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L'Huillier R, Michoud C, Dumortier J, Milot L. Massive peritoneal tumoral dissemination after hepatocellular carcinoma percutaneous microwave ablation with intraperitoneal CO 2 insufflation. Clin Res Hepatol Gastroenterol 2024; 48:102376. [PMID: 38754761 DOI: 10.1016/j.clinre.2024.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Romain L'Huillier
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; LabTAU - INSERM U1032, 69003 Lyon, France; The Everest Institute of the Liver, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Claire Michoud
- Department of Hepato-gastroenterology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Dumortier
- The Everest Institute of the Liver, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France; Department of Hepato-gastroenterology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; LabTAU - INSERM U1032, 69003 Lyon, France; The Everest Institute of the Liver, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
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Akimoto E, Kinoshita T, Yura M, Yoshida M, Okayama T, Habu T, Komatsu M, Nagata H, Terajima D. Feasibility of laparoscopic/robot-assisted surgery for Borrmann type 4 gastric cancer: a comparison study with conventional open surgery. Surg Endosc 2024; 38:3337-3345. [PMID: 38691134 DOI: 10.1007/s00464-024-10857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Laparoscopic surgery for early gastric cancer is regarded as a standard of care because of robust evidences obtained by several phase-III trials. Furthermore, the efficacy of laparoscopic radical surgery for advanced gastric cancer has been also reported. Meanwhile, the feasibility of laparoscopic surgery for Bormann type 4 gastric cancer, special type with unfavorable prognosis, remains unclear since excluded from eligibility of these trials. METHODS This study included 100 patients with type 4 gastric cancer who underwent laparoscopic/robot-assisted (minimally invasive surgery (MIS) group; n = 32) or open (Open group; n = 68) curative surgery between 2008 and 2021. After propensity score matching, 30 patients in each group were extracted for analysis. Clinical data, including surgical and midterm survival outcomes, were retrospectively compared between the two groups. RESULTS Incidences of postoperative complication (≥ Clavien-Dindo grade III) were recorded in 23.3% in the MIS group and 13.3% in the Open group, but no statistical significance was demonstrated (P = 0.50). The 3-year overall survival rate in the MIS group was better than that in the Open group (80.2% vs. 53.5%, log-rank, P = 0.03). The trend of recurrence site was similar. Multivariate analysis showed that adjuvant chemotherapy was an independent favorable prognostic factor (hazard ratio, 0.33, 95% confidence interval 0.11-0.93) for overall survival. MIS was indicated as a favorable prognostic factor (hazard ratio, 0.39, 95% confidence interval 0.39-1.07), but without statistical difference. CONCLUSION While multidisciplinary treatment is mainstay of treatment because of the poor prognosis of this disease, minimally invasive surgery may play an important role in treatment if appropriate patient selection is done. Further analyses with larger sample size are necessary to reach a final conclusion regarding oncological efficacy.
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Affiliation(s)
- Eigo Akimoto
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Masahiro Yura
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Mitsumasa Yoshida
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takafumi Okayama
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takumi Habu
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaru Komatsu
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiromi Nagata
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Daiki Terajima
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Yoon HJ, Kwon BS, Rho HJ, Lee TH, Jeong DH, Kim KH, Suh DS, Song YJ. Comparison of survival outcome of open, total laparoscopic, and laparoscopy-assisted radical vaginal hysterectomy for stage IB2 cervical cancer patients: A multicenter retrospective study. Medicine (Baltimore) 2024; 103:e37426. [PMID: 38457577 PMCID: PMC10919498 DOI: 10.1097/md.0000000000037426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
The aim of this study was to compare survival outcomes of 3 different radical hysterectomy (RH) types, namely total abdominal radical hysterectomy (TARH), total laparoscopic radical hysterectomy (TLRH), and laparoscopy-assisted radical vaginal hysterectomy (LARVH), in patients with FIGO stage IB2 cervical cancer. We retrospectively identified a cohort of patients who underwent RH for cervical cancer between 2010 and 2017. Patients with stage IB2 cervical cancer were included and were classified into TARH, TLRH, and LARVH treatment groups. Survival outcomes were estimated by the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards models were fit to estimate the independent association of RH technique with outcome. 194 patients were included in this study: 79 patients in the TARH group, 55 in the TLRH group, and 60 in the LARVH group. No significant differences were found in clinicopathological characteristics between the 3 RH groups. On comparing survival outcomes with TARH, both TLRH and LARVH showed no significant difference in terms of 5-year overall survival (TARH vs TLRH, P = .121 and TARH vs LARVH, P = .436). Conversely, compared to the TARH group, 5-year progression-free survival (PFS) was significantly worse in the TLRH group (P = .034) but not in the LARVH group (P = .288). Multivariate analysis showed that TLRH surgical approach (hazard ratio, 3.232; 95% confidence interval, 1.238-8.438; P = .017) was an independent prognostic factor for PFS in patients with IB2 cervical cancer. Our study suggests that in patients with FIGO stage IB2 cervical cancer, among the minimally invasive RH approaches, TLRH and LARVH, only TLRH approach was associated with worse PFS when compared with the TARH approach.
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Affiliation(s)
- Hyung Joon Yoon
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Byung Su Kwon
- Department of Obstetrics and Gynecology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hyun Jin Rho
- College of Medicine, University of Ulsan, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Tae Hwa Lee
- Department of Obstetrics and Gynecology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Dae Hoon Jeong
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
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Zhang J, Li M, Feng L, Zhai Y, Wang L, Chen Y. Laparoscopic versus laparotomic surgical treatment in apparent stage I ovarian cancer: a multi-center retrospective cohort study. World J Surg Oncol 2024; 22:62. [PMID: 38389046 PMCID: PMC10882876 DOI: 10.1186/s12957-024-03345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Laparoscopic treatment shows non-inferior survival outcomes and better surgical outcomes in apparent stage I ovarian cancer (OC) in some studies but has not been well defined. METHODS We conducted a retrospective study of patients with apparent stage I OC treated in two hospitals between 2012 and 2022. The surgical and oncologic outcomes were evaluated between patients receiving laparoscopic and laparotomic surgery. RESULTS We identified 37 patients with apparent stage I OC, including 15 (40.5%) serous carcinomas, 9 (24.3%) mucinous cancers, 3 (8.1%) endometroid cancers, 2 clear cell carcinomas, and 8 (21.6%) non-epithelial cancers. Sixteen patients received laparoscopic surgery and the other 21 patients underwent laparotomic surgery. The median age (44.5 vs. 49.0 years), mean mass size (10.5 vs. 11.3 cm), and median follow-up time (43.5 vs. 75.0 months) showed no statistically significant differences between patients in laparoscopic and laparotomic groups (all P > 0.05). All the patients underwent comprehensive surgical staging surgery, and the mean surgical time (213.5 vs. 203.3 min, P = 0.507), number of lymph nodes sampling (18.6 vs. 17.5, P = 0.359), proportion of upstaging (12.5% vs. 19.0%, P = 0.680), and postoperative complications (no Accordion Severity Grading System grade ≥ 3) were comparable between two surgical groups. Moreover, patients in the laparoscopic group had significantly less intraoperative blood loss (231.3 vs. 352.4 mL, P = 0.018), shorter interval between surgery and postoperative adjuvant chemotherapy (7.4 vs. 9.5 days, P = 0.004), shorter length of hospital stay (9.9 vs. 13.8 days, P < 0.001) than those treated with laparotomic surgery. During a median follow-up of 54.0 months, 9 (24.3%) relapsed and 1 (2.7%) died, with a 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rate of 70.6% and 100%, respectively. However, the 5-year RFS (93.3% vs. 58.8%, P = 0.084) and DSS (100% vs. 100%, P = 0.637) rates did not significantly differ between the two groups. CONCLUSION Laparoscopic surgical treatment had less intraoperative blood loss, earlier postoperative adjuvant chemotherapy administration, shorter hospitalization time, and non-inferior survival outcomes in apparent stage I OC when compared with laparotomic surgery.
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Affiliation(s)
- Jing Zhang
- Department of Gynecology, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), No. 376 Shunde Road, Xiangdu District, Xingtai, Hebei Province, 054000, People's Republic of China.
| | - Meiyan Li
- Department of Gynecology, Handan Central Hospital, Handan, Hebei Province, People's Republic of China
| | - Lan Feng
- Department of Gynecology, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), No. 376 Shunde Road, Xiangdu District, Xingtai, Hebei Province, 054000, People's Republic of China
| | - Yinjun Zhai
- Department of Intervention, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), Xingtai, Hebei Province, People's Republic of China
| | - Lin Wang
- Department of Gynecology, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), No. 376 Shunde Road, Xiangdu District, Xingtai, Hebei Province, 054000, People's Republic of China
| | - Yuancao Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xingtai Medical College (Xingtai First Hospital), Xingtai, Hebei Province, People's Republic of China
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Shvygin A, Manning-Geist BL, Sonoda Y. Fertility-sparing and minimally invasive surgery for early-stage cervical cancer. J Surg Oncol 2024; 129:112-116. [PMID: 38032090 DOI: 10.1002/jso.27540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Anna Shvygin
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Beryl L Manning-Geist
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Zhang Q, Silver M, Chen YJ, Wolf J, Hayek J, Alagkiozidis I. Comparison of Minimally Invasive Surgery with Open Surgery for Type II Endometrial Cancer: An Analysis of the National Cancer Database. Healthcare (Basel) 2023; 11:3122. [PMID: 38132012 PMCID: PMC10743283 DOI: 10.3390/healthcare11243122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Prior studies comparing minimally invasive surgery with open surgery among patients with endometrial cancer have reported similar survival outcomes and improved perioperative outcomes with minimally invasive surgery (MIS). However, patients with Type II endometrial cancer were underrepresented in these studies. We sought to compare the overall survival and surgical outcomes between open surgery and MIS in a large cohort of women with Type II endometrial cancer. METHODS Using data from the National Cancer Database, we identified a cohort of women who underwent hysterectomy for type II endometrial cancer (serous, clear cell, and carcinosarcoma) between January 2010 and December 2014. The primary outcome was a comparison of the overall survival for MIS with that for the open approach. The secondary outcomes included a comparison of the length of hospital stay, readmission within 30 days of discharge, and 30- and 90-day mortality. Outcomes were compared between the cohorts using the Mann-Whitney U test, Pearson's chi-square test, or Fisher's exact test. Multivariable logistic regression with inverse propensity weighting was used to determine clinical characteristics that were statistically significant predictors of outcomes. p values < 0.05 were considered significant. RESULTS We identified 12,905 patients with Type II, Stage I-III endometrial cancer that underwent a hysterectomy. In total, 7123 of these women (55.2%) underwent MIS. The rate of MIS increased from 39% to 64% over four years. Women who underwent MIS were more often White, privately insured, older, and had a higher income. The laparotomy group had a higher rate of carcinosarcoma histology (30.9% vs. 23.6%, p < 0.001), stage III disease (38.4% vs. 27.4%, p < 0.001), and larger primary tumors (59 vs. 45 mm, p < 0.001). Lymph node dissection was more commonly performed in the MIS group (89.6% vs. 85.4%, p < 0.001). With regard to adjuvant therapy, subjection to postoperative radiation was more common in the MIS group (37% vs. 40.1%, p < 0.001), while chemotherapy was more common in the laparotomy group (37.6% vs. 33.9%, p < 0.001). The time interval between surgery and the initiation of chemotherapy was shorter in the MIS group (39 vs. 42 days, p < 0.001). According to the results of propensity-score-weighted analysis, MIS was associated with superior overall survival (101.7 vs. 86.7 months, p = 0.0003 determined using the long-rank test), which corresponded to a 10% decreased risk of all-cause mortality (HR 0.9; CI 0.857-0.954, p = 0.0002). The survival benefit was uniform across all three histology types and stages. MIS was associated with superior perioperative outcomes, including shorter length of stay (1 vs. 4 days, p < 0.001), lower 30-day readmission rates (2.5% vs. 5%), and lower 30- and 90-day postoperative mortality (0.5% vs. 1.3% and 1.5% vs. 3.6%, respectively; p < 0.001 for both). The increased adoption of MIS from 2010 to 2014 corresponds to a decrease in 90-day postoperative mortality (2.8% to 2.2%, r = -0.89; p = 0.04) and overall mortality (51% to 38%, r = -0.95; p = 0.006). CONCLUSIONS In a large cohort of patients from the National Cancer Database, MIS was associated with improved overall survival and superior perioperative outcomes compared to open surgery among women with Type II endometrial cancer. A decrease in postoperative mortality and a shorter interval between surgery and the initiation of chemotherapy may contribute to the survival benefit of MIS. A racial and economic disparity in the surgical management of Type II endometrial cancer was identified, and further investigation is warranted to narrow this gap and improve patient outcomes.
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Affiliation(s)
- Qi Zhang
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Michael Silver
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Yi-Ju Chen
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Jennifer Wolf
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Judy Hayek
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Ioannis Alagkiozidis
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
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Tang X, Zhou S, Zhang X, Hua K, He Y, Wang P, Teng Y, Feng W. Comparison of the survival outcomes of laparoscopic, abdominal and gasless laparoscopic radical hysterectomy for early-stage cervical cancer: trial protocol of a multicenter randomized controlled trial (LAGCC trial). Front Oncol 2023; 13:1287697. [PMID: 38023150 PMCID: PMC10679326 DOI: 10.3389/fonc.2023.1287697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Radical hysterectomy (RH) is considered a cornerstone in the treatment of early-stage cervical cancer. However, the debate surrounding the optimal surgical approach, whether minimally invasive or open surgery, remains controversial. The objective of this trial is to evaluate the survival outcomes of cervical cancer patients who undergo different surgical approaches. Methods This study is designed as a prospective, multicenter, open, parallel, and randomized controlled trial. A total of 500 patients diagnosed with stage IA1 with LVSI, IA2, IB1, or IB2 (2018 FIGO) will be recruited. Recruitment of participants started in November 2020. The participants will be randomly assigned to one of three groups: conventional laparoscopic RH, gasless laparoscopic RH, or abdominal RH. The primary endpoint of this trial is the 2-year disease-free survival (DFS) rate. The secondary endpoints will include the 2-year overall survival (OS) rate, 5-year DFS/OS, recurrence rates, operation time, intraoperative blood loss, surgery-related complications, and impact on quality of life (QoL). Discussion We expect this trial to provide compelling and high-quality evidence to guide the selection of the most appropriate surgical approach for early-stage cervical cancer. Clinical trial registration Chinese Clinical Trial Register, identifier ChiCTR2000035515.
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Affiliation(s)
- Xiaoyan Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Shan Zhou
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yuan He
- Office of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ping Wang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Yincheng Teng
- Department of Gynecology and Obstetrics, Shanghai Sixth People Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Feng
- Department of Gynecology and Obstetrics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Kita M, Butsuhara Y, Hisamatsu Y, Yokoe T, Okada H. Pneumovaginoscopy-assisted radical hysterectomy for early-stage cervical cancer: a novel bidirectional approach for tumor spillage prevention and R0 resection. J Gynecol Oncol 2023; 34:e80. [PMID: 37477103 PMCID: PMC10627754 DOI: 10.3802/jgo.2023.34.e80] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study evaluated the feasibility and outcomes of pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fascia-oriented and nerve-sparing surgical approach. METHODS This retrospective observational cohort study examined the operative outcomes and prognoses of patients who underwent PVRH (n=59) for up to stage IIA cervical cancer. The basic procedure was Kyoto B2 (Viper Type II nerve-sparing) radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal (open or laparoscopic) approaches. In all cases, pneumovaginoscopy (PV) was used to create a vaginal cuff and dissect the paracolpium and paracervical endopelvic fascia to minimize nerve damage. RESULTS Thirty-eight (64.4%) patients had stage IB1 cancer. Seven (11.9%) had vaginal invasion (stage IIA1, n=4; IIA2, n=3). The abdominal approach was open in 38 cases and laparoscopic in 21. Adjuvant therapy was administered to 24 patients (41%); one patient received concurrent chemoradiotherapy for gastric-type adenocarcinoma. There were three (6.1%) intraoperative complications (CO2 gas embolism [n=1], sigmoid colon musculosa injury [n=1], and ureteral injury [n=1]) and 8 (14%) postoperative complications (lymphedema with cellulitis [n=4], vaginal cuff dehiscence [n=1], sub-ileus [n=1], symptomatic lymphocyst [n=l], and ureterovaginal fistula [n=1]). The median urination recovery period was 3 days. Microscopic R0 was achieved in all cases. The median follow-up was 44.5 (2-122) months, and no recurrence occurred. CONCLUSION PVRH is a new fascia-oriented and nerve-sparing surgery for early-stage cervical cancer. Further, it has favorable operative outcomes and good prognoses, similar to those of adjacent pelvic surgery such as trans-anal total mesorectal excision and radical prostatectomy.
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Affiliation(s)
- Masato Kita
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan.
| | - Yusuke Butsuhara
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| | - Yoji Hisamatsu
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| | - Takuya Yokoe
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| | - Hidetaka Okada
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
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Pegu B, Sri Saranya T, Subburaj SP, Murugesan R. Evaluating the Frequency and Characteristics of Unexpected Ovarian Malignancy in Postmenopausal Women Who Have Undergone Laparoscopic Surgery for Adnexal Masses - A Review of Five Years. Cureus 2023; 15:e42872. [PMID: 37664369 PMCID: PMC10474307 DOI: 10.7759/cureus.42872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Aim The aim of this study was to estimate the frequent existence of unexpected ovarian malignant lesions after laparoscopic surgery for an apparent benign adnexal mass and assess its clinical and ultrasound characteristics in postmenopausal women. Methods We re-examined the hospital records of 96 cases of postmenopausal women who underwent laparoscopic surgery for benign adnexal mass over five years. The age of the patient, parity, ultrasound findings, tumor markers level, intraoperative findings, and histopathological report were collected. Pearson's Chi-squared test and Fisher's exact test were used for statistical analysis, and a p-value of <0.05 was accepted as statistically significant. Results Of a total of 96, benign adnexal mass was in 93 (96.83%), an unexpected ovarian malignancy was observed in two (2.08%) cases, and one (1.04%) had a borderline ovarian tumor. Tumor marker CA-125 was done for all those cases of adnexal mass in postmenopausal women, and not a single case was found to have above 35 IU/ml, defined as the cut-off value for CA-125. Statistically significant differences were observed between the benign and malignant groups in relation to symptoms (p<0.05), ultrasound score (p=0.001), and bilaterality (p=0.013) of the tumor mass. Conclusion In postmenopausal women, the critical concern for laparoscopic surgery of benign adnexal mass is unexpected malignancy. So it is essential to select patients carefully for laparoscopic surgery. If a benign-looking adnexal mass turned out to be malignant on the histopathological report, we should try to post the patient for subsequent staging laparotomy as soon as possible.
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Affiliation(s)
- Bhabani Pegu
- Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Thangamuthu Sri Saranya
- Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sathiya P Subburaj
- Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Rajeswari Murugesan
- Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Ronsini C, Pasanisi F, Molitierno R, Iavarone I, Vastarella MG, De Franciscis P, Conte C. Minimally Invasive Staging of Early-Stage Epithelial Ovarian Cancer versus Open Surgery in Terms of Feasibility and Safety: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12113831. [PMID: 37298026 DOI: 10.3390/jcm12113831] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Epithelial ovarian cancer is women's fourth most common oncological cause of death. One of the main prognostic factors in ovarian cancer is the tumor stage. For instance, surgical staging of the disease is focal when choosing the best therapeutic option for each case. Although open surgery is the prevalent approach for staging and treating ovarian cancer, the use of minimally invasive surgery (MIS) has found recent application in staging or restaging cases of early disease. Our work compares oncological outcomes after MIS staging for FIGO I epithelial ovarian cancer with the laparotomic approach. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations, we systematically searched the Pub Med and Scopus databases in February 2023. No temporal nor geographical limitation was made. We included the articles containing data about Disease-Free Survival (DFS) and Overall Survival (OS), Recurrence Rates (RR), and Upstaging Rates (UpR). We used comparative studies for the meta-analysis. After the database search and article selection, 19 works matched the inclusion criteria for the systematic review. Eleven of these were comparative studies between MIS and Open Surgical Staging (OSS) approaches for ovarian cancer staging and were included in the meta-analysis. The meta-analysis did not show a statistically significant difference between the MIS and the OSS group concerning DFS, OS, and RR. Only Upstaging Rate ≥ FIGO Stage II was statistically significative higher in the OSS group. Likewise, MIS is confirmed to be an approach with a lower profile of surgical complications. In conclusion, our study did not show one approach to be safer than the other. However, the lack of dedicated studies limits the evidence of our study. For instance, we recommend adequately selecting the specimen, minimizing the risk of spillage, and optimizing surgical staging.
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Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n.1, 80122 Naples, Italy
| | - Francesca Pasanisi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n.1, 80122 Naples, Italy
| | - Rossella Molitierno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n.1, 80122 Naples, Italy
| | - Irene Iavarone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n.1, 80122 Naples, Italy
| | - Maria Giovanna Vastarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n.1, 80122 Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie n.1, 80122 Naples, Italy
| | - Carmine Conte
- Dipartimento Salute della Donna e del Bambino, Fondazione Universitaria Policlinico A. Gemelli, Largo Agostino Gemelli, 8, 00168 Rome, Italy
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11
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Serouart B, Cordoba A, Martinez-Gomez C, Bogart E, Le Deley MC, Leblanc É, Hudry D, Escande A, Le Tinier F, Pasquesoone C, Taieb S, El Hajj H, Narducci F. Results of a 20 Year Retrospective Analysis of Early-Stage Cervical Cancer: Should 3 cm Be Considered the New Ariadne's Thread in Early Cervical Cancer Treatment? Cancers (Basel) 2023; 15:cancers15051570. [PMID: 36900360 PMCID: PMC10001182 DOI: 10.3390/cancers15051570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
(1) This study aims to evaluate the overall survival (OS) and recurrence-free survivals (RFS) and assess disease recurrence of early-stage cervical cancer (ESCC) patients treated with minimally invasive surgery (MIS). (2) This single-center retrospective analysis was performed between January 1999 and December 2018, including all patients managed with MIS for ESCC. (3) All 239 patients included in the study underwent pelvic lymphadenectomy followed by radical hysterectomy without the use of an intrauterine manipulator. Preoperative brachytherapy was performed in 125 patients with tumors measuring 2 to 4 cm. The 5-year OS and RFS rates were 92% and 86.9%, respectively. Multivariate analysis found two significant factors associated with recurrence: previous conization with HR = 0.21, p = 0.01, and tumor size > 3 cm with HR = 2.26, p = 0.031. Out of the 33 cases of disease recurrence, we witnessed 22 disease-related deaths. Recurrence rates were 7.5%, 12.9%, and 24.1% for tumors measuring ≤ 2 cm, 2 to 3 cm, and > 3 cm, respectively. Tumors ≤ 2 cm were mostly associated with local recurrences. Tumors > 2 cm were frequently associated with common iliac or presacral lymph node recurrences. (4) MIS may still be considered for tumors ≤ 2 cm subject to first conization followed by surgery with the Schautheim procedure and extended pelvic lymphadenectomy. Due to the increased rate of recurrence, a more aggressive approach might be considered for tumors > 3 cm.
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Affiliation(s)
- Benjamin Serouart
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Abel Cordoba
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | - Emilie Bogart
- Department of Biostatistics, Oscar Lambret Center, 59000 Lille, France
| | | | - Éric Leblanc
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Delphine Hudry
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
| | - Alexandre Escande
- Department of Radiotherapy, Oscar Lambret Center, 59000 Lille, France
| | | | | | - Sophie Taieb
- Department of Imaging, Oscar Lambret Center, 59000 Lille, France
| | - Houssein El Hajj
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
- Correspondence: ; Tel.: +33-7-69-21-12-99
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France
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12
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Garg H, Mansour AM, Psutka SP, Kim SP, Porter J, Gaspard CS, Dursun F, Pruthi DK, Wang H, Kaushik D. Robot-assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes. BJU Int 2023. [PMID: 36754376 DOI: 10.1111/bju.15986] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease. MATERIALS AND METHODS The PubMed® , Scopus® , Cochrane Central Register of Controlled Trials, and Web of Science™ databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. RESULTS The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002). CONCLUSION Robot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.
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Affiliation(s)
- Harshit Garg
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Simon P Kim
- Division of Urology, University of Colorado-Denver, Denver, CO, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, WA, USA
| | | | - Furkan Dursun
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Deepak K Pruthi
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX, USA
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13
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Ramirez PT, Pareja R, Viveros-Carreño D, Frumovitz M. Open radical hysterectomy: The new standard of care in early-stage cervical cancer. BJOG 2023. [PMID: 36681892 DOI: 10.1111/1471-0528.17408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/02/2022] [Accepted: 01/03/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Pedro T Ramirez
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Gynecologic Oncology, Astorga Clínica de Oncología, Medellín, Colombia
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Gynecologic Oncology, Clínica Universitaria Colombia and Centro de tratamiento e investigación sobre el cáncer Luis Carlos Sarmiento Angulo, Bogotá, Colombia
| | - Michael Frumovitz
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Fusegi A, Kanao H, Tsumura S, Murakami A, Abe A, Aoki Y, Nomura H. Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review. J Gynecol Oncol 2023; 34:e5. [PMID: 36424702 DOI: 10.3802/jgo.2023.34.e5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022] Open
Abstract
Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons' skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons' inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.
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Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Shiho Tsumura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Murakami
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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15
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Hoegl J, Viveros-Carreño D, Palacios T, Gallego-Ardila A, Rauh-Hain JA, Estrada EE, Noll F, Krause K, Baiocchi G, Minig L, Grillo-Ardila CF, Pareja R. Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis. Int J Gynecol Cancer 2022; 32:1497-1504. [PMID: 36351746 DOI: 10.1136/ijgc-2022-003937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To assess the incidence of peritoneal carcinomatosis in patients undergoing minimally invasive or open radical hysterectomy for cervical cancer. METHODS The MEDLINE (accessed through Ovid), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials, and Scopus databases were searched for articles published from inception up to April 2022. Articles published in English were considered. The included studies reported on patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA squamous cell carcinoma, adenocarcinoma, and/or adenosquamous carcinoma of the cervix who underwent primary surgery. Studies had to report at least one case of peritoneal carcinomatosis as a recurrence pattern, and only studies comparing recurrence after minimally invasive surgery versus open surgery were considered. Variables of interest were manually extracted into a standardized electronic database. This study was registered in PROSPERO (CRD42022325068). RESULTS The initial search identified 518 articles. After the removal of the duplicate entries from the initial search, two authors independently reviewed the titles and abstracts of the remaining 453 articles. Finally, 78 articles were selected for full-text evaluation; 22 articles (a total of 7626 patients) were included in the analysis-one randomized controlled trial and 21 observational retrospective studies. The most common histology was squamous cell carcinoma in 60.9%, and the tumor size was <4 cm in 92.8% of patients. Peritoneal carcinomatosis pattern represented 22.2% of recurrences in the minimally invasive surgery approach versus 8.8% in open surgery, accounting for 15.5% of all recurrences. The meta-analysis of observational studies revealed a statistically significant higher risk of peritoneal carcinomatosis after minimally invasive surgery (OR 1.90, 95% CI 1.32 to 2.74, p<0.05). CONCLUSION Minimally invasive surgery is associated with a statistically significant higher risk of peritoneal carcinomatosis after radical hysterectomy for cervical cancer compared with open surgery.
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Affiliation(s)
- Jorge Hoegl
- Obstetrics and Gynecology. Division of Gynecological Oncology, Hospital General del Este "Dr. Domingo Luciani", Caracas, Bolivarian Republic of Venezuela
| | - David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia.,Gynecologic Oncology, Clínica Universitaria Colombia and Centro de tratamiento e investigación sobre cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Tatiana Palacios
- Hospital Infantil Universitario de San Jose. Fundación Universitaria de Ciencias de la Salud - FUCS, Bogotá, Colombia
| | - Andres Gallego-Ardila
- Vicerrectoría de Investigación, Fundación Universitaria de Ciencias de la Salud FUCS, Bogota, Colombia
| | - Jose Alejandro Rauh-Hain
- The University of Texas MD Anderson Cancer Center Department of Gynecologic Oncology and Reproductive Medicine, Houston, Texas, USA
| | | | - Florencia Noll
- Ginecología Oncológica, Hospital Sanatorio Allende, Cordoba, Argentina
| | - Kate Krause
- The University of Texas MD Anderson Cancer Center Research Medical Library, Houston, Texas, USA
| | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
| | - Lucas Minig
- Gynecologic Oncology, Valencian Institute of Oncology (IVO), Valencia, Spain
| | - Carlos Fernando Grillo-Ardila
- Universidad Nacional de Colombia Departamento de Obstetricia y Ginecología, Bogota, Colombia.,Grupo de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología, Bogota, Colombia
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia .,Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin, Colombia
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16
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Burgess L, AlDuwaisan W, Zhang T, Lupe K, Fung-Kee-Fung M, Faught W, Le T, Samant R. Evaluation of Surgical Approaches and Use of Adjuvant Radiotherapy with Respect to Oncologic Outcomes in the Management of Clinically Early-Stage Cervical Carcinoma. Curr Oncol 2022; 29:9525-9534. [PMID: 36547162 PMCID: PMC9777721 DOI: 10.3390/curroncol29120748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
The standard of care for early-stage cervix cancer is radical hysterectomy with pelvic lymphadenectomy. Adjuvant radiotherapy (RT) or chemoradiotherapy may be administered to reduce the risk of recurrence in patients considered to be at elevated risk based on a combination of pathologic factors. We performed a retrospective review to determine oncologic outcomes in patients treated for early-stage cervix cancer and to determine if surgical approach impacted oncologic outcomes or the decision to use adjuvant therapy. In total, 174 women underwent radical hysterectomy and pelvic lymphadenectomy over the 15-year period. Most of these women (146) had open surgery and 28 had minimally invasive surgery (MIS). In total, 81 had adjuvant pelvic RT; 76 in the open surgery group (52%) and 5 in the MIS group (18%). Five-year PFS and OS, respectively, were 84% and 91%. Five-year PFS was significantly lower in patients who had MIS vs. open surgery, without a difference in 5-year OS, suggesting MIS should be avoided. Five-year PFS was the same with RT or with its omission, despite those treated with RT having higher risk disease. We have demonstrated excellent outcomes in patients with early-stage cervix cancer after primary surgery and selective use of RT, with few recurrences and excellent survival.
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Affiliation(s)
- Laura Burgess
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Correspondence:
| | - Wafa AlDuwaisan
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Tinghua Zhang
- The Ottawa Methods Centre, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Krystine Lupe
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Michael Fung-Kee-Fung
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Wylam Faught
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Tien Le
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Rajiv Samant
- Department of Radiology, Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Department of Radiology, Division of Radiation Oncology, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
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17
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Droste A, Anic K, Hasenburg A. Laparoscopic Surgery for Ovarian Neoplasms - What is Possible, What is Useful? Geburtshilfe Frauenheilkd 2022; 82:1368-1377. [PMID: 36467976 PMCID: PMC9715350 DOI: 10.1055/a-1787-9144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
The use of minimally invasive surgical techniques is becoming increasingly important in gynecologic oncology due to technical advances and the increasing level of surgical expertise. In addition to laparoscopic approaches for the treatment of benign neoplasms, minimally invasive surgical methods have also become established in some areas for treating gynecologic malignancies. For tumor entities such as endometrial and cervical carcinoma, there are conclusive studies emphasizing the role of laparoscopy in surgical therapy. By contrast, due to a lack of prospective data with survival analyses, no clear conclusions can be drawn on the significance of laparoscopy in the surgical treatment of ovarian carcinoma. However, some smaller, mostly retrospective case-control studies and cohort studies open the way for a discussion, positing the possibility that laparoscopic surgical procedures, particularly for early ovarian carcinoma, are technically feasible and of a quality equivalent to that of conventional longitudinal laparotomy, and may also be associated with lower perioperative morbidity. In this article we discuss the most important aspects of using minimally invasive surgical techniques for ovarian carcinoma based on the current literature. In particular we look at the relevance of laparoscopy as a primary approach for surgical staging of early ovarian carcinoma, and we evaluate the role of diagnostic laparoscopy in assessing the operability of advanced ovarian carcinoma.
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Affiliation(s)
- Annika Droste
- 611615Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany,Korrespondenzadresse Dr. med. univ. Annika Droste Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für
Geburtshilfe und FrauengesundheitLangenbeckstraße 155131
MainzGermany
| | - Katharina Anic
- 611615Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
| | - Annette Hasenburg
- 611615Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
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18
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Cheng C, Hsu H, Tai Y, Chiang Y, Chen Y, Cheng W. Outcome and prognostic factors of unexpected ovarian carcinomas. Cancer Med 2022; 12:6466-6476. [PMID: 36366751 PMCID: PMC10067121 DOI: 10.1002/cam4.5415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/05/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated risk factors influencing the outcome of unexpected ovarian carcinomas. METHODS We reviewed the ovarian carcinoma patients treated at atertiary medical institution between 2000 and 2017 and analyze the clinico-pathological characteristics, treatment strategies, recurrence status, and outcome. RESULTS A total of 112 women (65 primary laparoscopic surgery [LSC] and 47 laparotomic surgery [LAPA]) were included in the analysis. The LSC group had smaller ovarian tumors (10.5 ± 7.3 cm vs. 16.6 ± 8.7 cm, p = 0.031) and higher incidence of subsequent staging surgery (56.9% vs. 25.5%, p = 0.0001) compared to the LAPA group. There were 98/112 (86.6%) of early stages (I/II) diseases. The difference between the recurrent rate (27.7% vs. 31.9%), disease-free survival (DFS), and overall survival (OS) were not significant among surgical groups. In the multivariate analysis, FIGO stage (stage II hazard ratio [HR] 6.61, p = 0.007; stage III HR 8.40, p = 0.002) was the only prognostic factor for DFS. FIGO stage (stage II HR 20.78, p = 0.0001; stage III HR 7.99, p = 0.017), histological type (mucinous HR 12.49, p = 0.036), and tumor grade (grade 3 HR 35.01, p = 0.003) were independent prognostic factors for OS, while women with latency >28 days from primary to staging surgery had significantly poorer OS (p = 0.008). Women with latency >28 days between primary surgery and adjuvant chemotherapy had similar DFS (p = 0.31) and a trend of poorer OS (p = 0.064). CONCLUSIONS The prognosis of unexpected ovarian cancer is independent from the primary surgical procedure and comprehensive staging surgery should be performed at close proximity after the diagnosis of unexpected ovarian malignancy.
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Affiliation(s)
- Ching‐Yu Cheng
- Department of Obstetrics and Gynecology, College of Medicine National Taiwan University Taipei Taiwan
- Department of Obstetrics and Gynecology National Taiwan University Hospital Hsin‐Chu Branch Hsinchu City Taiwan
- Department of Obstetrics and Gynecology Fu Jen Catholic University Hospital New Taipei City Taiwan
- Department of Surgery National Taiwan University Cancer Center Taipei Taiwan
| | - Heng‐Cheng Hsu
- Department of Obstetrics and Gynecology National Taiwan University Hospital Hsin‐Chu Branch Hsinchu City Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Yi‐Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine National Taiwan University Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine National Taiwan University Taipei Taiwan
| | - Ying‐Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine National Taiwan University Taipei Taiwan
| | - Yu‐Li Chen
- Department of Obstetrics and Gynecology, College of Medicine National Taiwan University Taipei Taiwan
| | - Wen‐Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine National Taiwan University Taipei Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine National Taiwan University Taipei Taiwan
- Graduate Institute of Oncology, College of Medicine National Taiwan University Taipei Taiwan
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19
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Ronsini C, Köhler C, de Franciscis P, La Verde M, Mosca L, Solazzo MC, Colacurci N. Laparo-assisted vaginal radical hysterectomy as a safe option for minimal invasive surgery in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2022:S0090-8258(22)00580-7. [PMID: 36150915 DOI: 10.1016/j.ygyno.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Radical hysterectomy and pelvic lymphadenectomy are considered the standard treatment for early-stage cervical cancer (ECC). Minimal Invasive approach to this surgery has been debated after the publication of a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC trial). It demonstrated poorer oncological outcomes for Minimal Invasive Surgery in ECC. However, the reasons are still an open debate. Laparo-Assisted Vaginal Hysterectomy (LAVRH) seems to be a logical option to Abdominal Radical Hysterectomy (ARH). This meta-analysis has the aim to prove it. METHODS Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the Pubmed database and Scopus database were systematically searched in January 2022 since early first publications. No limitation of the country was made. Only English article were considered. The studies containing data about Disease-free Survival (DFS) and/or Overall Survival (OS) and/or Recurrence Rate (RcR) were included. RESULTS 18 studies fulfilled inclusion criteria. 8 comparative studies were enrolled in meta-analysis. Patients were analyzed concerning surgical approach (Laparo-Assisted Vaginal Radical Hysterectomy) and compared with ARH Oncological outcomes such as DFS and OS were considered. 3033 patiets were included. Meta-analysis highlighted a non-statistic significant difference between LARVH and ARH (RR 0.82 [95% CI 0.55-1.23] p = 0.34; I2 = 0%; p = 0.96). OS was feasible only for 3 studies (RR 1.14 [95% CI 0.28-4.67] p = 0.43; I2 = 0 p = 0.86). Data about the type of recurrences (loco-regional vs distant) were collected. CONCLUSION LARVH does not appear to affect DFS and OS in ECC patients. The proposed results seem to be comparable with the open approach group of the LACC trial, which today represents the reference standard for the treatment of this pathology. More studies will be needed to test the safety and efficacy of LARVH in the ECC.
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Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Christhardt Köhler
- Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany; Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany.
| | - Pasquale de Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Cristina Solazzo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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20
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Sampurno S, Chittleborough T, Dean M, Flood M, Carpinteri S, Roth S, Millen RM, Cain H, Kong JCH, MacKay J, Warrier SK, McCormick J, Hiller JG, Heriot AG, Ramsay RG, Lynch AC. Effect of Surgical Humidification on Inflammation and Peritoneal Trauma in Colorectal Cancer Surgery: A Randomized Controlled Trial. Ann Surg Oncol 2022; 29:7911-7920. [PMID: 35794366 PMCID: PMC9261208 DOI: 10.1245/s10434-022-12057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pre-clinical studies indicate that dry-cold-carbon-dioxide (DC-CO2) insufflation leads to more peritoneal damage, inflammation and hypothermia compared with humidified-warm-CO2 (HW-CO2). Peritoneum and core temperature in patients undergoing colorectal cancer (CRC) surgery were compared. METHODS Sixty-six patients were randomized into laparoscopic groups; those insufflated with DC-CO2 or HW-CO2. A separate group of nineteen patients undergoing laparotomy were randomised to conventional surgery or with the insertion of a device delivering HW-CO2. Temperatures were monitored and peritoneal biopsies and bloods were taken at the start of surgery, at 1 and 3 h. Further bloods were taken depending upon hospital length-of-stay (LOS). Peritoneal samples were subjected to scanning electron microscopy to evaluate mesothelial damage. RESULTS Laparoscopic cases experienced a temperature drop despite Bair-HuggerTM use. HW-CO2 restored normothermia (≥ 36.5 °C) by 3 h, DC-CO2 did not. LOS was shorter for colon compared with rectal cancer cases and if insufflated with HW-CO2 compared with DC-CO2; 5.0 vs 7.2 days, colon and 11.6 vs 15.4 days rectum, respectively. Unexpectedly, one third of patients had pre-existing damage. Damage increased at 1 and 3 h to a greater extent in the DC-CO2 compared with the HW-CO2 laparoscopic cohort. C-reactive protein levels were higher in open than laparoscopic cases and lower in both matched HW-CO2 groups. CONCLUSIONS This prospective RCT is in accord with animal studies while highlighting pre-existing damage in some patients. Peritoneal mesothelium protection, reduced inflammation and restoration of core-body temperature data suggest benefit with the use of HW-CO2 in patients undergoing CRC surgery.
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Affiliation(s)
- Shienny Sampurno
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Timothy Chittleborough
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Meara Dean
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Michael Flood
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Sandra Carpinteri
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Sara Roth
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Rosemary M Millen
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Helen Cain
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Joseph C H Kong
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - John MacKay
- Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Satish K Warrier
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Jacob McCormick
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Jonathon G Hiller
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Alexander G Heriot
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Robert G Ramsay
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia. .,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. .,Epworth Healthcare, Richmond Victoria, Richmond, Australia.
| | - Andrew C Lynch
- Epworth Healthcare, Richmond Victoria, Richmond, Australia
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21
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Protective effect of pre-operative conization in patients undergoing surgical treatment for early-stage cervical cancer. Gynecol Oncol 2022; 166:57-60. [PMID: 35618539 DOI: 10.1016/j.ygyno.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of pre-operative conization on disease-free survival (DFS) in early-stage cervical cancer. METHODS In this population-based cohort study we analysed from clinical cancer registries to determine DFS of women with International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB1 cervical cancer with respect to conization preceding radical hysterectomy performed between January 2010 and December 2015. RESULTS Out of 993 datasets available for the analysis, 235 patients met the inclusion criteria of the current study. The median follow-up was 5.4 years. During the study period, 28 (11.9%) recurrences were observed. All of these occurred in patients with FIGO stage IB1. For further evaluation, patients with FIGO IB1 tumors <2 cm were further analysed and divided into two groups, based on pre-operative conization. Pre-operative conization was associated with a reduced rate of recurrence (p = 0.007), with only three (5.2%) recurrences in this group (CO) compared to 25 recurrences (21.0%) in the group without conization (NCO) preceding radical hysterectomy. DFS was estimated at 79.0% and 94.8% in NCO and CO, respectively (p = 0.008). After adjustment for other prognostic covariates, conization remained a favourable prognostic factor for DFS (HR 0.27; 95% CI 0.08-0.93, p = 0.037). Lymph node involvement was the only unfavourable factor (HR 4.38; 95% CI 1.36-14.14, p = 0.014) in the multivariable analysis. CONCLUSIONS Pre-operative conization is associated with improved DFS in early-stage cervical cancer independently of the surgical approach.
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22
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Ronsini C, Köhler C, De Franciscis P, La Verde M, Mosca L, Solazzo MC, Colacurci N. Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2022; 166:188-195. [PMID: 35513934 DOI: 10.1016/j.ygyno.2022.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radical hysterectomy and pelvic lymphadenectomy are considered the standard treatment for early-stage cervical cancer (ECC). Minimal Invasive approach to this surgery has been debated after the publication of a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC trial). It demonstrated poorer oncological outcomes for Minimal Invasive Surgery in ECC. However, the reasons are still an open debate. Laparo-Assisted Vaginal Hysterectomy (LAVRH) seems to be a logical option to Abdominal Radical Hysterectomy (ARH). This meta-analysis has the aim to prove it. METHODS Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the Pubmed database and Scopus database were systematically searched in January 2022 since early first publications. No limitation of the country was made. Only English article were considered. The studies containing data about Disease-free Survival (DFS) and/or Overall Survival (OS) and/or Recurrence Rate (RcR) were included. RESULTS 19 studies fulfilled inclusion criteria. 9 comparative studies were enrolled in meta-analysis. Patients were analyzed concerning surgical approach (Laparo-Assisted Vaginal Radical Hysterectomy) and compared with ARH Oncological outcomes such as DFS and OS were considered. 3196 patiets were included for the review. Meta-analysis of 1988 0f them highlighted a non-statistic significant difference between LARVH and ARH (RR 0.8 [95% CI 0.55-1.16] p = 0.24; I2 = 0%; p = 0.98). OS was feasible only for 4 studies (RR 0.84 [95% CI 0.23-3.02] p = 0.79; I2 = 0 p = 0.44). Sub-analysis for tumor with a maximum diameter greater than 2 cm was performed. Data about the type of recurrences (loco-regional vs distant) were collected. CONCLUSION LARVH does not appear to affect DFS and OS in ECC patients. The proposed results seem to be comparable with the open approach group of the LACC trial, which today represents the reference standard for the treatment of this pathology. More studies will be needed to test the safety and efficacy of LARVH in the ECC.
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Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Christhardt Köhler
- Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany; Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany.
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Cristina Solazzo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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23
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Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: A retrospective database cohort study. Ann Med Surg (Lond) 2022; 77:103507. [PMID: 35638032 PMCID: PMC9142398 DOI: 10.1016/j.amsu.2022.103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/13/2022] [Accepted: 03/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recent studies comparing minimally invasive versus open radical hysterectomy in patients with early-stage cervical cancer have reported a worse overall survival with minimally invasive surgery (MIS). However, in the patients with microscopic disease, there was no survival difference and the optimal surgical approach for microscopic cervical cancer remains unclear. Methods Using the National Cancer Database, we identified a cohort of women who underwent hysterectomy as the primary treatment for stage IA1/IA2 cervical cancer between January 2010 and December 2016. Using multivariable logistic regression, our primary outcome was to compare overall survival between the open and MIS groups. The data was stratified for simple and radical hysterectomies. Secondary endpoint was comparison of readmission rates and length of stay (LOS). Results We identified 6230 patients with stage IA1 and IA2 cervical cancer that underwent hysterectomy as primary treatment. 4054 of these women (65%) underwent MIS. There was no difference in age, lympho-vascular invasion, number of lymph nodes retrieved and histology between the two groups. In the overall cohort, there was no difference in survival between the open and the MIS group (Hazard ratio for the open group 1.23; CI 0.92–1.63). Post-operative radiation therapy was more common in the open group (5.24% vs 4.09%, p value < 0.02). The mean LOS (1.35 days vs 3.08 days) was shorter in MIS group (p value < 0.0001). No difference was found in the readmission rates (60% for the MIS group vs 55% for the open group; p value 0.14). Conclusions Our data suggest that MIS is associated with similar overall survival and shorter length of hospital stay compared to the open hysterectomy in women with stage IA cervical cancer. Based on this large data set, MIS appears to be a safe and effective surgical approach for women with stage IA1/IA2 cervical cancer. Our study is the largest analysis to date on the use of MIS in stage-IA cervical cancer. There was no difference in overall survival between MIS and open surgery for stage IA cervical cancer. MIS was associated with a shorter length of stay. No difference was found in readmission rates. The two groups were similar for lympho-vascular invasion, number of lymph nodes retrieved, histology, and age.
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24
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Nagata H, Kawai K, Oba K, Nozawa H, Yamauchi S, Sugihara K, Ishihara S. Laparoscopic colectomy: a risk factor for postoperative peritoneal metastasis. Clin Colorectal Cancer 2022; 21:e205-e212. [DOI: 10.1016/j.clcc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
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25
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Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned? Curr Oncol 2022; 29:1093-1106. [PMID: 35200592 PMCID: PMC8871281 DOI: 10.3390/curroncol29020093] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) emerged as the mainstay in the surgical management of cervical cancer, bringing advantages such as lower operative morbidity and shorter hospital stay compared to open surgery while maintaining comparable oncologic outcomes in numerous retrospective studies. However, in 2018, a prospective phase III randomized controlled trial, “Laparoscopic Approach to Carcinoma of the Cervix (LACC)”, unexpectedly reported that MIS was associated with a statistically significant poorer overall survival and disease-free survival compared to open surgery in patients with early-stage cervical cancer. Various hypotheses have been raised by the authors to try to explain these results, but the LACC trial was not powered to answer those questions. In this study, through an exhaustive literature review, we wish to explore some of the potential causes that may explain the poorer oncologic outcomes associated with MIS, including the type of MIS surgery, the size of the lesion, the impact of CO2 pneumoperitoneum, prior conization, the use of uterine manipulator, the use of protective measures, and the effect of surgical expertise/learning curve.
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26
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He F, Yuan S, Chen X, Zhang S, Han Y, Lin T, Xu B, Huang S, Pan Z. Effect of modified no-touch laparoscopic radical hysterectomy on outcomes of early stage cervical cancer: A retrospective cohort study. Cancer Med 2022; 11:2224-2232. [PMID: 35156771 PMCID: PMC9160811 DOI: 10.1002/cam4.4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/19/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives We aimed to compare the prognosis of modified no‐touch laparoscopic radical hysterectomy (MLRH) and laparoscopic radical hysterectomy (LRH) on survival in patients with early stage cervical cancer. Materials and Methods The clinicopathological data of patients with stage IB1 and IIA1 cervical cancer, who underwent radical surgery between 2014 and 2019, were retrospectively reviewed. The 5‐year disease‐free survival (DFS) and overall survival (OS) were compared between the MLRH and LRH groups using the Kaplan–Meier method. Independent prognostic factors for 5‐year DFS and OS were identified using multivariate, forward, stepwise Cox proportional hazards regression models. Results A total of 223 patients with stage IB1 and IIA1 cervical cancer were included. Kaplan–Meier analysis revealed that the 5‐year DFS and OS rates in the MLRH (n = 81) group were significantly higher than those in the LRH group (n = 142) (DFS, 94.5% vs. 78.8%, p = 0.007; OS, 96.7% vs. 87.6%, p = 0.033). No significant differences were identified between the two groups in terms of operative time, blood loss, transfusion requirement, and intraoperative or postoperative complications. MLRH was an independent prognostic factor associated with increased 5‐year DFS (adjusted hazard ratio [HR], 0.202; 95% confidence interval [CI], 0.069–0.594; p = 0.004) and 5‐year OS (adjusted HR, 0.163; 95% CI, 0.035–0.748; p = 0.020). Conclusion The oncologic outcomes were superior with MLRH than with LRH in patients with stage IB1 and IIA1 cervical cancer. Contact of cervical tumor cells with the pelvic cavity likely explains the worse prognosis associated with LRH.
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Affiliation(s)
- Fangjie He
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Songhua Yuan
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Xia Chen
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Siyou Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Yubin Han
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Tiecheng Lin
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Bingnan Xu
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Shimin Huang
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Zhiyin Pan
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
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Fusegi A, Kanao H, Ishizuka N, Nomura H, Tanaka Y, Omi M, Aoki Y, Kurita T, Yunokawa M, Omatsu K, Matsuo K, Miyasaka N. Oncologic Outcomes of Laparoscopic Radical Hysterectomy Using the No-Look No-Touch Technique for Early Stage Cervical Cancer: A Propensity Score-Adjusted Analysis. Cancers (Basel) 2021; 13:cancers13236097. [PMID: 34885205 PMCID: PMC8657300 DOI: 10.3390/cancers13236097] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/04/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Minimally invasive radical hysterectomy is contraindicated in early stage cervical cancer cases because of poor prognosis. The no-look no-touch technique (NLNT) eliminates intraoperative tumor spillage and may improve survival outcomes. We evaluated oncologic outcomes of laparoscopic radical hysterectomy performed using NLNT. We compared the outcomes of abdominal radical hysterectomy and NLNT using inverse probability of treatment weighting. We found no significant differences in disease-free survival between the groups, even in patients with tumor sizes ≥ 2 cm. We also studied NLNT’s non-inferiority to abdominal radical hysterectomy by evaluating heterogeneity between the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial and those of our study. We did not observe significant heterogeneity, although there was a trend toward a lower hazard ratio in our study compared with the non-inferiority margin in the LACC trial. Laparoscopic radical hysterectomy using NLNT is a plausible alternative surgical treatment for early stage cervical cancer. Abstract 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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Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
- Correspondence: ; Tel.: +81-3-3520-0111
| | - Naoki Ishizuka
- Clinical Research Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Yuji Tanaka
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Tomoko Kurita
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Mayu Yunokawa
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Kohei Omatsu
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
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28
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Lv H, Zhou T, Rong F. Proteomic analysis of the influence of CO 2 pneumoperitoneum in cervical cancer cells. J Cancer Res Ther 2021; 17:1253-1260. [PMID: 34850775 DOI: 10.4103/jcrt.jcrt_638_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective The effect of CO2 pneumoperitoneum (CDP) on the oncology outcomes of patients undergoing laparoscopic radical hysterectomy for cervical cancer remains unclear. In this study, we investigated the effects of CDP on the proliferation of cervical cancer cells and examined the molecular mechanism. Materials and Methods We established an in vitro CDP model to study the effects of CDP on the proliferation of cervical cancer cells by Cell Counting Kit-8 (CCK-8) assay, xenografted tumor assay. Tandem mass tag-based quantitative proteomics were used to study the proteomic changes in HeLa cells after CDP treatment. Western blot assay was used to detect the expressions of PI3K/Akt signaling pathway proteins. Results CDP increased cell proliferation after a short period of inhibition in vitro and promoted tumorigenesis in vivo. Proteomic analysis showed that the expression levels of 177 and 309 proteins were changed significantly 24 and 48 h after CDP treatment, respectively. The acidification caused by CO2 inhibited the proliferation of cervical cancer cells by inhibiting the phosphorylation of PI3K and Akt. Conclusions CDP promoted the proliferation of human cervical cancer cells after a short time of inhibition. The mechanism of which is related to the inhibition of phosphorylation of the PI3K/Akt signaling pathway.
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Affiliation(s)
- Hongtao Lv
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| | - Fengnian Rong
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
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Fusegi A, Kanao H. Total Laparoscopic Nerve-Sparing Radical Hysterectomy Using the No-look No-touch Technique. Surg J (N Y) 2021; 7:S77-S83. [PMID: 35111933 PMCID: PMC8799310 DOI: 10.1055/s-0041-1736178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Radical 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 CO
2
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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Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
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Zhao W, Xiao Y, Zhao W, Yang Q, Bi F. Survival Outcomes in Patients With 2018 FIGO Stage IA2-IIA2 Cervical Cancer Treated With Laparoscopic Versus Open Radical Hysterectomy: A Propensity Score-Weighting Analysis. Front Oncol 2021; 11:682849. [PMID: 34222001 PMCID: PMC8247576 DOI: 10.3389/fonc.2021.682849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Objective To compare the survival and recurrence outcomes between open and laparoscopic radically hysterectomy (RH) for stage IA2-IIA2 cervical cancer based on Federation International of Gynecology and Obstetrics (FIGO) 2018. Methods Data of 1,373 early cervical cancer patients undergoing open or laparoscopic radically hysterectomy at ShengJing Hospital of China Medical University between January 1, 2013, and December 31, 2016, were retrospectively reviewed. Propensity score-based inverse probability of treatment weighting (PS-IPTW) was used to balance the covariates between the two groups. Results A total of 705 cervical cancer patients of FIGO 2009 stage IA2-IIA2 were finally enrolled in this study. After IPTW adjustment, the OS (HR = 2.095, 95% CI: 1.233-3.562, P = 0.006) and PFS (HR = 1.950, 95%CI: 1.194-3.184, P = 0.008) rates were significantly higher in the open RH (ORH) group compared with the laparoscopic RH (LRH) group. Then after re-staging according to the FIGO 2018 staging system, 561 patients still belonged to stage IA2-IIA2, 144 patients were upgraded to stage IIIC1p-IIIC2p. The ORH group had a significantly superior OS (HR = 1.977, 95%CI: 1.077-3.626, P = 0.028) and PFS (HR = 1.811, 95%CI: 1.046-3.134, P = 0.034) compared with the LRH group after PS-IPTW analysis. Furthermore, in patients with no high and intermediate risks, difference of the OS (HR = 1.386, 95%CI: 0.287-6.69, P = 0.684) and PFS (HR = 1.524, 95%CI: 0.363-6.396, P = 0.565) rates between the two groups were with no statistical meaning. Conclusions Outcomes of this retrospective cohort study were in compliance with indications for ORH recommended by the National Comprehensive Cancer Network guidelines Version 1, 2021. However, LRH showed non-inferiority for patients with no prognostic risk factors compared with ORH.
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Affiliation(s)
- Wancheng Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunyun Xiao
- Department of Gynecology and Obstetrics, Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University & Dalian Maternal and Child Health Care Hospital, Dalian, China
| | - Wei Zhao
- Department of Gynecology and Obstetrics, Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University & Dalian Maternal and Child Health Care Hospital, Dalian, China
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fangfang Bi
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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31
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Sert BM, Kristensen GB, Kleppe A, Dørum A. Long-term oncological outcomes and recurrence patterns in early-stage cervical cancer treated with minimally invasive versus abdominal radical hysterectomy: The Norwegian Radium Hospital experience. Gynecol Oncol 2021; 162:284-291. [PMID: 34083029 DOI: 10.1016/j.ygyno.2021.05.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/24/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare long-term oncological outcomes in early-stage cervical cancer (CC) patients treated with minimally invasive radical hysterectomy (MIRH) versus abdominal radical hysterectomy (ARH), with a focus on recurrence patterns, tumor sizes, and conization. METHODS This single-institution, retrospective study consisted of stage IA1-IB1 (FIGO 2009) squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix, who underwent radical hysterectomy between 2000 and 2017. RESULTS Of the 582 patients included, 353 (60.7%) underwent ARH, and 229 (39.3%) MIRH. The median follow-up was 14.4 years in the ARH group and 6.1 years in the MIRH group (p < 0.0001). Among the 96 stage IA patients, only 3 (3.1%) experienced recurrence. Among stage IB1 patients, the risk of recurrence, after adjusting for standard prognostic variables, was twofold higher in the MIRH group versus the ARH group (HR 2.73, 95% CI: 1.56-4.80), and the relative difference was similar in terms of risk of cancer-specific survival (CSS) (HR 3.04, 95% CI: 1.28-7.20) and overall survival (OS) (HR 2.35, 95% CI: 1.21-4.59). In stage IB1 ≤ 2 cm patients without conization MIRH was associated with reduced time to recurrence (TTR) (HR 4.00, 95% CI: 1.67-9.57), CSS (HR 3.71, 95% CI: 1.19-11.58) and OS (HR 3.02, 95% CI: 1.24-7.34). Intraperitoneal combined recurrences accounted for 12 of 30 (40.0%) recurrences in the MIRH group but were not identified after ARH (p = 0.0001). CONCLUSIONS MIRH was associated with reduced TTR, CSS and OS versus ARH in stage IB1 CC patients. The risk of peritoneal recurrence was high, even for tumors ≤2 cm without conization.
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Affiliation(s)
- Bilal M Sert
- Department of Gynecologic Oncology, Oslo University Hospital, Oslo, Norway.
| | - Gunnar B Kristensen
- Department of Gynecologic Oncology, Oslo University Hospital, Oslo, Norway; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Andreas Kleppe
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway; Department of Informatics, University of Oslo, Oslo, Norway
| | - Anne Dørum
- Department of Gynecologic Oncology, Oslo University Hospital, Oslo, Norway
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Lee CL, Huang KG, Chua PT, Mendoza MCVR, Lee PS, Lai SY. Standardization and experience may influence the survival of laparoscopic radical hysterectomy for cervical cancer. Taiwan J Obstet Gynecol 2021; 60:463-467. [PMID: 33966729 DOI: 10.1016/j.tjog.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Minimally invasive radical hysterectomy has been shown to be associated with poorer outcome in an influential prospective, randomized trial. However, many centers worldwide performing minimally invasive radical hysterectomy have data and experience that prove otherwise. We aim to review surgical and oncologic outcomes of patients operated by Laparoscopic Radical Hysterectomy in a tertiary hospital, by experienced surgeons and standardization in radicality, for cervical carcinoma Stage 1A1-1B1 from January 2009 to May 2014. MATERIALS & METHODS Standardised surgical technique with Parametrium & Paracolpium resection approach was adopted by qualified and experienced Gynecologic/Gyne-Oncologic Endoscopic & Minimally Invasive Surgeons in performing Laparoscopic Radical Hysterectomy for Cervical Cancer stage 1A1-1B1 from January 2009-May 2014, involving 53 patients. Electronic Medical Record system (EMR) Of Chang Gung Memorial Hospital(Tertiary Referral Centre), Department of Obstetrics & Gynecology was accessed for surgical and oncologic outcomes. RESULTS Fifty-Three patients operated from January 2009 to May 2014 were followed up for an average of 96.7 months with longest follow-up at 127 months. There were no cases of recurrence or death reported. 5 Year - Survival Rate and 5 Year Disease-Free Survival Rate were 100%. Two patients received post-operative pelvic radiation concurrent with chemotherapy using Cisplatin due to greater than 1/3 cervical stromal invasion. CONCLUSION It is vital to standardize minimally invasive surgical techniques for early stage cervical cancer, with focus on adequate radicality and resection which may contribute to excellent survival outcomes. Further international multi-center randomized trial (Minimally Invasive Therapy Versus Open Radical Hysterectomy In Cervical Cancer) will provide justification for continued practice of MIS in early stage cervical cancer.
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Affiliation(s)
- Chyi-Long Lee
- Department of Obstetrics & Gynaecology, Division of Gynaecological Endoscopy & Minimally Invasive Therapy, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics & Gynaecology, Division of Gynaecological Endoscopy & Minimally Invasive Therapy, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Peng Teng Chua
- Department of Obstetrics & Gynaecology, Division of Gynaecological Endoscopy & Minimally Invasive Therapy, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan; Mahkota Medical Centre, Malacca, Malaysia.
| | - Marie Christine Valerie R Mendoza
- Department of Obstetrics & Gynaecology, Division of Gynaecological Endoscopy & Minimally Invasive Therapy, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan; Department of Obstetrics and Gynecology, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Pei San Lee
- Department of Obstetrics & Gynaecology, Division of Gynaecological Endoscopy & Minimally Invasive Therapy, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Siew Yen Lai
- Department of Obstetrics & Gynaecology, Division of Gynaecological Endoscopy & Minimally Invasive Therapy, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
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Wang Y, Wang Y, Wu W, Lu X, An T, Jiang J. Laparoscopic gastrectomy plus D2 lymphadenectomy is as effective as open surgery in terms of long-term survival: a single-institution study on gastric cancer. World J Surg Oncol 2021; 19:102. [PMID: 33827589 PMCID: PMC8028217 DOI: 10.1186/s12957-021-02218-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy. METHODS The clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared. Then, the prognostic significance of positive lymph node ratio (LNR) was assessed. RESULTS As a whole, OS (P = 0.789) and DFS (P = 0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.573) and DFS (P = 0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.567) and DFS (P = 0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.773) and DFS (P = 0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS. High LNR was significantly associated with worse OS (P < 0.001) and DFS (P < 0.001). Surgical type did not significantly affect prognosis of patients with low LNR or survival of patients with high LNR. CONCLUSIONS For patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes. LNR is a useful prognostic marker for GC patients.
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Affiliation(s)
- Yawei Wang
- The First Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518020, Guangdong, China
| | - Yan Wang
- Department of Radiology, Shenzhen People's Hospital, Dongmen North Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Wang Wu
- Center of Digestive Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Zhenyuan Road 628, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Xiaofang Lu
- Department of Pathology, The Seventh Affiliated Hospital, Sun Yat-sen University, Zhenyuan Road 628, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Tailai An
- Center of Digestive Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Zhenyuan Road 628, Guangming District, Shenzhen, 518107, Guangdong, China.
| | - Jiling Jiang
- The First Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518020, Guangdong, China.
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Huang H, Yan B, Hao H, Shang M, He Q, Liu L, Xi Z. Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis. Int J Urol 2021; 28:673-680. [PMID: 33714227 PMCID: PMC9291606 DOI: 10.1111/iju.14537] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To compare perioperative and oncologic survival outcomes between laparoscopic radical cystectomy and open radical cystectomy. METHODS A total of 607 patients underwent open radical cystectomy (n = 412) or laparoscopic radical cystectomy (n = 195) at a single academic institution from January 2006 to April 2017. Their medical records were retrospectively analyzed. One-to-one propensity score matching was carried out to reduce selection bias. Estimated blood loss and complications were compared. Overall survival, cancer-specific survival and progression-free survival estimates for all patients and patients with locally advanced bladder cancer were analyzed using the Kaplan-Meier method. RESULTS Either before or after matching, the laparoscopic radical cystectomy group had less estimated blood loss (P < 0.001 and P < 0.001) and fewer complications (P < 0.001 and P = 0.008). There was no difference in the overall survival (P = 0.216 and P = 0.961) and progression-free survival (P = 0.826 and P = 0.462) for all the patients having either laparoscopic radical cystectomy or open radical cystectomy. However, the 5-year progression-free survival of open radical cystectomy was higher than that of laparoscopic radical cystectomy (P = 0.019 and P = 0.021) for patients with locally advanced bladder cancer. CONCLUSIONS Laparoscopic radical cystectomy is superior to open radical cystectomy in terms of perioperative outcomes, and similar to open radical cystectomy in terms of oncologic outcomes for patients with early stage bladder cancer. However, for patients with locally advanced bladder cancer, laparoscopic radical cystectomy seems to be associated with shorter progression-free survival than open radical cystectomy.
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Affiliation(s)
- Haiwen Huang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Bing Yan
- Department of Urology, Xingtai People's Hospital, Xingtai, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Meixia Shang
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Libo Liu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Zhijun Xi
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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Zhao W, Yang Q. Lymph-Vascular Space Invasion in Patients with Stages IA2-IIA2 Cervical Cancer Treated with Laparoscopic versus Open Radical Hysterectomy. Cancer Manag Res 2021; 13:1179-1186. [PMID: 33603463 PMCID: PMC7881771 DOI: 10.2147/cmar.s292477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/23/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To explore the relationship between laparoscopic radical hysterectomy (LRH) and cervical cancer lymph-vascular space invasion (LVSI) by comparing the prevalence of LVSI in cervical cancer patients who underwent LRH versus open radical hysterectomy (ORH). Methods The study participants were 1087 cervical cancer patients (FIGO 2009 stages IA2-IIA2) with pathologically confirmed with or without LVSI who underwent radical hysterectomy at Shengjing Hospital of China Medical University from 2013 through 2018. The patients were divided according to the type of surgical procedure into an LRH group (n=148) and an ORH group (n=939). Results In the LRH group, 31.76% of patients (47/148) had LVSI-positive tumors compared to 33.23% of patients (312/939) in the ORH group; the difference was not significant (p=0.724). No between-group differences in LVSI prevalence according to lymph node metastasis, interstitial infiltration depth, differentiation degree, and parametrial infiltration were found. However, the number of LVSI-positive patients whose cervical cancer lesions >4 cm (stage I B2 and II A2) was significantly higher in the LRH group than in the ORH group (Odds Ratio [OR] 0.333, 95% confidence interval [CI] 0.157–0.706, p=0.005). The 3-Year disease-free survival (DFS) in the LRH group is lower than that in the ORH group (94.75% vs 97.27%), but there was no significance (P=0.187). Furthermore, the percentage of LVSI-positive tumors in patients with lymph node metastases was significantly higher than those without lymph node metastases (OR 2.897, 95% CI 2.129–3.942, p=0.000). The 3-Year DFS were 98.22% in the LVSI negative patients and 93.78% in the LVSI positive patients, the difference was significant (P=0.002). Conclusion A higher risk of lymph node metastasis and a lower 3-Year DFS was found in the LVSI-positive patients. In case of LVSI, it would be dangerous to treat patient in laparoscopy, especially in case of cervical cancer lesions >4cm.
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Affiliation(s)
- Wancheng Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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Varela Cagetti L, Gonzague-Casabianca L, Zemmour C, Lambaudie E, Houvenaeghel G, Provansal M, Sabatier R, Sabiani L, Blache G, Jauffret C, Ferré M, Mailleux H, Paciencia M, Tallet A. The impact of modern preoperative high-dose-rate brachytherapy in early-stage cervical cancer. Gynecol Oncol 2021; 161:166-172. [PMID: 33563488 DOI: 10.1016/j.ygyno.2021.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/25/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the clinical outcomes and the safety of preoperative high-dose-rate (HDR) image-guided adaptive brachytherapy (IGABT) followed by minimally invasive surgery (MIS) in the multidisciplinary management of early-stage cervical cancer. METHODS AND MATERIALS Medical records of all consecutive patients with early-stage cervical cancer treated at our institution between 2012 and 2018 with preoperative IGABT in a multidisciplinary approach were reviewed. Treatment schedule was pelvic node dissection, preoperative IGABT followed 6-8 week later by MIS hysterectomy. RESULTS Seventy patients with cervical cancer FIGO stages (IB1 18.6%, IB2 75.7% and IIA1 5.7%) were treated by preoperative HDR brachytherapy. With a median follow-up of 37.4 months [95% confidence interval, 32.1-39.7 months] isolated vaginal vault recurrence was not observed, 3 pelvic relapses were reported (4.3%). None of patients received postoperative radiotherapy (EBRT) or radiochemotherapy. The estimated 3-year local and pelvis relapse free survival for the entire population were respectively 98% [95% confidence interval, 89%-100%] and 90% [80%-96%]. The estimated 3-year disease-free survival (DFS) for the entire population was 88% [77-94%]. The 3-year overall survival (OS) rate was 97% [88%-99%]. Microscopic vaginal resection margin (R1) was observed in one patient ([1].4%). Lymph-vascular space invasion (LVSI) was found found in 6 (8.6%) patients. Forty-eight late complications in 36 patients (51.4%) were observed. Five (7.1%) grade 3 vaginal wound dehiscence toxicities were observed. Urinary and gastrointestinal toxicities were grade 1-2. No grade 4-5 complications were observed. CONCLUSIONS Preoperative image-guided adaptive brachytherapy followed by minimally invasive surgery allows high local control, reduces positive surgical margins and rates of lymph-vascular space invasion avoiding adjuvants treatments. Surgical approaches must be discussed with patients including preoperative brachytherapy as a down-staging treatment.
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Affiliation(s)
| | | | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, 13000 Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, CRCM, 13000 Marseille, France; Aix-Marseille University, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France; Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Magalie Provansal
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France; Département of Molecular Oncology, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Laura Sabiani
- Departemet of Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Guillaume Blache
- Departemet of Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Camille Jauffret
- Departemet of Oncology Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Marjorie Ferré
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Hugues Mailleux
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Maria Paciencia
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | - Agnès Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
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Liu Y, Huang S, Ming X, Jing H, Li Z. Surgical Approach and Use of Uterine Manipulator Are Not Associated with LVSI in Surgery for Early-stage Cervical Cancer. J Minim Invasive Gynecol 2021; 28:1573-1578. [PMID: 33497723 DOI: 10.1016/j.jmig.2021.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE In 2018, the Laparoscopic Approach to Cervical Cancer trial reported that patients undergoing minimally invasive surgery for cervical cancer (CC) had poorer outcomes than patients undergoing open surgery. Several hypotheses have been made to explain the results. We aimed to investigate whether laparoscopic procedures and use of a uterine manipulator increase the risk of lymphovascular space invasion (LVSI) in early-stage CC. DESIGN A retrospective study. SETTING A Chinese women's and children's hospital. PATIENTS Patients with early-stage CC who underwent radical hysterectomy in West China Second University Hospital between April 2019 and May 2020. INTERVENTIONS Laparoscopic surgery (with uterine manipulator and uterine manipulator-free) and open surgery. MEASUREMENTS AND MAIN RESULTS A total of 979 patients diagnosed with CC were registered in West China Second University Hospital for surgical treatment. Of these, 525 patients underwent laparoscopic surgery and 454 patients underwent open surgery. In total, 735 patients with early-stage cancer underwent radical hysterectomy and pelvic lymphadenectomy, including 357 by laparoscopic surgery and 378 by open surgery. For those who underwent radical hysterectomy and pelvic lymphadenectomy, the incidence of LVSI was 48.41% and 47.34% in laparoscopic and open groups, respectively (p = .771). After 1:1 propensity score matching with age, International Federation of Gynecology and Obstetrics stage, pathology, and tumor size, the incidence of LVSI was 45.54% and 51.79% in laparoscopic and open groups, respectively (p = .186). Subdividing the laparoscopic group into uterine manipulator and uterine manipulator-free groups, the incidence of LVSI was 45.22% and 48.35%, respectively (p = .580). After propensity score matching with age, International Federation of Gynecology and Obstetrics stage, pathology, and tumor size, the incidence of LVSI was 45.78% and 55.42% in these 2 groups, respectively (p = .214). Multiple factor analysis revealed that lymph node metastasis and deep stromal invasion were associated with LVSI (p value <.05 in both groups). CONCLUSION The surgical approach and use of a uterine manipulator are not associated with LVSI in surgery for early-stage CC. Lymph node metastasis and deep stromal invasion are associated with LVSI.
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Affiliation(s)
- Yinxia Liu
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China (all authors)
| | - Shuying Huang
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China (all authors)
| | - Xiu Ming
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China (all authors)
| | - Huining Jing
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China (all authors)
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China (all authors).
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You K, Park HC, Park SC, Sohn DK, Oh JH, Lee DW, Park SS, Kang SB, Heo SC, Kim MJ, Park KJ. Laparoscopic approach for T4 colon cancer can be associated with poor prognosis in right-sided T4b tumours. Eur J Surg Oncol 2021; 47:1645-1650. [PMID: 33500180 DOI: 10.1016/j.ejso.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/21/2020] [Accepted: 01/14/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Although recent studies have demonstrated the safety of laparoscopic surgery in T4 colon cancer, some patients could have poor prognosis. In this study, we aimed to analyse the risk factors affecting oncologic outcome of laparoscopic surgery. MATERIALS AND METHODS Among the 1033 T4 colon cancer patients collected from a multicentre database (2004-2017), 584 patients (458 T4a and 126 T4b) underwent laparoscopic approach for radical surgery. Risk factors associated with 3-year disease-free survival (DFS) and overall survival (OS) were evaluated through multivariate analysis. In addition, subgroups were classified using a combination of risk factors, and the survival rate was evaluated. RESULTS During this period, 188 (32.2%) had recurrence, and 151 (25.9%) died. In the multivariate analysis for oncologic outcome, elevated carcinoembryonic antigen level (hazard ratio [HR] 1.37) and absence of adjuvant chemotherapy (HR 1.60) were associated with poor DFS. T4b (HR 1.56, 1.46), right-sided location (HR 1.52, 1.42), and open conversion (HR 2.70, 2.12) were independently associated with both poor DFS and OS. When four subgroups were analysed through the combination of tumour location and T stage, the DFS and OS rates were significantly lower in patients with right-sided T4b cancer than in other groups (log-rank p < 0.001). CONCLUSION Right-sided T4b colon cancer for laparoscopic surgery may lead to poor oncologic outcome. This approach could be a caution in suspected cases preoperatively.
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Affiliation(s)
- Kiho You
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hyoung-Chul Park
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea.
| | - Sung Chan Park
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dong-Won Lee
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sung-Sil Park
- Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Dai D, Huang H, Feng Y, Wan T, Liu Z, Tong C, Liu J. Minimally invasive surgery vs laparotomy for early stage cervical cancer: A propensity score-matched cohort study. Cancer Med 2020; 9:9236-9245. [PMID: 33236825 PMCID: PMC7774733 DOI: 10.1002/cam4.3527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/08/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the long-term oncologic outcomes of minimally invasive surgery (MIS) vs laparotomy for patients with stage IB (2018 FIGO) cervical cancer. METHODS A matched retrospective study of cervical cancer patients who underwent MIS or laparotomy at Sun Yat-sen University Cancer Center from January 2012 to December 2015 was carried out. Patients were restaged according to the 2018 FIGO staging system for cervical cancer, 700 cases with stage IB cervical cancer were enrolled. Propensity score matching (PSM) was performed by software SPSS version 22.0, and a total of 426 patients were enrolled and analyzed. Oncologic outcomes were compared between patients undergoing MIS vs laparotomy. RESULTS After PSM, there were no statistical differences in other baseline characteristics between MIS and laparotomy, except for age (p = 0.008). In all stage IB patients, MIS group had significantly lower disease-free survival (DFS) rate and overall survival (OS) rate compared with laparotomy group (5-year DFS rate, 87.5% vs 94.1%, hazard ratio for disease recurrence, 2.403; 95% CI, 1.216-4.744; 5-year OS rate, 92.3% vs 98.1%, hazard ratio for death, 3.719; 95% CI, 1.370-10.093). In stage IB1 patients population, MIS was still associated with worse DFS and OS compared to laparotomy (5-year DFS rate: 89.5% vs 100%, p = 0.012; 5-year OS rate: 93.4% vs 100%, p = 0.043). Even in stage IB1 patients without lymph vascular space invasion, worse oncologic outcome could be observed in MIS group (DFS: p = 0.021; OS: p = 0.076). CONCLUSION Our study suggested that laparotomy resulted in better OS and DFS compared with MIS among patients with stage IB cervical cancer. Even in stage IB1 patients without lymph vascular space invasion (2018 FIGO), laparotomy might be still an oncologically safer approach.
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Affiliation(s)
- Danian Dai
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
- Department of Gynecology and ObstetricsThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - He Huang
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
- Department of Gynecology and ObstetricsThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Yanling Feng
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
| | - Ting Wan
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
| | - Zhimin Liu
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
| | - Chongjie Tong
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
| | - Jihong Liu
- Department of Gynecologic OncologyState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
- Department of Gynecology and ObstetricsThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
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Song J, Le T, Hopkins L, Fung-Kee-Fung M, Jooya A, Lupe K, Gaudet M, Samant R. Treatment of Early Stage High-Risk Endometrioid-Type Endometrial Cancer and Patterns of Disease Relapse: A Retrospective Analysis. Adv Radiat Oncol 2020; 5:910-919. [PMID: 33083653 PMCID: PMC7557164 DOI: 10.1016/j.adro.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose A recently published randomized controlled trial has demonstrated that in patients with endometrial cancer with high-risk features, the addition of chemotherapy to radiation therapy, compared with radiation therapy alone, resulted in a significant improvement in failure-free survival. However, in the study, the effect of chemotherapy was limited to stage III patients, and the benefit was less pronounced in stage I and II patients. Our study aims to investigate the current practice of treatment and clinical outcomes in stage I high-risk endometrioid-type endometrial cancer. Methods and Materials A single-center retrospective study was conducted on patients with stage I high-risk endometrioid-type endometrial cancer without serous or clear cell features who have undergone hysterectomy between 1998 and 2015. Data on patients, tumor, and treatments were collected and correlated with clinical outcomes. Results A total of 1,572 patients with stage I disease were identified and 46 patients who met the inclusion criteria were selected for final analysis. The median age at diagnosis was 63 years (range, 49-86 years) and median follow-up was 5.9 years. Among the entire cohort, 40 (87.0%) patients underwent adjuvant radiation therapy, of which 36 (78.2%) patients underwent external beam radiation therapy and 4 (8.7%) patients underwent vaginal brachytherapy. Two of the 40 patients who received adjuvant radiation therapy also received adjuvant chemotherapy. Six (13.0%) patients received no adjuvant treatment. Of the 46 patients, the cumulative risk of distant recurrence was 19.6%, and only 1 patient (2.2%) recurred within pelvis (perirectal lymph node). Five-year disease-free survival and overall survival rates were 73.1% and 80.1%, respectively. Conclusions Adjuvant radiation therapy in stage I endometrioid-type endometrial cancer patients with high-risk features resulted in high rates of locoregional disease control, and most recurrences occurred at distant sites. Effective systemic therapy may be indicated in this patient population to further reduce the risk of distant relapses and improve survival.
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Affiliation(s)
- Jiheon Song
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Tien Le
- Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Laura Hopkins
- Division of Gynecologic Oncology, Saskatoon Cancer Center, Saskatoon, SK, Canada
| | | | - Alborz Jooya
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Krystine Lupe
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rajiv Samant
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON, Canada
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Yang W, Chen R, Li C, Li L, Luo N, Cheng Z. Laparoscopic Regional Radical Hysterectomy Showed Promising Clinical Outcomes in Early-stage Cervical Cancer. Gynecol Minim Invasive Ther 2020; 9:220-226. [PMID: 33312866 PMCID: PMC7713656 DOI: 10.4103/gmit.gmit_75_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives: To evaluate the clinical outcomes of standardized and region-specific excision in laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer (ECC). Materials and Methods: This is a retrospective case–controlled study from 2011 to December 2016. A total of 328 women with ECC (IA1, IA2, IB1, or IIA1) underwent primary surgery by laparoscopy or laparotomy in our institute. Women diagnosed as stage IB1 or IIA1 were treated with radical hysterectomy (RH) by open or laparoscopic route. The total parametrium excision in the process of RH was measured and highlighted in the study. Results: A total of 186 patients underwent open surgery and 142 ones were treated with laparoscopic surgery. Laparoscopic surgery was associated with less blood loss (194.43 ± 84.40 ml vs. 362.68 ± 253.36 ml, P < 0.01), shorter hospital stay (11 vs. 14 days, P < 0.01), and lower risk of blood transfusion (2.8% vs. 18.8%, P < 0.01). There was no significant difference in the postoperative complications between two groups (18/142, 12.7% vs. 21/186, 11.3%; P > 0.05). The rate of 5-year overall survival (OS) was 92.8% in laparoscopy group, similar to that of 94.4% in the open group (P = 0.762). Disease-free survival (DFS) rate at 3 years in laparoscopy group was decreased when compared to open group (91.8% vs. 95.0%, P = 0.030), but there was no significant difference in 3-year DFS among the women with tumor size <2 cm (100% vs. 97.0%, P = 0.818). Conclusion: Laparoscopic surgery was associated with better surgical outcomes compared to open surgery in ECC. 5-Year OS was comparable between the groups and cases with tumor size <2 cm showed no difference in 3-year DFS. LRH may be a better fit for women with tumor size <2 cm. Standardized region-specific RH helps to optimize the clinical outcomes of LRH in ECC.
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Affiliation(s)
- Weihong Yang
- Department of Gynecology and Obstetrics, Tenth People's Hospital, China.,Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, University in Shanghai, China
| | - Rong Chen
- Department of Gynecology and Obstetrics, Tenth People's Hospital, China.,Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, University in Shanghai, China
| | - Caixia Li
- Department of Gynecology and Obstetrics, Tenth People's Hospital, China.,Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, University in Shanghai, China
| | - Li Li
- Department of Gynecology and Obstetrics, Tenth People's Hospital, China
| | - Ning Luo
- Department of Gynecology and Obstetrics, Tenth People's Hospital, China
| | - Zhongping Cheng
- Department of Gynecology and Obstetrics, Tenth People's Hospital, China.,Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, University in Shanghai, China
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Tsuji S, Hori K, Tashima L, Yoshimura M, Ito K. Multiple metastases after laparoscopic surgery for early-stage endometrial cancer: A case report. Int J Surg Case Rep 2020; 76:552-556. [PMID: 33207430 PMCID: PMC7607062 DOI: 10.1016/j.ijscr.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/03/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic surgery is less invasive but leads to a peculiar recurrence pattern. Aspiration biopsy provides limited diagnostic accuracy in some cases. Preoperative histological diagnosis should always be confirmed with D&C. Preoperative recurrence risk might be underestimated. TLH associated with poor oncologic outcomes in moderate to high recurrence risk.
Introduction Laparoscopic surgery for early-stage endometrial cancer is associated with lower morbidity compared to open surgery and has comparable oncologic outcomes. We observed unexpected multiple metastases after laparoscopic surgery for endometrial cancer, the recurrence risk of which has previously been estimated to be low. Herein, we present this case and discuss the optimal management of endometrial cancer. Presentation of case A 58-year-old woman complaining of atypical genital bleeding lasting for 5 months was diagnosed with stage IA endometrioid carcinoma grade 1. According to our primary strategy, she underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The post-operative diagnosis was consistent with the pre-operative diagnosis. Since the recurrence risk was post-operatively revised to an intermediate level, she was administered adjuvant chemotherapy. However, multiple metastases were observed 4 months post-operatively, and despite treatment for recurrent disease, she died 2 months later. The uterine specimen was re-examined after the diagnosis of recurrence, and the post-operative diagnosis was revised to endometrioid carcinoma grade 3, indicating that her recurrence risk might have been underestimated. Discussion The multiple metastases observed in this case, including those in the subcutaneous tissue, were presumably caused by pneumoperitoneum. Aspiration biopsy was used to confirm the histological diagnosis pre-operatively. However, dilation and curettage would have been preferable, considering aspiration biopsy provides limited diagnostic accuracy in some cases. Laparoscopic surgery is less invasive; however, it leads to a peculiar recurrence pattern, which is sometimes difficult to assess pre-operatively. Conclusion Physicians should carefully consider indications for laparoscopic surgery for malignant diseases.
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Affiliation(s)
- Saori Tsuji
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Kensuke Hori
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Lena Tashima
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Michiko Yoshimura
- Department of Pathology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Kimihiko Ito
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
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Pedone Anchora L, Bizzarri N, Kucukmetin A, Turco LC, Gallotta V, Carbone V, Rundle S, Ratnavelu N, Cosentino F, Chiantera V, Fagotti A, Fedele C, Gomes N, Ferrandina G, Scambia G. Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach. Eur J Surg Oncol 2020; 47:1090-1097. [PMID: 33039294 DOI: 10.1016/j.ejso.2020.09.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Recent findings show a detrimental impact of the minimally invasive approach on patients with early stage cervical cancer (ECC). Reasons beyond these results are unclear. The aim of the present article is to investigate the possible role of peritoneal contamination during intracorporeal colpotomy. METHODS patients with early stage cervical cancer were divided into 2 groups: no intraperitoneal exposure (N-IPE) intraperitoneal exposure (IPE) during minimally invasive surgery. Patients of the 2 groups were propensity-matched according to the major risk factors. RESULTS 226 cases of the IPE group had a significant worst prognosis than the 142 cases of the N-IPE group (4.5-years disease free survival: 86.6% vs 95.9% respectively, p = 0.005), while N-IPE had similar survival to open surgery (4.5-years disease free survival: 95.0% vs 90.5% respectively, p = 0.164). Distant recurrence was more frequent among IPE patients with a borderline significance (3.5% vs 0.4% among IPE and N-IPE respectively, p = 0.083). On multivariate analysis, intraperitoneal tumor exposure was an independent prognostic factors for worse survival; patients belonging to the N-IPE group had a risk of recurrence of about 3-fold lower compared to patients of the IPE group (hazard ratio: 0.37, 95% confidence interval: 0.15-0.88, p = 0.025). CONCLUSION it would be advisable that further prospective studies investigating the efficacy of different surgical approach in ECC take into consideration of this issue. Moreover, all other measures that could potentially prevent peritoneal exposure of tumor should be adopted during minimally invasive surgery for early stage cervical cancer to provide higher survival outcomes.
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Affiliation(s)
- Luigi Pedone Anchora
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.
| | - Ali Kucukmetin
- Northern Gynaecological Oncology Center, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Luigi Carlo Turco
- Gemelli Molise, Dipartimento di Oncologia, UOC Ginecologia Oncologica, Campobasso, Italy; Gynecology and Brest Care Unit, Mater Olbia Hospital, Olbia, Italy
| | - Valerio Gallotta
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Vittoria Carbone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Stuart Rundle
- Northern Gynaecological Oncology Center, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Nithya Ratnavelu
- Northern Gynaecological Oncology Center, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Francesco Cosentino
- Gemelli Molise, Dipartimento di Oncologia, UOC Ginecologia Oncologica, Campobasso, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Camilla Fedele
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Nana Gomes
- Northern Gynaecological Oncology Center, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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Sampurno S, Chittleborough TJ, Carpinteri S, Hiller J, Heriot A, Lynch AC, Ramsay RG. Modes of carbon dioxide delivery during laparoscopy generate distinct differences in peritoneal damage and hypoxia in a porcine model. Surg Endosc 2020; 34:4395-4402. [PMID: 31624943 DOI: 10.1007/s00464-019-07213-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Insufflation with CO2 can employ continuous flow, recirculated gas and/or additional warming and humidification. The ability to compare these modes of delivery depends upon the assays employed and opportunities to minimize subject variation. The use of pigs to train colorectal surgeons provided an opportunity to compare three modes of CO2 delivery under controlled circumstances. METHODS Sixteen pigs were subjected to rectal resection, insufflated with dry-cold CO2 (DC-CO2) (n = 5), recirculated CO2 by an AirSeal device (n = 5) and humidification and warming (HW-CO2) by a HumiGard device (n = 6). Peritoneal biopsies were harvested from the same region of the peritoneum for fixation for immunohistochemistry for hypoxia-inducible factor 1 alpha (HIF-1α) and scanning electron microscopy (SEM) to evaluate hypoxia induction or tissue/cellular damage, respectively. RESULTS DC-CO2 insufflation by both modes leads to significant damage to mesothelial cells as measured by cellular bulging and retraction as well as microvillus shortening compared with HW-CO2 at 1 to 1.5 h. DC-CO2 also leads to a rapid and significant induction of HIF-1α compared with HW-CO2. CONCLUSIONS DC-CO2 insufflation induces substantive cellular damage and hypoxia responses within the first hour of application. The use of HW-CO2 insufflation ameliorates these processes for the first one to one and half hours in a large mammal used to replicate surgery in humans.
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Affiliation(s)
- Shienny Sampurno
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Timothy J Chittleborough
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sandra Carpinteri
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jonathan Hiller
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Alexander Heriot
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Andrew Craig Lynch
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Robert George Ramsay
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum, Department of Oncology, University of Melbourne, Melbourne, Australia. .,Differentiation and Transcription Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
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Chiancone F, Fabiano M, Califano A, Langella NA, Pucci L, Franzese D, Izzo A, Perdonà S, Fedelini P. Massive intra-abdominal recurrence after robotic-assisted radical cystectomy: A case report and critical appraisal of literature. Urologia 2020; 88:21-24. [PMID: 32945242 DOI: 10.1177/0391560320957235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Over the years, the robotic surgery is gaining increasing importance in the treatment of bladder cancer. Some doubts remain about the oncological safety of robotic approach and alerts have been raised about the occurrence of atypical recurrences, including peritoneal carcinomatosis and port-site metastasis. CASE PRESENTATION The patient referred to our Emergency Department because of acute confusional state probably due to severe anemia and sepsis. A left nephroureterectomy, left hemicolectomy with end colostomy and the surgical excision of the huge mass was performed through a xipho-pubic incision associated to another left peri-stomal incision. The histological specimen analysis showed a high-grade sarcoma, not otherwise specified (sarcoma, NOS-type), measuring 29 cm × 8 cm × 5 cm in diameters. The left kidney and ureter were not infiltrated by the neoplasm while serosa membranes and muscular layers of left colon were infiltrated by the mass. The patient died because of a cardiac arrest 4 days after surgery. DISCUSSION RARC is a safe and feasible alternative to open radical cystectomy (ORC) with satisfactory operative time, little blood loss, and low transfusion rates. Despite this, RARC is associated with a low, but not neglectable, risk of atypical metastases like peritoneal implants and port-site metastasis. Although a small amount (7%) of RARC were performed in non-urothelial variants of bladder cancer, the sarcomatoid one can be related to a greater risk of atypical recurrence and special precaution should be taken to reduce potential causes of tumor seeding.
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Affiliation(s)
| | - Marco Fabiano
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | | | | | - Luigi Pucci
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | - Dario Franzese
- Department of Urology, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", Naples, Italy
| | - Alessandro Izzo
- Department of Urology, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", Naples, Italy
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", Naples, Italy
| | - Paolo Fedelini
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
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Shigeta K, Matsumoto K, Takeda T, Hattori S, Kaneko G, Matsushima M, Abe T, Tanaka N, Mizuno R, Asanuma H, Kikuchi E, Oya M. Evaluating the Oncological Outcomes of Pure Laparoscopic Radical Nephroureterectomy Performed for Upper-Tract Urothelial Carcinoma Patients: A Multicenter Cohort Study Adjusted by Propensity Score Matching. Ann Surg Oncol 2020; 28:465-473. [PMID: 32840743 DOI: 10.1245/s10434-020-09046-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset. METHODS Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes. RESULTS Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%, p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR. CONCLUSION Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.
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Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Seiya Hattori
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Gou Kaneko
- Department of Urology, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Takayuki Abe
- Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Hyung WJ, Yang HK, Park YK, Lee HJ, An JY, Kim W, Kim HI, Kim HH, Ryu SW, Hur H, Kim MC, Kong SH, Cho GS, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Han SU. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol 2020; 38:3304-3313. [PMID: 32816629 DOI: 10.1200/jco.20.01210] [Citation(s) in RCA: 201] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated. PATIENTS AND METHODS A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups. RESULTS From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7% v 23.4%, respectively; P = .0027) and late complications (4.7% v 9.5%, respectively; P = .0038), particularly intestinal obstruction (2.0% v 4.4%, respectively; P = .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank P = .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank P = .827; P for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank P = .900; P for noninferiority = .030). CONCLUSION Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.
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Affiliation(s)
- Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Wan Ryu
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Korea, Busan, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jong Won Kim
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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Abel MK, Chan JK, Chow S, Darcy K, Tian C, Kapp DS, Mann AK, Liao CI. Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer. Int J Gynecol Cancer 2020; 30:1347-1355. [PMID: 32753561 DOI: 10.1136/ijgc-2020-001646] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION A recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement. METHODS Data for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. χ2 testing, Kaplan-Meier methods, and Cox models were used for statistical analyses. RESULTS Of 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change -12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95% CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95% CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95% CI 1.25 to 2.02; p<0.001) and individuals with co-morbidities (HR 1.45, 95% CI 1.21 to 1.75, p<0.001) had worse adjusted survival and the highest rates of open hysterectomy. CONCLUSION The use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.
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Affiliation(s)
- Mary Kathryn Abel
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - John K Chan
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, California, USA
| | - Stephanie Chow
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amandeep K Mann
- Division of Gynecologic Oncology, Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Wang Y, Li B, Ren F, Song Z, Ouyang L, Liu K. Survival After Minimally Invasive vs. Open Radical Hysterectomy for Cervical Cancer: A Meta-Analysis. Front Oncol 2020; 10:1236. [PMID: 32903313 PMCID: PMC7396529 DOI: 10.3389/fonc.2020.01236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background: The comparison of survival outcomes between minimally invasive surgery and open surgery for cervical cancer patients remains controversial. We evaluated the survival outcomes of cervical cancer patients who underwent different surgical approaches. Methods: A literature search was performed in PubMed, Embase, and Cochrane databases up to February 2020, using the MESH terms “minimally invasive surgical procedures” and “Uterine Cervical Neoplasms.” Included were all original comparative studies and trials both published and unpublished in English that were related to minimally invasive surgery and open surgery for cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage < IIB. Begg's and Egger's regressions were used to evaluate publication bias. Results: This meta-analysis included 28 studies enrolling 18,961 patients with cervical cancer. The overall analyses indicated that cervical cancer patients with FIGO 2009 stage < IIB who underwent minimally invasive surgery had a lower rate of OS (HR = 1.43, 95% CI = 1.06–1.92, P = 0.019) and DFS (HR = 1.50, 95% CI = 1.21–1.85, P < 0.001) than those who underwent open surgery. Moreover, minimally invasive surgery could lower OS (HR = 2.30, 95% CI = 1.50–3.52, P < 0.001) and DFS (HR = 1.94, 95% CI = 1.36–2.76, P < 0.001) of cervical cancer patients with FIGO 2009 stage ≤ IB1 compared to open surgery. However, there were no significant differences in OS (HR = 1.07, 95% CI = 0.65–1.76, P = 0.801) and DFS (HR = 1.20, 95% CI = 0.65–2.19, P = 0.559) in patients with tumors < 2 cm between the two groups. Conclusions: Minimally invasive radical hysterectomy was associated with poor survival outcomes compared to open surgery. Patients with FIGO 2009 stage ≤ IB1 cervical cancer who underwent minimally invasive surgery have lower OS and DFS rates than those who underwent open surgery. Therefore, open surgery should be performed for cervical cancer patients. However, patients with tumors < 2 cm might take the most advantage of minimally invasive surgery without increasing poor prognosis. There are some limitations in the meta-analysis, which needs further high-quality multicenter studies to confirm and update our findings.
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Affiliation(s)
- Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bo Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang Ren
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Ouyang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kuiran Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Laparoscopic surgery for T4 colon cancer: a risk factor for peritoneal recurrences? Surgery 2020; 168:119-124. [PMID: 32305228 DOI: 10.1016/j.surg.2020.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/17/2020] [Accepted: 02/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although some preclinical studies have inferred that laparoscopic surgery for advanced cancer may increase the risk of peritoneal metastasis, this potential hazard has not been fully evaluated in the clinical setting. This study aimed to clarify whether laparoscopic surgery is associated with an increased risk of postoperative peritoneal recurrence after resection of T4 colon cancer. METHODS This study included 272 patients who underwent curative resection for pathological T4a colon cancer without distant metastases at the University of Tokyo Hospital between 1997 and 2017. Multivariable Fine-Gray analysis was performed to evaluate whether the use of laparoscopy was an independent risk factor for postoperative peritoneal recurrence. Thereafter, oncological outcomes (overall and relapse-free survival, and organ-specific recurrence) were compared between laparoscopic colectomy and open colectomy using propensity score matching. RESULTS Multivariable analysis found that laparoscopic surgery was a significant risk factor for postoperative peritoneal recurrence (hazard ratio: 1.89; 95% confidence interval: 1.01-3.65; P = .046). Comparison after propensity score matching revealed that the incidence of peritoneal recurrence was significantly higher after laparoscopic colectomy than after open colectomy (5-year cumulative incidence: 28.1% vs 12.1%; P = .003). CONCLUSION This study suggested that laparoscopic surgery may be related to an increased risk of peritoneal recurrence in patients with pathological T4a colon cancer. Clinicians should be fully aware of this potential risk and seek an optimal treatment plan for the prevention and early detection of peritoneal metastasis.
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