Advances in laparoscopic surgery for cervical cancer

Analysis of Risk Factors of Postoperative Lower Extremity Deep Venous Thrombosis in Patients With Cervical Cancer

Deep venous thrombosis (DVT) has a significant negative impact on surgical and tumor patient's safety and quality of life. There was no specific report on the incidence and risk factors of postoperative lower extremity DVT in cervical cancer patients. Analysis of the risk factors of postoperative DVT in patients with cervical cancer is of great clinical significance for prevention and treatment. We retrospectively analyzed 309 cervical cancer patients treated by the Hubei Cervical Cancer Prevention Center and used a logistic regression model to test the risk variables of postoperative lower extremity deep venous thrombosis in cervical cancer patients. By univariate analyses, the results of the study showed that the incidence of postoperative DVT was significantly increased in cervical cancer patients complicated with old age, obesity, high preoperative plasma D-dimer level, increased preoperative triglyceride level, chronic diseases (hypertension, diabetes, and cardiovascular disease), open surgery, long operation time, intraoperative blood transfusion, advanced tumor stage, and preoperative chemotherapy/radiotherapy. Advanced age, obesity, elevated preoperative D-dimer level, high preoperative triglyceride level, and open surgery were independent risk factors for postoperative lower extremity DVT in patients with cervical cancer by multivariate regression analyses (all P < .05). In gynecologic patients with cervical cancer, there is a high incidence of postoperative lower extremity DVT. Clinicians should develop systematic and comprehensive prevention and treatment measures for the risk factors to lower this morbidity and improve patient prognosis.

Demographic disparities in trend of gynecological cancer in the United States

PURPOSE

This study aimed to analyze the age-adjusted mortality rates (AAMR) per 100,000 for gynecological cancer-related deaths in the United States from 1999 to 2020. We compare trends by different demographic groups to identify significant disparities in these rates between populations within the United States.

METHODS

The National Cancer Institute's Joinpoint Regression Program was used to calculate the average Annual Percent Change (AAPC) to identify trends over the study period using data from the CDC Wonder database, which comprises of demographic information for all causes of mortality in the United States from death certificate records.

RESULTS

From 1999 to 2020, the African American population exhibited a significant downtrend (AAPC, -0.8% [95% CI, - 1.0% to - 0.6%]; p < 0.01), while the white population also demonstrated a notable downtrend (AAPC, - 1.0% [95% CI, - 1.2% to - 0.8%]; p < 0.01). Similarly, the AI/AN population experienced a decline (AAPC, - 1.6% [95% CI, - 2.4% to - 0.9%]; p < 0.01). The AAPI population did not observe a significant trend (AAPC, - 0.2% [95% CI, - 0.5% to 0.5%]; p = 0.127). In addition, the Hispanic/LatinX population experiencing a lower rate of decline compared to non-Hispanics (p = 0.025).

CONCLUSIONS

We found that the AI/AN population to observe the greatest downtrend in mortality rates, while the AAPI observed the least and that the African American population observed a smaller downtrend when compared to the white population. In addition, the Hispanic/LatinX community are significantly being underserved by developing therapies compared to the non-Hispanic/LatinX population. These findings provide valuable insights into the impact of gynecological cancers on specific demographic groups, emphasizing the urgency of targeted interventions to address disparities and improve outcomes.

Complications of radical hysterectomy with pelvic lymph node dissection for cervical cancer: a 10-year single-centre clinical observational study

BACKGROUND AND PURPOSE

The complications of radical surgery for cervical cancer can increase patient suffering and affect their quality of life. This retrospective study assessed the safety of radical hysterectomy (RH) with pelvic lymph node dissection (PLND) by observing the complications of patients with cervical cancer who underwent this procedure in a single centre over 10 years. Our findings may provide experience and evidence for preventing and reducing complications.

METHODS

A total of 2226 cervical cancer patients who met the inclusion criteria were enrolled. All patients underwent RH + PLND. Intraoperative injury to adjacent tissues and short-term and long-term complications were recorded to analyze factors associated with the occurrence of complications.

RESULTS

Postoperative complications occurred in 34.41% (766/2226) of patients, including 7.68% of patients with injury to adjacent tissues, 31.45% with short-term complications, and 2.96% with long-term complications. Age, tumor size, invasion depth, parametrial invasion, lymph vascular space invasion (LVSI), lymph node metastasis, International Federation of Gynaecology and Obstetrics (FIGO) stage, and surgical procedure were closely associated with the postoperative complications of RH + PLND (P < 0.05).

CONCLUSIONS

The results of this study showed that RH + PLND for cervical cancer is safe and practical. Patients aged 40-60 years, with tumors ≥ 4 cm, invasion depth ≥ 2/3, parametrial invasion, LVSI, lymph node metastasis, FIGO stage > IB2, and who underwent open surgery were more prone to complications.

Safety and efficacy of a modified technique of laparoscopic radical hysterectomy for cervical cancer

AIM

Objective to investigate the feasibility, safety, and short-term efficacy of laparoscopic radical hysterectomy without uterine lifter combined with self-locking nylon band.

METHODS

The clinical data of 152 patients who underwent a laparoscopic radical hysterectomy in the Department of gynecology and oncology of Changzhou maternal and child health hospital from January 2017 to June 2020 were analyzed retrospectively, including 97 patients who used uterine lifter (traditional laparoscopic radical hysterectomy) and 55 patients who underwent operation without uterine lifter but combining with self-locking nylon band (modified laparoscopic radical hysterectomy). The differences in operation time, intraoperative blood loss, the width of excised parauterine tissue, the length of the excised vaginal wall, postoperative pathology and short-term prognosis between the two groups were compared and analyzed.

RESULTS

There were no significant differences between the two groups in operation time, intraoperative blood loss, the width of parauterine tissue, and the length of the vaginal wall (p > 0.05). There were no significant differences in the number of lymph nodes, pelvic lymph node metastasis rate and depth of cervical interstitial infiltration between the two groups (p > 0.05), the infiltration rate of lymphatic vascular space in the traditional group was higher than that in the improved group (p < 0.05).

CONCLUSION

It is feasible and safe for laparoscopic radical hysterectomy without uterine lifter combining with a self-locking nylon band to seal the vaginal wall. The uterine lifter may lead to lymphatic vascular space infiltration of tumor cells.

Trends and characteristics of ovarian conservation at hysterectomy for young women with cervical cancer

OBJECTIVE

The association between early surgical menopause and increased mortality has been well demonstrated. Prior studies have also demonstrated that ovarian conservation is not associated with worse oncologic outcomes in early-stage cervical cancer. This study examined the contemporary trends and characteristics of ovarian conservation at time of hysterectomy in young women with cervical cancer.

METHODS

This is a retrospective cohort study examining the National Inpatient Sample. The study population was 4900 women aged ≤50 years with cervical cancer who had hysterectomy-based surgical treatment from 10/2015 to 12/2018. The exposure allocation was the adnexal procedure status (ovarian conservation versus oophorectomy). The main outcome measures were temporal trends of ovarian conservation over time and per patient age. Multivariable binary logistic regression model was fitted to identify independent characteristics associated with ovarian conservation. A classification-tree was constructed by recursive partitioning analysis to examine the utilization patterns of ovarian conservation.

RESULTS

A total of 2,940 (60.0%) women underwent ovarian conservation at hysterectomy. Ovarian conservation rates remained stable until age 37 years, ranging from 82.5% to 77.9% (P = 0.502), after which time the rate sharply and significantly decreased by 7.4% (95% confidence interval 5.4-9.3, P < 0.001) in one-year age increments from 77.9% at age 37 years to 28.7% at age 50 years. The rate of ovarian conservation increased from 54.7% in Q4/2015 to 64.4% in Q4/2018 (P = 0.002). In multivariable analysis, recent surgery remained an independent factor for ovarian conservation (adjusted-odds ratio per year-quarter 1.04, 95% confidence interval 1.03-1.06). A classification-tree model identified 24 unique patterns of ovarian conservation based on patient factor (age, race/ethnicity, primary expected payer, and year of surgery), surgical factor (minimally invasive hysterectomy), and facility factor (hospital bed capacity and region), ranging from <20% to 90% (absolute percentage difference, >80%).

CONCLUSION

Increasing rates of ovarian conservation at the time of hysterectomy in women undergoing surgical management of cervical cancer is encouraging; however, the marked decrease noted in patients in their mid-30s as well as substantial variability in ovarian conservation based on patient, surgical, and hospital factors are striking and warrant further consideration in clinical practice guidelines.

Effect of nursing model based on risk prediction with Logistic regression model on recovery of gastrointestinal motility function and quality of life in patients after gynecological laparoscopy

BACKGROUND

Laparoscopic surgery is a common treatment in gynecology. Although it is a typical minimally invasive procedure, postoperative complications still exist and affect early postoperative recovery. Logistic regression models can be developed to obtain the weights of independent variables and to understand the risk factors for postoperative complications after laparoscopy, which can help to develop intervention strategies.

AIM

To evaluate the effect of a nursing model based on the risk prediction with a Logistic regression model on the early postoperative recovery, gastrointestinal motility, and quality of life in patients after gynecological laparoscopy.

METHODS

The case data of 232 patients undergoing gynecological laparoscopy at our hospital from January 2019 to January 2021 were selected to construct a Logistic regression model to predict the independent risk factors and incidence of gastrointestinal dysfunction after gynecological laparoscopy. Ninety-eight patients who would undergo gynecological laparoscopic surgery were prospectively selected and divided into either a control group or an observation group according to the order in which they were filed, with 49 cases in each group. The control group was given routine care, and the observation group adopted a care model based on the risk prediction using the Logistic regression model. The postoperative recovery status (time to first exhaust, time to first defecation, time to recovery of bowel sounds, and time to gastrointestinal peristalsis) and quality of life were compared between the two groups.

RESULTS

Among 232 patients undergoing gynecological laparoscopy, the incidence of postoperative gastrointestinal dysfunction was 38.36%. Logistic regression analysis showed that age ≥ 60 years old, time to postoperative start of activity ≥ 3 d, drainage tube indwelling time ≥ 7 d, abnormal postoperative potassium, no use of postoperative analgesia, and no use of postoperative gastrointestinal motility drugs were independent risk factors for gastrointestinal dysfunction after gynecological laparoscopic surgery (P < 0.05). Based on these independent risk factors, a Logistic regression model was constructed, and the receiver operating characteristic curve (ROC) was drawn based on the predicted value and the true value. When Logistic (P) was > 0.209, the area under the curve was 0.859, the predictive sensitivity was 95.92%, and the specificity was 93.27%. The time to first exhaustion, time to first defecation, time to bowel sound recovery, and time to gastrointestinal peristalsis were shorter in the observation group than in the control group (P < 0.05). After intervention, the quality of life of patients in the observation group was significantly better than that of the control group (P < 0.05).

CONCLUSION

The nursing model based on risk prediction using a Logistic regression model can promote the early recovery of patients undergoing gynecological laparoscopy, accelerate the recovery of gastrointestinal function, and improve their postoperative quality of life.

The impaction laparoscopic versus laparotomy for lymphovascular space invasion of early cervical cancer: A multicenter retrospective study

Objectives:

The aim of this study was to compare the lymphovascular space invasion between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH).

Materials and Methods:

One retrospective study was conducted with 391 patients treated with 242 patients underwent ARH and 149 patients underwent LRH between May 2010 and August 2019. We collected clinicopathological and perioperative outcome from medical records. We adopt Student's t-test and Chi-square test was used to compare continuous and categorical variables between LRH and ARH.

Results:

Our research found that there was no difference in tumor size, histology, pathology grades, positive lymph nodes, and postoperative complications between LRH and ARH (P > 0.05). The estimated blooding loss (EBL) and length of postoperative hospital stay were less for LRH than ARH (248.12 ml vs. 412.56 ml, P < 0.05, and 10.48 days vs. 15.16 days, P < 0.05). The mean operative time was longer for LRH than ARH (227.51 min vs. 215.62 min, P < 0.05). Significant difference was found in intraoperative complications (P < 0.05). However, LVSI was higher for LRH than ARH (36.8% vs. 19.8%, P < 0.05). We discovered that the LVSI was related with International Federation of Obstetrics and Gynecology stage and tumor size.

Conclusion:

Compared to ARH, the LRH would be advantageous for early cervical cancer in terms of EBL, length of postoperative hospital stay, and intraoperative complications. The ARH was superior to LRH in operative time. In addition to, LRH was more likely to lead to LVSI. Furthermore, when tumor size or stage was increasing, LRH was easily to generate LVSI. But, we cannot confirm recurrence rate is related to LVSI.

Proteomic analysis of the influence of CO2 pneumoperitoneum in cervical cancer cells

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.

Minimally invasive surgery in cervical cancer

In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.

Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters

PURPOSE

The aim of the study was to compare recurrence-free survival (RFS) and overall survival (OS) of patients with early stage cervical cancer in dependence of surgical approach and treatment center.

PATIENTS AND METHODS

A population-based cohort study including women with early stage IA1-IIB2 cervical cancer treated by radical hysterectomy between January 2010 and December 2015 was performed.

RESULTS

The median follow-up time was 5.6 years. After exclusions, 413 patients were eligible for analysis: 111 (26.9%) underwent minimal-invasive surgery (MIS) and 302 (73.1%) open surgery. Both treatment groups were well balanced regarding the clinical and pathological characteristics. The mean age of the patients was 51.0 years. MIS was associated with improved RFS and OS compared with the open surgery. The 5-year RFS rates were 89.2% in the MIS group and 73.4% in the open surgery group (p = 0.004). The 5-year OS rates were 93.7% in the MIS group and 81.8% in the open surgery group (p = 0.016). After adjustment for other prognostic covariates, the MIS was further associated with improved RFS (HR = 0.45, 95% CI 0.24-0.86; p = 0.015) but not with OS. Nevertheless, after adjustment for treatment center, the surgical approach was not associated with significant difference in RFS (HR = 0.61, 95% CI 0.31-1.19; p = 0.143). Overall survival of patients treated in university cancer centers was significantly increased compared to patients treated in non-university cancer centers. The treatment center remains a strong prognostic factor regarding RFS (HR = 0.49, 95% CI 0.28-0.83; p = 0.009) and OS (HR = 0.50, 95% CI 0.26-0.94; p = 0.031).

CONCLUSIONS

The treatment center but not the surgical approach was associated with the survival of patients treated with radical hysterectomy for early stage cervical cancer.

Primary conization overcomes the risk of developing local recurrence following laparoscopic radical hysterectomy in early stage cervical cancer

OBJECTIVE

To investigate whether primary conization might overcome the risk of local dissemination in patients undergoing laparoscopic radical hysterectomy.

METHODS

Consecutive data of 262 patients with early stage cervical cancer were retrieved: 88 women had conization followed by radical hysterectomy. A propensity-matched comparison (1:1) was carried out in order to compare laparoscopy and open surgery. Accumulating data highlighted that minimally invasive surgery has been associated with higher recurrence rates and worse overall survival than open surgery in women with early stage cervical cancer.

RESULTS

Data of 35 paired patients (total 70 patients) were analyzed. No between-group differences in baseline, disease, and pathological variables were observed. Patients undergoing laparoscopy correlated with lower blood loss (50 [range 30-100] vs 150 [range 50-500] mL; P<0.001) and shorter length of stay (3 ± 0.8 vs 5.4 ± 1.4 days; P<0.001) compared to open surgery. One local recurrence was observed per group (P=1.00). Type of surgical approach did not influence site of recurrence (P=1.00) or survival outcomes, in terms of 10-year disease-free (P=0.549, log-rank test) and overall survivals (P=0.615, log-rank test).

CONCLUSIONS

The data show that primary conization might overcome the risk of local recurrence after laparoscopic radical hysterectomy in early stage cervical cancer. Further prospective evidence is needed.