Feasibility and Outcomes of “No-Look No-Touch” Laparoscopic Radical Trachelectomy for Early-Stage Cervical Cancer

Intraoperative tumor manipulation and dissemination may compromise the survival of women with early-stage cervical cancer who undergo laparoscopic surgery. This study aimed to examine survival and obstetrical outcomes related to laparoscopic radical trachelectomy (LRT) with a “no-look no-touch” technique in 40 women. This technique incorporates five measures to prevent tumor spillage and damage to the uterine artery perfusion. Five LRTs were aborted because of positive nodes or positive surgical margins. Compared with those of type III laparoscopic radical hysterectomy, the surgical outcomes of LRT in 35 patients were acceptable: operative time (380 min), estimated blood loss (140 mL), length of hospital stay (15 days), and lengths of excised parametrium and vagina. During follow-up (median, 41.3 months), the 5-year disease-free survival and overall survival were 95.0% (95% CI: 69.5–99.3%) and 100%, respectively. Of the nine patients (26%) who attempted pregnancy, seven conceived (nine pregnancies, 76%). Eight were delivered by term cesarean section, while one was miscarried in the first trimester. Our study suggests that the no-look no-touch technique may be effective in reducing the risk of recurrence and improving obstetrical outcomes during LRT for early-stage cervical cancer.

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

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31820b3003 ◽

2011 ◽

Vol 21 (2) ◽

pp. 391-396 ◽

Cited By ~ 29

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.

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Abdominal Radical Trachelectomy: A Romanian Series

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000076 ◽

2014 ◽

Vol 24 (3) ◽

pp. 615-619 ◽

Cited By ~ 13

Author(s):

Mihai Emil Căpîlna ◽

Nicolae Ioanid ◽

Viorel Scripcariu ◽

Madalina Mihaela Gavrilescu ◽

Bela Szabo

Keyword(s):

Cervical Cancer ◽

Postoperative Complications ◽

Early Stage ◽

Intraoperative Complications ◽

Gynecologic Oncology ◽

First Trimester ◽

Complication Rates ◽

Radical Trachelectomy ◽

Fertility Sparing ◽

Early Stage Cervical Cancer

ObjectiveAbdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. The published results of ART, in comparison with vaginal radical trachelectomy, so far are limited.Materials and MethodsThis retrospective study comprises all cases of female patients referred to ART with early-stage cervical cancer from 2 gynecologic oncology centers in Romania.ResultsA total of 29 women were referred for ART, but subsequently, fertility could not be preserved in 3 of them. Eleven women had stage IA2 disease (42.3%), 14 (53.8%) women had stage IB1 disease, and 1 (3.8%) woman had stage IB2 disease. Histologic subtypes were 15 (57.6%) squamous, 8 (30.7%) adenocarcinoma, and 3 (11.5%) adenosquamous. There were no major intraoperative complications in both hospitals. Early postoperative complications were mainly related to the type C parametrectomy—bladder dysfunction for more than 7 days (8 [30.7%] women) and prolonged constipation (6 [23.0%] women). Other complications consisted in symptomatic lymphocele in 2 (7.6%) patients, which were drained. Median follow-up time was 20 months (range, 4–43 months). Up to the present time, there has been 1 (3.8%) recurrence in our series. Most patients did not experience late postoperative complications. Three (11.5%) women are amenorrheic, and 1 (3.8%) woman developed a cervical stenosis. Of the 23 women who have normal menstruation and maintained their fertility, a total of 7 (30.4%) women have attempted pregnancy, and 3 (42.8%) of them achieved pregnancy spontaneously. These pregnancies ended in 2 first trimester miscarriages and 1 live birth at term by cesarean delivery.ConclusionsOur results demonstrate that ART preserves fertility and maintains excellent oncological outcomes with low complication rates.

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Minimally invasive versus open radical trachelectomy for early-stage cervical cancer: protocol for a multicenter randomized controlled trial in China

Trials ◽

10.1186/s13063-020-04938-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Xiaopei Chao ◽

Lei Li ◽

Ming Wu ◽

Huanwen Wu ◽

Shuiqing Ma ◽

...

Keyword(s):

Cervical Cancer ◽

Randomized Controlled Trial ◽

Early Stage ◽

Controlled Trial ◽

Disease Free Survival ◽

Radical Trachelectomy ◽

Free Survival ◽

Randomized Controlled ◽

Early Stage Cervical Cancer ◽

Disease Free

Abstract Background There are limited data comparing the oncologic and fertility outcomes of patients with early-stage cervical cancer (CC) treated by minimally invasive radical trachelectomy (MIRT) or abdominal radical trachelectomy (ART). The purpose of this multicenter study is to compare the oncologic and fertility outcomes of patients treated by MIRT or ART in a randomized controlled manner in China. Methods This is a noninferiority, randomized controlled trial performed at 28 Chinese centers; the study is designed to compare the oncologic and fertility outcomes of patients treated by MIRT (robot-assisted or laparoscopic RT) or ART. Patients will be recruited if they have been diagnosed with stage IA1 (with lymphovascular space invasion), IA2, or IB1 CC (with a maximum tumor diameter ≤ 2 cm) in the FIGO 2009 staging system and histological subtypes of squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma and if they are also aged 18 to 40 years. These candidates will be randomly assigned to undergo MIRT or ART. The primary endpoint will be disease-free survival. Secondary endpoints will consist of overall and disease-free survival rates, fertility outcomes, and quality of life. A total of 414 patients are needed to accomplish the study goal, with 90.1% power at a 0.050 significance level to detect an equivalence hazard ratio of 0.75 in the ART group, considering 20% loss to follow-up. Discussion The results of the trial should provide robust evidence to surgeons regarding options for the surgical approach in patients with early-stage CC who have a strong willingness to preserve fertility. Trial registration ClinicalTrials.gov NCT03739944. Registered on November 14, 2018

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COMPARISON OF MRI, PET-CT, AND FROZEN BIOPSY IN THE EVALUATION OF LYMPH NODE STATUS BEFORE FERTILITY-SPRING RADICAL TRACHELECTOMY IN EARLY STAGE CERVICAL CANCER

10.26226/morressier.599bdc7ad462b80296ca0cf5 ◽

2017 ◽

Author(s):

Park Jeong-Yeol

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Early Stage ◽

Lymph Node Status ◽

Radical Trachelectomy ◽

Node Status ◽

Pet Ct ◽

Early Stage Cervical Cancer

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154 Disease-free survival in early-stage cervical cancer: comparison of laparoscopic versus open surgery in a tertiary centre

10.1136/ijgc-2020-esgo.11 ◽

2020 ◽

Author(s):

Amanda Veiga-Fernández ◽

María López-Altuna ◽

Ignacio Romero-Martínez ◽

Elsa Mendizábal Vicente ◽

Patricia Rincon Olbes ◽

...

Keyword(s):

Cervical Cancer ◽

Open Surgery ◽

Early Stage ◽

Disease Free Survival ◽

Free Survival ◽

Tertiary Centre ◽

Early Stage Cervical Cancer ◽

Disease Free

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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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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 ◽

10.1136/bmjopen-2020-038020 ◽

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

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