Maulard ◽  
Stéphanie Schérier ◽  
Alexandra Leary ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Radical Trachelectomy ◽  
Risk Of Recurrence ◽  
Pelvic Node ◽  
Pelvic Node Dissection ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Negative Lymph Nodes ◽  
Cancer And Fertility

Radical hysterectomy with pelvic node dissection is the standard treatment for early-stage cervical cancer. However, the latter can be diagnosed at a young age when patients have not yet achieved their pregnancy plans. Dargent first described the vaginal radical trachelectomy for patients with tumors <2 cm. It has since been described a population of low risk of recurrence: patients with tumors <2 cm, without deep stromal infiltration, without lymphovascular invasion (LVSI), and with negative lymph nodes. These patients can benefit from a less radical surgery such as conization or simple trachelectomy with the evaluation of the pelvic node status. Tumors larger than 2 cm have a higher risk of recurrence and their treatment is a challenge. There are currently two options for these patients: abdominal radical trachelectomy or neoadjuvant chemotherapy (NACT), followed by fertility-sparing surgery. All patients who wish to preserve their fertility must be referred to expert centers.

Laparoscopic Radical Trachelectomy Is an Alternative to Laparotomy With Improved Perioperative Outcomes in Patients With Early-Stage Cervical Cancer

2014 ◽  
Vol 24 (1) ◽  
pp. 135-140 ◽  
Author(s):  
Ali Kucukmetin ◽  
Ioannis Biliatis ◽  
Nithya Ratnavelu ◽  
Amit Patel ◽  
Iain Cameron ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Length Of Stay ◽  
Blood Loss ◽  
Early Stage ◽  
Demographic Data ◽  
Laparoscopic Approach ◽  
Perioperative Outcomes ◽  
Radical Trachelectomy ◽  
Late Morbidity ◽  
Early Stage Cervical Cancer

ObjectiveRadical trachelectomy is an established surgical approach for managing young women with cervical cancer wishing to preserve fertility. The aim of this study was to compare perioperative outcomes between laparoscopic (LRT) and abdominal radical trachelectomy (ART).MethodsWe reviewed the records of all women undergoing either LRT or ART in our institution since 2004. Demographic data, clinicopathologic data, and perioperative outcomes were collected and compared between the 2 procedures.ResultsOverall, 27 women were identified. All of them had stage IB1 disease. Eleven (40.8%) women underwent LRT, whereas 16 (59.2%) women underwent ART. Age, parity, and body mass index, as well as histologic type, grade, and presence of lymphovascular space invasion were comparable between groups. The median length of the parametrial tissue removed was shorter in LRT versus ART (P = 0.022). The median blood loss and length of stay were significantly reduced in the LRT group (85 vs 800 mL, P < 0.001; and 4 versus 7 days, P = 0.003). The median operative time was longer with the laparoscopic approach (320 versus 192.5 minutes, P < 0.001). Early grade 1 to 2 postoperative morbidity (mainly high urinary residuals) was comparable between groups; however, more grade 3 and late morbidity events were recorded in the ART group.ConclusionsThis first comparison study between LRT and ART for fertility preservation in women with cervical cancer shows that laparoscopy performed better in terms of blood loss and length of stay. Laparoscopic radical trachelectomy could be the preferred option for these patients; however, further studies are needed to confirm comparable survival outcomes.

scholarly journals The Safety and Effectiveness of Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer During Pregnancy

2018 ◽  
Vol 28 (4) ◽  
pp. 782-787 ◽  
Author(s):  
Kosuke Yoshihara ◽  
Tatsuya Ishiguro ◽  
Makoto Chihara ◽  
Eiri Shima ◽  
Sosuke Adachi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Blood Loss ◽  
Pregnant Women ◽  
Early Stage ◽  
Oncologic Outcomes ◽  
Survival Times ◽  
Radical Trachelectomy ◽  
Surgical Time ◽  
Lymph Node Count ◽  
Early Stage Cervical Cancer

ObjectivesCervical cancer is one of the most frequently diagnosed cancers in pregnancy. Our aim was to evaluate the safety and efficacy of abdominal radical trachelectomy (ART) for pregnant women with early-stage cervical cancer who strongly desire to preserve their pregnancies.Methods/MaterialsA retrospective observational study was performed for stage IB1 cervical cancer patients who underwent ART or radical hysterectomy (RH) at our hospital between February 2013 and June 2017. We compared differences in perioperative findings and oncologic outcomes among ART during pregnancy (ART-DP), ART, and RH groups.ResultsA total of 38 patients were included in this analysis. Six, 10, and 22 patients were assigned to the ART-DP, ART, and RH groups, respectively. There were no significant differences in the distribution of pathological TNM classifications, histology, tumor size, stromal invasion, and lymph-vascular space invasion among the 3 groups. The patients in the ART-DP group were younger than those in the RH group (P = 0.014). The ART-DP group was associated with more blood loss and prolonged surgery compared with the RH group (P = 0.017 and P = 0.014). The number of total lymph nodes in the ART-DP group was lower than that in the RH group (P = 0.036). However, there were no significant differences in age, surgical time, blood loss, or lymph node count between the ART-DP and ART groups. There were no significant differences in progression-free and overall survival times among the 3 groups, and no recurrence was observed in the ART-DP group.ConclusionsAbdominal radical trachelectomy may be a tolerable treatment option for pregnant women with early-stage cervical cancer who strongly desire a baby.

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