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Yujing L, Sijing L, Chengli N. Regarding "Symptomatic Lymphocele After Robot-Assisted Pelvic Lymphadenectomy as Part of the Primary Surgical Treatment for Cervical and Endometrial Cancer: A Retrospective Cohort Study". J Minim Invasive Gynecol 2024:S1553-4650(24)00239-5. [PMID: 38824997 DOI: 10.1016/j.jmig.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Li Yujing
- Center for Infectious Diseases, West China Hospital, Sichuan University, Chengdu, 610044, PR China
| | - Li Sijing
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400000, PR China
| | - Nie Chengli
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 400000, PR China.
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Yun Z, Li X, Zhu D, Li L, Jiang S. A meta-analysis examining the impact of open surgical therapy versus minimally invasive surgery on wound infection in females with cervical cancer. Int Wound J 2024; 21:e14535. [PMID: 38169097 PMCID: PMC10961045 DOI: 10.1111/iwj.14535] [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: 11/14/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
A meta-analysis study was executed to measure the effect of minimally invasive surgery (MIS) and open surgical management (OSM) on wound infection (WI) in female's cervical cancer (CC). A comprehensive literature study till February 2023 was applied and 1675 interrelated investigations were reviewed. The 41 chosen investigations enclosed 10 204 females with CC and were in the chosen investigations' starting point, 4294 of them were utilizing MIS, and 5910 were utilizing OSM. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilized to compute the value of the effect of MIS and OSM on WI in female's CC and by the dichotomous approaches and a fixed or random model. The MIS had significantly lower WI (OR, 0.23; 95% CI, 0.15-0.35, p < 0.001) with no heterogeneity (I2 = 0%) and postoperative aggregate complications (PACs) (OR, 0.49; 95% CI, 0.37-0.64, p < 0.001) in females with CC and compared OSM. However, MIS compared with OSM in females with CC and had no significant difference in pelvic infection and abscess (PIA) (OR, 0.59; 95% CI, 0.31-1.16, p = 0.13). The MIS had significantly lower WI, and PACs, though, had no significant difference in PIA in females with CC and compared with OSM. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
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Affiliation(s)
- Zhouhui Yun
- Obstetrics DepartmentZhejiang HospitalHangzhouChina
| | - Xiumin Li
- Obstetrics DepartmentZhejiang HospitalHangzhouChina
| | - Di Zhu
- Obstetrics DepartmentZhejiang HospitalHangzhouChina
| | - Lijie Li
- Obstetrics DepartmentZhejiang HospitalHangzhouChina
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Fusegi A, Kanao H, Kamata M, Nishino S, Abe A, Omi M, Nomura H. Clinical implications of the superficial uterine vein pattern for the dissection of the anterior layer of the vesicouterine ligament in radical hysterectomy. J Gynecol Oncol 2024; 35:35.e50. [PMID: 38282260 DOI: 10.3802/jgo.2024.35.e50] [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: 09/03/2023] [Revised: 12/06/2023] [Accepted: 12/31/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To describe anatomic patterns of the superficial uterine vein (sUV) and assess their association with aspects of the dissection procedure of the anterior layer of the vesicouterine ligament (aVUL) by retrospectively reviewing surgical videos. METHODS We analyzed patients who underwent laparoscopic radical hysterectomy for early-stage cervical cancer from 2014 to 2019. The primary endpoint was the time required for aVUL dissection. Multiple linear regression analyses were performed to identify factors influencing the time required for aVUL dissection. RESULTS Fifty-three Japanese patients were included. Two sUV configurations were observed: type 1 (the vein ran ventral to the ureter along the uterine artery) and type 2 (the vein did not run along the usual ventral course; it ran dorsal to the ureter or was absent). Approximately 30% of the sUVs were type 2. The total time for dissection of both sides of the aVUL was significantly shorter for type 2 sUVs than for type 1 sUVs. The number of hemostatic interventions during dissection of each side of the aVUL was significantly lower for type 2 sUVs than for type 1 sUVs. In the multivariate analysis, the sUV configuration was the factor significantly influencing the duration of aVUL dissection on each side (right side: β=-143.4; left side, β=-160.4). CONCLUSION We demonstrated that the sUV had 2 types of courses, ventral and others, and its course affected the time required for dissection and the number of hemostatic interventions. Our results provide information supportive of improved radical hysterectomy outcomes.
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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.
| | - Mayumi Kamata
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shogo Nishino
- 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
| | - Makiko Omi
- 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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Zheng S, Liu X, Cheng L, Wu Q, Meng F. Effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer: A meta-analysis. Int Wound J 2023; 20:1061-1071. [PMID: 36111540 PMCID: PMC10031228 DOI: 10.1111/iwj.13962] [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: 08/25/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer. A systematic literature search up to July 2022 was performed and 10 231 subjects with cervical cancer at the baseline of the studies; 4307 of them were using the minimally invasive surgery, and 5924 were using laparotomy. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of minimally invasive surgery and laparotomy on wound infection and postoperative and intraoperative complications in the management of cervical cancer using the dichotomous methods with a random or fixed-effect model. The minimally invasive surgery had significantly lower wound infection (OR, 0.20; 95% CI, 0.13-0.30, P < .001), and postoperative complications (OR, 0.48; 95% CI, 0.37-0.64, P < .001) in subjects with cervical cancer compared laparotomy. However, minimally invasive surgery compared with laparotomy in subjects with cervical cancer had no significant difference in intraoperative complications (OR, 1.04; 95% CI, 0.80-1.36, P = 0.76). The minimally invasive surgery had significantly lower wound infection, and postoperative complications however, had no significant difference in intraoperative complications in subjects with cervical cancer compared with laparotomy. The analysis of outcomes should be with caution because of the low sample size of 22 out of 41 studies in the meta-analysis and a low number of studies in certain comparisons.
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Affiliation(s)
- Shuangyun Zheng
- Department of Gynecology, The Eighth Affiliated Hospital of SUN YAT-SEN University, Shenzhen, Guangdong, China
| | - Xiaole Liu
- Department of Gynecology, The Eighth Affiliated Hospital of SUN YAT-SEN University, Shenzhen, Guangdong, China
| | - Liqin Cheng
- Department of Gynecology, The Eighth Affiliated Hospital of SUN YAT-SEN University, Shenzhen, Guangdong, China
| | - Qiaozhu Wu
- Department of Gynecology, The Eighth Affiliated Hospital of SUN YAT-SEN University, Shenzhen, Guangdong, China
| | - Fanhang Meng
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Liang C, Liu P, Kang S, Li W, Chen B, Ji M, Chen C. Risk factors for and delayed recognition of genitourinary fistula following radical hysterectomy for cervical cancer: a population-based analysis. J Gynecol Oncol 2023; 34:e20. [PMID: 36603848 PMCID: PMC9995873 DOI: 10.3802/jgo.2023.34.e20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. METHODS This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test. RESULTS In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). CONCLUSION Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.
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Affiliation(s)
- Cong Liang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Kang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Moufawad G, Laganà AS, Habib N, Chiantera V, Giannini A, Ferrari F, Vitagliano A, Della Corte L, Bifulco G, Sleiman Z. Learning Laparoscopic Radical Hysterectomy: Are We Facing an Emerging Situation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032053. [PMID: 36767419 PMCID: PMC9915887 DOI: 10.3390/ijerph20032053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 05/29/2023]
Abstract
Despite wide screening campaigns and early detection, cervical cancer remains the fourth most common cancer among women. Radical hysterectomy, whether by open, laparoscopic or by robotic-assisted techniques, is the mainstay treatment. However, for adequate surgical results and good oncological prognosis, a gynecological surgeon should be trained to perform those procedures. The learning curve of radical hysterectomy, especially by laparoscopy, is influenced by several factors. The LACC trial, the decrease in cervical cancer incidence and radical hysterectomy procedures have widely reduced the learning curve for surgeons. This article mainly discusses the learning curve of laparoscopic radical hysterectomy for cervical cancers, and how several factors are influencing it negatively, with the need to have medical authorities reset specific surgical training programs and allocate them to special oncological centers.
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Affiliation(s)
- Graziella Moufawad
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Nassir Habib
- Obstetrics and Gynecology Department, Francois Quesnay Hospital, 78200 Mantes-La-Jolie, France
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, 00185 Rome, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon
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Retrospective Comparison of Laparoscopic versus Open Radical Hysterectomy for Early-Stage Cervical Cancer in a Single Tertiary Care Institution from Lithuania between 2009 and 2019. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040553. [PMID: 35454391 PMCID: PMC9031924 DOI: 10.3390/medicina58040553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: A great debate within the academic arena was evoked by the LACC study, giving rise to doubt regarding the oncological outcomes of the laparoscopic approach for early-stage cervical cancer. This encouraged us to conduct a retrospective analysis of CC treatment surgical approaches applied to the patients at tertiary level Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania, between 2009 and 2019. Materials and Methods: The retrospective study was carried out to evaluate the outcomes after 28 laparoscopic and 62 laparotomic radical hysterectomies for early cervical cancer in a single tertiary care institution performed during the period 2009–2019. For statistical analysis of patients’ parameters, SPSS v. 17.0 was applied, together with the Kaplan–Meier method with a long-rank test and the Cox proportional hazard regression model used for bi-variate analysis determining OS outcomes between MIS and open-surgery groups. Results: After computing data with the Cox regression model, there was no significant difference of the 36-months overall survival between laparoscopy and laparotomy groups, as opposed to the LACC study. Conclusions: Our tertiary institution faces a considerable challenge, and we acknowledge the limitations of the study and also feel a responsibility to follow the latest guidelines. Currently, it appears that the most substantial attention should be focused on the cessation of uterine manipulator use as well as laparoscopic technique learning curves.
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Li P, Liu J, Wang L, Kang S, Yang Y, Guo J, Yao J, Lu A, Wang Z, Lin B, Li Z, Bin X, Lang J, Liu P, Chen C. The Effect of Laparoscopic Radical Hysterectomy Surgical Volume on Oncology Outcomes in Early-Stage Cervical Cancer. Front Surg 2021; 8:692163. [PMID: 34557515 PMCID: PMC8455083 DOI: 10.3389/fsurg.2021.692163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose: To examine the association between surgical volume and surgical and oncological outcomes of women with stage IB1 cervical cancer who underwent laparoscopic radical hysterectomy (LRH). Methods: We retrospectively analyzed the oncological outcomes of 1,137 patients with stage IB1 cervical cancer receiving LRH from 2004 to 2016. The surgical volume for each surgeon was defined as low [fewer than 50 surgeries, n = 392(34.5%)], mid [51-100 surgeries, n = 315(27.7%)], and high [100 surgeries or more, n = 430(37.8%)]. Surgical volume-specific survival was examined with Kaplan–Meier analysis, multivariable analysis, and propensity score matching. Results: The operative times of the high-volume group (227.35 ± 7.796 min) were significantly shorter than that of the low- (272.77 ± 4.887 min, p < 0.001) and mid-volume (255.86 ± 4.981 min, p < 0.001) groups. Blood loss in the high-volume group (169.42 ± 8.714 ml) was significantly less than that in the low-volume group (219.24 ± 11.299 ml, p = 0.003). The 5-year disease-free survival (DFS) and overall survival (OS) in the low-volume, mid-volume, and high-volume groups were similar (DFS: 91.9, 86.7, and 89.2%, p = 0.102; OS: 96.4, 93.5, and 94.2%, p = 0.192). Multivariable analysis revealed surgical volume was not an independent risk factor for OS or DFS. The rate of intraoperative and postoperative complications was similar among the three groups (p = 0.210). Conclusions: Surgical volume of LRH may not be a prognostic factor for patients with stage IB1 cervical cancer. Surgery at high-volume surgeon is associated with decreased operative time and blood loss.
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Affiliation(s)
- Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiaqi Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Wang
- Department of Gynecologic Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shang Kang
- Department of Gynecology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying Yang
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jianxin Guo
- Department of Obstetrics and Gynecology, Daping Hospital, Army Medical University, Chonqing, China
| | - Jilong Yao
- Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Anwei Lu
- Department of Gynecology, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Zhonghai Wang
- Department of Gynecology, Shenzhen Sixth People's Hospital, Shenzhen, China
| | - Bin Lin
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, China
| | - Zhiqiang Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaonong Bin
- Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Pedone Anchora L, Bizzarri N, Gallotta V, Chiantera V, Fanfani F, Fagotti A, Cosentino F, Vizzielli G, Carbone V, Ferrandina G, Scambia G. Impact of surgeon learning curve in minimally invasive radical hysterectomy on early stage cervical cancer patient survival. Facts Views Vis Obgyn 2021; 13:231-239. [PMID: 34555877 PMCID: PMC8823276 DOI: 10.52054/fvvo.13.3.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Recently, it has been sustained that only surgeons skilled in minimally invasive radical hysterectomy (MI-RH) could provide valuable oncological outcomes in early-stage cervical cancer. Still, literature lacks data correlating surgeon experience with patient survival rate. Objective To investigate the impact of surgeon training patient survival rate following MI-RH for early stage cervical cancer. Methods This was a retrospective study of 243 early-stage cervical cancer treated with MI-RH. Multiple regression analyses were undertaken to investigate the impact of the surgeons learning curve, according to the number of MI-RH, on patients prognosis. Results A steady trend of reduction in disease recurrence risk is associated with increased surgeon experience. The peak of the learning curve was shown at the 19th MI-RH (hazard ratio of disease-free survival: 0.321; 95%CI: 0.140-0.737; p= 0.007). The 3 years disease-free survival that a surgeon could provide to patients is significantly lower at the beginning of his/her learning path comparing to what he/she could guarantee once adequate experience had been achieved (75.4% and 91.6% respectively, p=0.005). Surgeon experience appears to be an independent prognostic factor. Conclusion The experience that a surgeon can achieve practicing in MI-RH significantly influences oncological outcomes of early-stage cervical cancer patients. Future studies comparing minimally invasive and open surgery should take this into account. It would be advisable that the scientific community precisely establishes the minimum training required in the field of MI-RH for early-stage cervical cancer.
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A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education. J Robot Surg 2021; 16:749-763. [PMID: 34480323 PMCID: PMC8415702 DOI: 10.1007/s11701-021-01302-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022]
Abstract
We conducted a comprehensive review of surgical simulation models used in robotic surgery education. We present an assessment of the validity and cost-effectiveness of virtual and augmented reality simulation, animal, cadaver and synthetic organ models. Face, content, construct, concurrent and predictive validity criteria were applied to each simulation model. There are six major commercial simulation machines available for robot-assisted surgery. The validity of virtual reality (VR) simulation curricula for psychomotor assessment and skill acquisition for the early phase of robotic surgery training has been demonstrated. The widespread adoption of VR simulation has been limited by the high cost of these machines. Live animal and cadavers have been the accepted standard for robotic surgical simulation since it began in the early 2000s. Our review found that there is a lack of evidence in the literature to support the use of animal and cadaver for robotic surgery training. The effectiveness of these models as a training tool is limited by logistical, ethical, financial and infection control issues. The latest evolution in synthetic organ model training for robotic surgery has been driven by new 3D-printing technology. Validated and cost-effective high-fidelity procedural models exist for robotic surgery training in urology. The development of synthetic models for the other specialties is not as mature. Expansion into multiple surgical disciplines and the widespread adoption of synthetic organ models for robotic simulation training will require the ability to engineer scalability for mass production. This would enable a transition in robotic surgical education where digital and synthetic organ models could be used in place of live animals and cadaver training to achieve robotic surgery competency.
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Li Y, Kong Q, Wei H, Wang Y. Comparison of the complications between minimally invasive surgery and open surgical treatments for early-stage cervical cancer: A systematic review and meta-analysis. PLoS One 2021; 16:e0253143. [PMID: 34197466 PMCID: PMC8248723 DOI: 10.1371/journal.pone.0253143] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/29/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND This meta-analysis comprehensively compared intraoperative and postoperative complications between minimally invasive surgery (MIS) and laparotomy in the management of cervical cancer. Even though the advantages of laparotomy over MIS in disease-free survival and overall survival for management of gynecological diseases have been cited in the literature, there is a lack of substantial evidence of the advantage of one surgical modality over another, and it is uncertain whether MIS is justifiable in terms of safety and efficacy. METHODS In this meta-analysis, the studies were abstracted that the outcomes of complications to compare MIS (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics classification stage IA1-IIB) cervical cancer. The primary outcomes were intraoperative overall complications, as well as postoperative aggregate complications. Secondary outcomes included the individual complications. Two investigators independently performed the screening and data extraction. All articles that met the eligibility criteria were included in this meta-analysis. RESULTS The meta-analysis finally included 39 non-randomized studies and 1 randomized controlled trial (8 studies were conducted on robotic radical hysterectomy (RRH) vs open radical hysterectomy (ORH), 27 studies were conducted on laparoscopic radical hysterectomy (LRH) vs ORH, and 5 studies were conducted on all three approaches). Pooled analyses showed that MIS was associated with higher risk of intraoperative overall complications (OR = 1.41, 95% CI = 1.07-1.86, P<0.05) in comparison with ORH. However, compared to ORH, MIS was associated with significantly lower risk of postoperative aggregate complications (OR = 0.40, 95% CI = 0.34-0.48, P = 0.0143). In terms of individual complications, MIS appeared to have a positive effect in decreasing the complications of transfusion, wound infection, pelvic infection and abscess, lymphedema, intestinal obstruction, pulmonary embolism, deep vein thrombosis, and urinary tract infection. Furthermore, MIS had a negative effect in increasing the complications of cystotomy, bowel injury, subcutaneous emphysema, and fistula. CONCLUSIONS Our meta-analysis demonstrates that MIS is superior to laparotomy, with fewer postoperative overall complications (wound infection, pelvic infection and abscess, lymphedema, intestinal obstruction, pulmonary embolism, and urinary tract infection). However, MIS is associated with a higher risk of intraoperative aggregate complications (cystotomy, bowel injury, and subcutaneous emphysema) and postoperative fistula complications.
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Affiliation(s)
- Yilin Li
- Clinical Medical College, Weifang Medical University, Weicheng District, Weifang, Shandong, China
- Division of Gynecology and Obstetrics, Life Science Park of Zhongguancun, Peking University International Hospital, Changping District, Beijing, China
| | - Qingduo Kong
- Clinical Medical College, Weifang Medical University, Weicheng District, Weifang, Shandong, China
- Division of Gynecology and Obstetrics, Life Science Park of Zhongguancun, Peking University International Hospital, Changping District, Beijing, China
| | - Hongyi Wei
- Division of Gynecology and Obstetrics, Life Science Park of Zhongguancun, Peking University International Hospital, Changping District, Beijing, China
| | - Yongjun Wang
- Division of Gynecology and Obstetrics, Life Science Park of Zhongguancun, Peking University International Hospital, Changping District, Beijing, China
- * E-mail:
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Li J, Ouyang X, Gong X, Li P, Xiao L, Chang X, Tang J. Survival outcomes of minimally invasive surgery for early-stage cervical cancer: A single-center, one surgeon, retrospective study. Asian J Surg 2021; 45:320-325. [PMID: 34148755 DOI: 10.1016/j.asjsur.2021.05.037] [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] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Recent studies have shown that minimally invasive surgery (MIS) is associated with a higher recurrence rate in patients with early-stage cervical cancer. In this study, we aim to report the survival outcomes of patients with early-stage cervical cancer who received MIS, performed in a single center by the same surgeon. METHODS Eligible participants included patients with early-stage cervical cancer in stage IA1 with lymphovascular space invasion (LVSI+), IA2, and IB1. The surgeries were carried out by a single surgeon and survival outcomes of the 137 patients were evaluated retrospectively. RESULTS The median follow-up time for the 137 patients was 53 (25-94) months, with the five-year disease-free survival (DFS) rate of 96.4% and the five-year overall survival (OS) rate of 96.8%. Among them, six (4.38%) patients relapsed and four (2.92%) of whom died. The five-year DFS rate was significantly higher in patients with tumor≤2 cm in size than in those with tumor >2 cm (P = 0.013), however, with no significant difference in the five-year OS rate (P = 0.219). CONCLUSION According to the existing literature and the results of this study, for MIS, the proficiency levels of a surgeon may be associated with survival outcomes of cancer patients. Tumor size may also be an important factor affecting survival outcomes of cervical cancer patients.
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Affiliation(s)
- Jinjin Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Xiping Ouyang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Xue Gong
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Pujun Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Lin Xiao
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Xiaoxia Chang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China
| | - Junying Tang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, China.
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13
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Laparoscopic and Robotic Surgery for Endometrial and Cervical Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e372-e382. [PMID: 34053834 DOI: 10.1016/j.clon.2021.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/18/2022]
Abstract
Minimally invasive surgery (MIS) has many benefits, in the form of reduced postoperative morbidity, improved recovery and reduced inpatient stay. It is imperative, however, when new techniques are adopted, in the context of treating oncology patients, that the oncological efficacy and safety are established rigorously rather than assumed based on first principles. Here we have attempted to provide a comprehensive review of all the contentious and topical themes surrounding the use of MIS in the treatment of endometrial and cervix cancer following a thorough review of the literature. On the topic of endometrial cancer, we cover the role of laparoscopy in both early and advanced disease, together with the role and unique benefits of robotic surgery. The surgical challenge of patients with a raised body mass index and the frail and elderly are discussed and finally the role of sentinel lymph node assessment. For cervical cancer, the role of MIS for staging and primary treatment is covered, together with the interesting and highly specialist topics of fertility-sparing treatment, ovarian transposition and the live birth rate associated with this. We end with a discussion on the evidence surrounding the role of adjuvant hysterectomy following radical chemoradiation and pelvic exenteration for recurrent cervical cancer. MIS is the standard of care for endometrial cancer. The future of MIS for cervix cancer, however, remains uncertain. Current recommendations, based on the available evidence, are that the open approach should be considered the gold standard for the surgical management of early cervical cancer and that MIS should only be adopted in the context of research. Careful counselling of patients on the current evidence, discussing in detail the risks and benefits to enable them to make an informed choice, remains paramount.
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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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15
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Yang FC, Huang W, Yang W, Liu J, Ai G, Luo N, Guo J, Chua PT, Cheng Z. Cervical Cancer Surgery: Current State of Affairs. Gynecol Minim Invasive Ther 2021; 10:75-83. [PMID: 34040965 PMCID: PMC8140537 DOI: 10.4103/gmit.gmit_81_20] [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: 06/07/2020] [Revised: 07/21/2020] [Accepted: 01/18/2021] [Indexed: 11/04/2022] Open
Abstract
Cervical cancer surgery has a history of more than 100-years whereby it has transitioned from the open approach to minimally invasive surgery (MIS). From the era of clinical exploration and practice, minimally invasive gynecologic surgeons have never ceased to explore new frontiers in the field of gynecologic surgery. MIS has fewer postoperative complications, including reduction of treatment-related morbidity and length of hospital stay than laparotomy; this forms the mainstay of treatment for early-stage cervical cancer. However, in November 2018, the New England Journal of Medicine had published two clinical studies on cervical cancer surgery (Laparoscopic Approach to Cervical Cancer [LACC]). Following these publications, laparoscopic surgery for early-stage cervical cancer has come under intense scrutiny and negative perceptions. Many studies began to explore the concept of standardized surgery for early-stage cervical cancer. In this article, we performed a review of the history of cervical cancer surgery, outlined the standardization of cervical cancer surgery, and analyzed the current state of affairs revolving around cervical cancer surgery in the post-LACC era.
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Affiliation(s)
- Fan Chun Yang
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Wei Huang
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Weihong Yang
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Jie Liu
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Guihai Ai
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ning Luo
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Jing Guo
- Gynecological Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
| | | | - Zhongping Cheng
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.,Gynecological Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
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Alliende RI, Carrasco ÁM, Levancini M, Kovoor E, Guzmán-Rojas RA, Miranda-Mendoza I. 5,926 hysterectomies: complications described by Clavien-Dindo classification. J OBSTET GYNAECOL 2021; 41:1102-1106. [PMID: 33432854 DOI: 10.1080/01443615.2020.1835843] [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] [Indexed: 10/22/2022]
Abstract
Hysterectomy is the most common major gynaecological surgery. Due to its high volume, the analysis of its results is relevant. The objective of this study was to describe intraoperative complications and reoperations, for both benign and malignant causes, using the Clavien-Dindo classification (approved by local ethics committee, number 100220). Between 2000 and 2019, 5926 elective hysterectomies were performed, of which 90.2% were for benign aetiology and 9.8% for malignant causes. The abdominal route was 52.7%, vaginal 40.1% and laparoscopic 7.2%. Intraoperative complications and reoperations (grade III Clavien-Dindo) were 4% and 2.1%, respectively. Oncological surgery had significantly more intraoperative complications (10% vs. 3.4%) and reoperations (3.6% vs. 1.9%) than benign procedures. Noteworthy, intraoperative complications required a new operation in only 3.4% for malignant and 2.8% for benign surgery. Our data showed the relevance of detecting and rectifying intraoperative complications during surgery, which consequently leads to a lower reoperation rate, minimising postoperative morbidity and mortality for patients.Impact StatementWhat is already known on this subject? The surgical complications of hysterectomy, both intraoperative and postoperative, are extensively described. However, this information is not well systematised, in which elective and emergency surgery are mixed. In addition to the above, there are few documents comparing the results of hysterectomies due to benign versus malignant causes.What the results of this study add? Using the Clavien-Dindo classification, this study adds an organised description of intraoperative complications and reoperations of hysterectomy in the context of elective surgery. In addition, it provides information on the comparison between surgery for benign versus malignant causes, as well as information on intraoperative complications requiring a new operation.What the implications are of these findings for clinical practice and/or further research? These findings provide clear and orderly data about the risks of elective hysterectomy and showed the relevance of detecting and rectifying intraoperative complications during the procedure. This is useful for specialists to preoperatively identify the risks for each hysterectomy group and provide their patients with more detailed information during informed consent.
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Affiliation(s)
- Rodrigo I Alliende
- Department of Obstetrics and Gynecology, Hospital de la Florida, Santiago, Chile
| | - Álvaro M Carrasco
- Department of Obstetrics and Gynecology, Hospital de la Florida, Santiago, Chile
| | - Marco Levancini
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile
| | | | - Rodrigo A Guzmán-Rojas
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile.,Department of Obstetrics and Gynecology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Ignacio Miranda-Mendoza
- Department of Obstetrics and Gynecology, Hospital Padre Hurtado, Santiago, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, Chile.,Department of Obstetrics and Gynecology, Hospital Clinico Universidad de Chile, Santiago, Chile
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17
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Laparoscopic nerve-sparing radical hysterectomy without uterine manipulator for cervical cancer stage IB: description of the technique, our experience and results after the era of LACC trial. Arch Gynecol Obstet 2020; 303:1039-1047. [PMID: 33068159 DOI: 10.1007/s00404-020-05835-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/07/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this study is to evaluate surgical data and oncological outcome of laparoscopic nerve-sparing radical hysterectomy without uterine manipulator for cervical cancer stage IB, over the last 8 years. METHODS This retrospective study includes 32 patients with cervical cancer Figo stage (2009) IB who underwent laparoscopic nerve-sparing radical hysterectomy without using any kind of uterine manipulator. Patients were eligible if they had squamous cell carcinoma, adenocarcinoma, or adeno-squamous carcinoma, and no para-aortic lymph node involvement by imaging or after frozen section. The median value and range were assessed for operative outcomes and relapse rate and disease-free survival rate were evaluated using the Kaplan-Meier method. RESULTS In the study, 32 patients were included and among them 27 women were stage IB1 (18 cases with tumor size 2-4 cm) and 5 women stage IB2 (Figo stage 2009). The median age of patients was 50.5 years (range 31-68) and median body mass index (B.M.I) was 25.3 kg/m2 (range 19-33.5 kg/m2). The average operating time was 228 min (range 147-310 min) and median hospital stay was 2.7 days (range 2-7 days). Approximate blood loss was 188 ml (range 120-300 ml). After a median follow-up of 37 months, we had 2 recurrences out of 32 cases and no death. Especially for patients with Figo stage (2009) IB1, the recurrence rate was 3.7% (1/27). The 3-year PFS was 93.7% and the number at risk 23 (71.8%) and especially for the IB1 stage (2009) women, the 3-year PFS was 96.1% and the number at risk 21 (77.7%). The 3-year OS was 100% with no. at risk 71.8%. CONCLUSIONS Laparoscopic nerve-sparing radical hysterectomy without uterine manipulator is feasible and safe surgical procedure for cervical cancer with acceptable surgical and oncological outcomes in the hands of well-trained and experienced laparoscopic surgeons. Our retrospective study reveals better oncological outcome compared to other studies on the minimally invasive approach, where uterine manipulator was routinely used and no vaginal sealing of the tumor was made.
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18
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Chao X, Wu M, Ma S, Tan X, Zhong S, Song X, Li L. Efficacy of different surgical approaches on survival outcomes in patients with early-stage cervical cancer: protocol for a multicentre longitudinal study in China. BMJ Open 2020; 10:e038020. [PMID: 32819996 PMCID: PMC7443279 DOI: 10.1136/bmjopen-2020-038020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Recent studies have revealed that the oncological survival outcomes of minimally invasive radical hysterectomy (MIRH) are inferior to those of abdominal radical hysterectomy (ARH) in early-stage cervical cancer, but the potential reasons are unclear. METHODS AND ANALYSIS Each expert from 28 study centres participating in a previously reported randomised controlled trial (NCT03739944) will provide successive eligible records of at least 100 patients who accepted radical hysterectomy for early-stage cervical cancer between 1 January 2009 and 31 December 2015. Inclusion criteria consist of a definite pathological evaluation of stages IA1 (with positive lymphovascular space invasion), IA2 and IB1 according to the International Federation of Gynecology and Obstetrics 2009 staging system and a histological subtype of squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma. The primary endpoint is 5-year disease-free survival between the MIRH and ARH groups. The secondary endpoints include the MIRH learning curves of participating surgeons, 5-year overall survival between the MIRH and ARH groups, survival outcomes according to surgical chronology, surgical outcomes and sites of recurrence and potential risk factors that affect survival outcomes. A subgroup analysis in patients with tumour diameter less than 2 cm will follow the similar flow diagram. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of Peking Union Medical College Hospital (registration no. JS-1711), and is also filed on record by all other 27 centres. The results will be disseminated through community events and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03738969.
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Affiliation(s)
- Xiaopei Chao
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Ming Wu
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Shuiqing Ma
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Xianjie Tan
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Sen Zhong
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaochen Song
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Lei Li
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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Risk factors and long-term impact of urologic complications during radical hysterectomy for cervical cancer in China, 2004-2016. Gynecol Oncol 2020; 158:294-302. [PMID: 32507516 DOI: 10.1016/j.ygyno.2020.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/18/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The primary objective was to describe the incidence and risk factors of urologic complications during radical hysterectomy for cervical cancer. The secondary objective was to investigate the impact of urologic complications on long-term survival. METHODS Patients who underwent radical hysterectomy for cervical cancer from 2004 to 2016 were identified in the MSCCCC (Major Surgical Complications of Cervical Cancer in China) database. Data on demographic characteristics, clinical characteristics, hospital characteristics and urologic complications were collected. Multivariable logistic regression was used to assess the risk factors of urologic complications and Cox proportional hazards models were performed to identify prognostic factors. RESULTS A total of 21,026 patients undergoing radical hysterectomy for cervical cancer were identified. The incidence of any urologic complications was 1.54%: 83 (0.39%) ureteral injuries, 17 (0.08%) bladder injuries, 1 (0.005%) ureteral injury combined with bladder injury, and 223 (1.05%) genitourinary fistulas. In a multivariable analysis, surgery at a women and children's hospital (OR = 2.26, 95% CI 1.47-3.48), surgery at a facility in a first-tier city (OR = 2.08, 95% CI 1.24-3.48), and laparoscopic surgery (OR = 4.68, 95% CI 3.44-6.36) were associated with a higher risk of urologic complications. Cox proportional hazards models revealed that the occurrence of urologic complications was a significant predictor of 2-year overall survival (OR = 1.78, 95% CI = 1.09-2.92), but was not a predictor of 5-year overall survival (OR = 1.27, 95% CI = 0.83-1.94). CONCLUSION The incidence of urologic complications during radical hysterectomy is low. The risk of urologic complications may be higher for patients who are treated at a women and children's hospital, are treated in first-tier city hospitals, and receive laparoscopic surgery. Urologic complications have an impact on short-term survival, but not on long-term survival.
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20
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Learning curve could affect oncologic outcome of minimally invasive radical hysterectomy for cervical cancer. Asian J Surg 2020; 44:174-180. [PMID: 32467009 DOI: 10.1016/j.asjsur.2020.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVE Recent prospective studies have shown poorer oncologic outcomes following minimally invasive surgery, which has led many surgeons to deeply inspect their practices. We reviewed our experience and evaluated the results of radical hysterectomy in patients with early stage cervical cancer. METHODS This retrospective study included patients with early stage cervical cancer (Ia1 - IIa1) who were treated with radical hysterectomy from May 2006 to Dec 2016. Patients were divided into three groups according to the surgical approach: radical abdominal hysterectomy (RAH), laparoscopic radical hysterectomy (LRH), and robot-assisted radical hysterectomy (RRH). RESULTS Learning curves of each type of surgery were obtained using the cumulative sum method. Survival rates were compared using Kaplan-Meier curves. To analyze the learning curve of a single surgeon, 89 patients were selected from the whole population. Learning curves of each group showed two distinct phases. The minimum number of cases required to achieve surgical improvement were 16 in RAH, 13 in LRH, and 21 in RRH. Progression-free survival (PFS) and overall survival did not vary between RAH and minimally invasive surgery (MIS) (p = .828 and p = .757, respectively). However, when stratified by the phases of the learning curves, patients included in the early phase of MIS showed a poorer PFS (p = .014). CONCLUSIONS Surgical proficiency could significantly affect the oncologic outcome in MIS. A prospective study regarding sufficient surgical competence is necessary for elaborate analysis of the feasibility of minimally invasive radical hysterectomy.
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Patel H, Madhuri K, Rockell T, Montaser R, Ellis P, Chatterjee J, Butler‐Manuel S, Tailor A. Robotic radical hysterectomy for stage
1B1
cervical cancer: A case series of survival outcomes from a leading
UK
cancer centre. Int J Med Robot 2020; 16:e2116. [DOI: 10.1002/rcs.2116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Hersha Patel
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Kavitha Madhuri
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Thomas Rockell
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Rugaia Montaser
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Patricia Ellis
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Jayanta Chatterjee
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Simon Butler‐Manuel
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Anil Tailor
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
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22
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Eoh KJ, Li LY, Shin W, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Survival outcomes of single-port access laparoscopic radical hysterectomy for early-stage cervical cancer. Surg Oncol 2020; 34:140-145. [PMID: 32891319 DOI: 10.1016/j.suronc.2020.04.005] [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: 06/12/2019] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emerging data from the Laparoscopic Approach to Cervical Cancer trial (NCT00614211) suggested that minimally invasive surgery (MIS) for cervical cancer is correlated with worse survival outcomes than open surgery. This finding could be attributed to the different learning curves for laparoscopic surgery among surgeons. This study aimed to assess the feasibility, safety, and survival outcomes of single-port access (SPA) laparoscopic radical hysterectomy (LRH) for treating early cervical cancer. METHODS This was a retrospective cohort study of consecutive patients with early-stage cervical cancer who underwent SPA LRH between 2009 and 2018 performed by a single surgeon with expertise in SPA laparoscopy using conventional instrumentation and a homemade glove port system. RESULTS Type C (93.2%) and B (6.8%) radical hysterectomy were performed in 59 women with cervical cancer classified as IA (3.4%), IB (94.9%), and IIA (1.7%). Forty-one patients (69.5%) had squamous cell carcinoma and 32 patients (52.5%) had tumors < 2 cm. The median operative time was 235 (125-382) minutes. There were no perioperative complications or cases of conversion to open surgery. Postoperative complications, including chylous ascites, low hemoglobin, lymphedema, and vault dehiscence, were observed in 5 patients (8.5%). Median follow-up time was 3.1 (0.6-8.6) years and 3 patients experienced recurrence (1 local and 2 distant failures). Five-year disease-free survival was 94.9% (56/59) and the 5-year overall survival rate was 98.3% (58/59). CONCLUSIONS SPA LRH is feasible and safe for patients with early-stage cervical cancer when performed by experienced surgeons without compromising the radicality and oncologic outcomes.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Republic of Korea; Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lan Ying Li
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Whan Shin
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Yun Lee
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Ji Nam
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunghoon Kim
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Tae Kim
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Wun Kim
- Institute of Women's Life Medical Science, Women's Cancer Center, Department of Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Chen C, Liu P, Ni Y, Tang L, Xu Y, Bin X, Lang J. Laparoscopic versus abdominal radical hysterectomy for stage IB1 cervical cancer patients with tumor size ≤ 2 cm: a case-matched control study. Int J Clin Oncol 2020; 25:937-947. [PMID: 32062731 DOI: 10.1007/s10147-020-01630-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/28/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND To investigate the survival outcomes of stage IB1 cervical cancer patients with tumor size ≤ 2 cm who underwent laparoscopic or abdominal radical hysterectomy. METHODS We retrospectively analyzed stage IB1 cervical cancer patients with a tumor size ≤ 2 cm who underwent laparoscopic or abdominal radical hysterectomy in China between 2004 and 2016. A real-world study (RWS) and 1:1 matching was used in the study. RESULTS After 1:1 matching, laparoscopic (n = 926) and abdominal radical hysterectomy (n = 926) had similar 5-year overall survival and disease-free survival rates in stage IB1 cervical cancer with a tumor size ≤ 2 cm. Subsequently, in cervical squamous carcinoma with tumor size ≤ 2 cm, the laparoscopic and abdominal groups (724 cases, respectively) showed comparable 5-year overall survival and disease-free survival rates. Finally, in cervical adenocarcinoma or adenosquamous carcinoma with tumor size ≤ 2 cm, the laparoscopic group (n = 174) had a similar 5-year overall survival rate but a lower disease-free survival rate compared to those of the abdominal group (disease-free survival: 89.9% vs. 98.0%, respectively, P = 0.006; hazard ratio (HR), 5.094; 95% confidence interval (CI), 1.400-18.535; P = 0.013; n = 174). The RWS results were similar to the 1:1 matching results. CONCLUSIONS Patients with squamous cell carcinoma in stage IB1 cervical cancer with tumor size ≤ 2 cm might be suitable for laparoscopic surgery, while patients with adenocarcinoma or adenosquamous carcinoma with tumor size ≤ 2 cm are not candidates for laparoscopic surgery.
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Affiliation(s)
- Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Yan Ni
- Department of Gynecology, Yuncheng Central Hospital, Yuncheng, Shanxi, China
| | - Lian Tang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China
| | - Yan Xu
- Department of Obstetrics and Gynecology, Pan Yu Central Hospital, Guangzhou, China
| | - Xiaonong Bin
- Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
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Van Boxel GI, Kingma BF, Ruurda JP. Formal assessment of the learning curve for minimally invasive methods is vital in retrospective cohort studies. Am J Obstet Gynecol 2020; 222:95-96. [PMID: 31542252 DOI: 10.1016/j.ajog.2019.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
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Wang W, Li L, Wu M, Ma S, Tan X, Zhong S. Laparoscopic vs. Abdominal Radical Hysterectomy for Locally Advanced Cervical Cancer. Front Oncol 2019; 9:1331. [PMID: 31828044 PMCID: PMC6890871 DOI: 10.3389/fonc.2019.01331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/14/2019] [Indexed: 01/18/2023] Open
Abstract
This study is to compare the survival outcomes of laparoscopic radical hysterectomy (LRH) to those of abdominal radical hysterectomy (ARH) for patients with locally advanced cervical cancer (LACC). Patients with the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2 to IIB LACC who underwent radical hysterectomy between 2001 and 2015 were identified. The disease-free survival (DFS) and overall survival (OS) were compared according to the surgical approach and were adjusted based on clinicopathologic characteristics. A total of 396 patients were included in the study, with 179 (45.2%) and 217 (54.8%) patients in the ARH and LRH groups, respectively. The LRH group showed a significantly lower amount of estimated blood loss, lower blood transfusion rate and shorter length of hospital stay. Overall, there were no significant differences in the 5-year DFS and 5-year OS between the LRH and ARH groups with the Kaplan-Meier method. However, multivariate analyses identified LRH as an independent prognostic factor for a poor DFS (hazard ratio [HR] 2.5; 95% confidence interval [95% CI] 0.19 to 0.87; p = 0.02). The analysis of stage IB2 disease and the squamous subtype (61.9% and 87.9% of all participants, respectively) reached the same conclusion. When stratifying by FIGO stage, the patients with IB2 (n = 348) in the ARH group had a significantly better DFS (HR 0.14, 95% CI 0.05–0.42, p < 0.01) and OS (HR 0.17, 95% CI 0.04–0.67, p = 0.11) than those in the LRH group in the Cox regression model. However, no differences were found in patient with stage IIA1, IIA2, or IIB in Cox regression model. When stratifying by histological types, for the patients with squamous carcinomas (n = 375), in Cox model, ARH had a significantly superior DFS compared with those who underwent LRH (HR 0.45, 95% CI 0.25–0.82, p = 0.01), but the OS was not statistically significant (HR 0.57, 95% CI 0.27–1.20, p = 0.14). However, no differences were found in patient with adenocarcinoma and adenosquamous carcinomas in the Cox model. Therefore, ARH was associated with a higher DFS than LRH in patients with LACC, especially in patients with stage IB2 disease or the squamous subtype.
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Affiliation(s)
- Wenhui Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Shuiqing Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Xianjie Tan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Sen Zhong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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Cancer du col utérin opérable de stade précoce par chirurgie minimale invasive. Recommandations des chirurgiens du groupe GINECO. Bull Cancer 2019; 106:939-940. [DOI: 10.1016/j.bulcan.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/21/2022]
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Liu Y, Li L, Wu M, Ma S, Tan X, Zhong S, Lang J. The impact of the surgical routes and learning curve of radical hysterectomy on the survival outcomes in stage IB cervical cancer: A retrospective cohort study. Int J Surg 2019; 68:72-77. [DOI: 10.1016/j.ijsu.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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Chao X, Li L, Wu M, Ma S, Tan X, Zhong S, Lang J, Cheng A, Li W. Efficacy of different surgical approaches in the clinical and survival outcomes of patients with early-stage cervical cancer: protocol of a phase III multicentre randomised controlled trial in China. BMJ Open 2019; 9:e029055. [PMID: 31362966 PMCID: PMC6677993 DOI: 10.1136/bmjopen-2019-029055] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In the last three decades, minimally invasive surgery (MIS) for radical hysterectomy (RH) has become a popular treatment option for early-stage cervical cancer. However, a recently published randomised controlled trial (LACC trial) and an epidemiological study in the USA revealed strong evidence against the survival advantage of MIS for RH. However, the influencing factors of research centres and the learning curves of surgeons in these studies lacked sufficient evaluation. The efficacy of different surgical approaches for early-stage cervical cancer in the clinical and survival outcomes remains to be validated. METHODS AND ANALYSIS Patients diagnosed with FIGO (2009) stage IA1 (with lymphovascular space invasion), IA2 or IB1 cervical cancer with histological subtype of squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma will be recruited in this multicentre randomised controlled study. Patients will be randomly assigned to undergo MIS (robot-assisted or laparoscopic RH) or abdominal RH. Within 2 years, 1448 patients in 28 centres in China will be recruited to meet the criteria of a non-inferiority threshold of HR of 1.6 with bilateral nominal α <0.05 and power of 0.8. All surgeries will be performed by the indicated experienced surgeons. At least 100 RH cases in the individual past one decade of practice will be analysed as proof of learning curves. The primary objective of this study is 5-year disease-free survival. The secondary objectives include the overall survival rate, progression-free survival rate, disease-free survival rate, cost-effectiveness and quality of life. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of Peking Union Medical College Hospital and is filed on record by all other centres. Written informed consent will be obtained from all eligible participants before enrolment. The results will be disseminated through community events, academic conferences, student theses and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03739944.
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Affiliation(s)
- Xiaopei Chao
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Lei Li
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Ming Wu
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Shuiqing Ma
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Xianjie Tan
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Sen Zhong
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Jinghe Lang
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Aoshuang Cheng
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Wenhui Li
- Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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Kong TW, Son JH, Paek J, Chang SJ, Ryu HS. Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer. J Gynecol Oncol 2019; 31:e7. [PMID: 31788997 PMCID: PMC6918891 DOI: 10.3802/jgo.2020.31.e7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/03/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate oncologic outcomes of minimally invasive radical hysterectomy (RH) in early cervical cancer before and after the application of parametrial invasion (PMI) criterion on magnetic resonance imaging (MRI) and vaginal colpotomy (VC). METHODS A total of 216 International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer patients who underwent minimally invasive RH was identified between April 2006 and October 2018. Patients were classified into the pre-PMI intracorporeal or VC (IVC) (n=117) and post-PMI VC groups (n=99). In the pre-PMI IVC group, PMI criterion (intact stromal ring) on MRI was not applied and the patients received IVC. In the post-PMI VC group, surgical candidates were selected using the PMI criterion on MRI and all patients received VC only. Oncologic outcomes and prognostic factors associated with disease recurrence were analyzed. RESULTS The rate of positive vaginal cuff margins in the pre-PMI IVC group was higher than that in the post-PMI VC group (11.1% vs. 1.0%, p=0.003). Two-year disease-free survival was different between the 2 groups (84.5% in pre-PMI IVC vs. 98.0% in post-PMI VC groups, p=0.005). Disrupted stromal ring on MRI (hazard ratio [HR]=20.321; 95% confidence interval [CI]=4.903-84.218; p<0.001) and intracorporeal colpotomy (HR=3.059; 95% CI=1.176-7.958; p=0.022) were associated with recurrence. CONCLUSION The intact cervical stromal ring on MRI might identify the low-risk group of patients in terms of PMI and lymphovascular/stromal invasion in early cervical cancer. Minimally invasive RH should be performed in optimal candidates with an intact stromal ring on MRI, using VC.
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Affiliation(s)
- Tae Wook Kong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Joo Hyuk Son
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Jiheum Paek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Suk Joon Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Sug Ryu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
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Park JY, Nam JH. How should gynecologic oncologists react to the unexpected results of LACC trial? J Gynecol Oncol 2019; 29:e74. [PMID: 29806249 PMCID: PMC5981115 DOI: 10.3802/jgo.2018.29.e74] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/20/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Rao ST, Nusrath S, Iyer RR, Patnaik SC, Saksena AR, Vanzar P, Shukla S. Interpretation and Implications of LACC Trial. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0278-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Arora V, Somashekhar S. Essential surgical skills for a gynecologic oncologist. Int J Gynaecol Obstet 2018; 143 Suppl 2:118-130. [DOI: 10.1002/ijgo.12619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vivek Arora
- Royal Hospital for Women; University of New South Wales Randwick; Sydney Australia
| | - S.P. Somashekhar
- Manipal Comprehensive Cancer Center; Manipal Hospital; Bangalore India
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Kanao H, Aoki Y, Takeshima N. Unexpected result of minimally invasive surgery for cervical cancer. J Gynecol Oncol 2018; 29:e73. [PMID: 29770633 PMCID: PMC5981114 DOI: 10.3802/jgo.2018.29.e73] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan.
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Nobuhiro Takeshima
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
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Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared With the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer. Int J Gynecol Cancer 2018; 27:1990-1999. [PMID: 28858908 PMCID: PMC5671798 DOI: 10.1097/igc.0000000000001101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients. Methods We have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients. Results Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusions The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.
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Comparison of the Long-Term Oncological Outcomes Between the Initial Learning Period of Robotic and the Experienced Period of Laparoscopic Radical Hysterectomy for Early-Stage Cervical Cancer. Int J Gynecol Cancer 2018; 28:226-232. [DOI: 10.1097/igc.0000000000001172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Abstract
PURPOSE OF REVIEW Robotically assisted laparoscopy has been introduced in the armamentarium of gynaecologic oncology surgeons. A lot of studies compared robotic surgery and laparotomy when the real issue is to demonstrate the interest and added value of robotically assisted laparoscopy versus standard laparoscopy. In this review, we will describe the most meaningful indications and advantages of robotically assisted laparoscopy in gynaecologic oncology. RECENT FINDINGS The learning curve for advanced procedures in robot-assisted laparoscopy is shorter and easier than with the standard laparoscopy, especially for beginners. In most of the series, operating time is longer with robot, but complication rates are often decreased, especially in obese patients with a conversion rate to laparotomy that is decreased compared with standard laparoscopy. Robot-assisted laparoscopy can be used for surgery of high-risk endometrial cancer, staging of early-ovarian cancer, and pelvic exenteration in case of recurrent malignancies. Furthermore, more recent robots allow performing sentinel node biopsy in endometrial or cervical cancer using fluorescence detection with indocyanine green. SUMMARY The spreading of robotic surgery led to an enhancement of minimal invasive surgical approach in general, and to the development of new indications in gynaecologic oncology. The superiority of robot-assisted laparoscopy still has to be demonstrated with properly designed trials.
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Gucer F, Misirlioglu S, Ceydeli N, Taskiran C. Robot-assisted laparoscopic transperitoneal infrarenal lymphadenectomy in patients with locally advanced cervical cancer by single docking: Do we need a backup procedure? J Robot Surg 2017; 12:49-58. [DOI: 10.1007/s11701-017-0685-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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Takiguchi S, Miyazaki Y, Murakami K, Makino T, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, Miyata H, Mori M, Doki Y. Laparoscopic lymphadenectomy around the left renal vein (16a2lat) by tunneling under the pancreas for advanced Siewert type II adenocarcinoma. Surg Today 2015; 46:1108-13. [PMID: 26482844 DOI: 10.1007/s00595-015-1264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
The para-aortic lymph nodes around the left renal vein (16a2lat) are now considered important to target in the treatment of advanced adenocarcinoma of the esophagogastric junction. We describe a laparoscopic approach for resecting these nodes. This new tunneling approach starts from the ligament of Treitz and then enters the retroperitoneal space. The left renal vein and left adrenal vein are dissected to identify the anatomy of the 16a2lat area. After this dissection, the 16a2lat nodes are retrieved through the suprapancreatic area. Six patients with advanced type II junctional cancer underwent laparoscopic 16a2lat lymph node dissection. The median operative time and estimated blood loss were 479 (390-750) min and 250 (130-500) ml, respectively. The median hospital stay was 22 (17-54) days and there were no deaths or serious complications. Although this series was relatively small, our technique proved effective and feasible.
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Affiliation(s)
- Shuji Takiguchi
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yasuhiro Miyazaki
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kohei Murakami
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukinori Kurokawa
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Yamasaki
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kiyokazu Nakajima
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroshi Miyata
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Suh DH, Cho HY, Kim K, No JH, Kim YB. Matched-Case Comparisons in a Single Institution to Determine Critical Points for Inexperienced Surgeons' Successful Performances of Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Stage IA2-IIA Cervical Cancer. PLoS One 2015; 10:e0131170. [PMID: 26110866 PMCID: PMC4482442 DOI: 10.1371/journal.pone.0131170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/29/2015] [Indexed: 11/25/2022] Open
Abstract
This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye-Yon Cho
- Department of Obstetrics and Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
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Zhou J, Xiong BH, Ma L, Cheng Y, Huang W, Zhao L. Robotic vs laparoscopic radical hysterectomy for cervical cancer: a meta-analysis. Int J Med Robot 2015; 12:145-54. [PMID: 25823530 DOI: 10.1002/rcs.1652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/07/2015] [Accepted: 02/18/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Jing Zhou
- First Affiliated Hospital of Chongqing Medical University; Yuanjiagang, Yuzhong District Chongqing People's Republic of China
| | - Bing Hong Xiong
- Department of General Surgery; Peking University Shougang Hospital; Shijingshan District Beijing People's Republic of China
| | - Li Ma
- Department of Endocrinology; Third Hospital of Mianyang; Sichuan Province Mianyang People's Republic of China
| | - Yong Cheng
- First Affiliated Hospital of Chongqing Medical University; Yuanjiagang, Yuzhong District Chongqing People's Republic of China
| | - Wei Huang
- Department of General Surgery; Ninth People's Hospital of Chongqing City; People's Republic of China
| | - Lin Zhao
- Department of Obstetrics and Gynaecology; Mianyang 404 Hospital, Sichuan Province, and Second Affiliated Hospital; Medical College of North Sichuan Mianyang People's Republic of China
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Robotic Versus Laparoscopic Radical Hysterectomy in Cervical Cancer Patients: A Matched-Case Comparative Study. Int J Gynecol Cancer 2014; 24:1466-73. [DOI: 10.1097/igc.0000000000000232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThis study aimed to compare initial surgical outcomes and complication rates of patients with early-stage cervical cancer who underwent robotic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH).MethodsPatients diagnosed with invasive cervical cancer (International Federation of Gynecology and Obstetrics stage I-IIA) who underwent RRH (n = 23) at Samsung Medical Center from January 2008 to May 2013 were compared with matched patients who underwent LRH (n = 69) during the same period. The 2 surgical groups were matched 3:1 for variables of age, body mass index, International Federation of Gynecology and Obstetrics stage, histological subtype, tumor size, and node positivity. All patient information and surgical and postoperative follow-up data were retrospectively collected.ResultsOperating time was significantly longer (317 vs 236 minutes; P < 0.001) in the RRH group compared with the LRH group but mean estimated blood loss was significantly reduced in the RRH group (200 vs 350 mL; P = 0.036). Intraoperative and postoperative complications were not significantly different between the 2 groups (4.3% for RRH vs 1.45% for LRH; P = 0.439). Recurrences were 2 (8.7%) in the RRH and 7 (10.1%) in the LRH group. The overall 3-year recurrence-free survival was 91.3% in RRH group and 89.9% in the LRH group (P = 0.778).ConclusionsAlthough operating time was longer in the RRH cases because of lesser experience on robotic platform, we showed that surgical outcomes and complication rate of RRH were comparable to those of LRH. In addition, surgical skills for LRH easily and safely translated to RRH in case of experienced laparoscopic surgeon.
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Ercil H, Altunkol A, Kuyucu F, Sener NC, Vuruskan E, Ortoglu F, Gurbuz ZG. Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy. Asian J Surg 2014; 38:91-5. [PMID: 25059816 DOI: 10.1016/j.asjsur.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/22/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate clinical experience and learning curve associated with laparoscopic ureterolithotomy performed for upper ureteral stones. MATERIALS AND METHODS The medical data of 50 patients who had undergone retroperitoneal laparoscopic ureterolithotomy between June 2010 and March 2013 were retrospectively analyzed. To assess the learning curve, patients were divided into two groups: Group A (the first 25 cases) and Group B (the last 25 cases). In Group A, double J stents were placed in 17 patients, whereas in Group B 15 patients received double J stents. In Group A, three ports were placed in nine patients and four ports in 16 patients. In Group B, three ports were placed in 20 patients and five patients had four ports. The patients were compared according to demographics, operative time, stone size, complications, hospital stay, and transfusion. RESULTS The mean age for Group A was 47.8 ± 14.13 (21-72) years and that for Group B was 44.2 ± 14.98 (22-78) years. Mean operative times were 106.4 ± 38 (55-210) minutes and 70.76 ± 30.4 (30-180) minutes for Groups A and B, respectively (p < 0.05). The mean hospital stay was 7.12 ± 4.47 (3-22) days and 4.04 ± 2.05 (2-12) days for Groups A and B, respectively (p < 0.05). The mean stone size was 20.12 ± 5.18 (12-30) mm and 19.44 ± 4.44 (13-28) mm for Groups A and B, respectively (p > 0.05). CONCLUSION In our study, as staff experience (in performing laparoscopic retroperitoneal ureterolithotomy) increased, operative time, length of hospital stay, and complication rates have correspondingly declined.
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Affiliation(s)
- Hakan Ercil
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adem Altunkol
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey.
| | - Faruk Kuyucu
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Nevzat Can Sener
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ediz Vuruskan
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ferhat Ortoglu
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Zafer Gokhan Gurbuz
- Ministry of Health, Department of Urology, Adana Numune Training and Research Hospital, Adana, Turkey
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Park JY, Nam JH. Laparotomy Conversion Rate of Laparoscopic Radical Hysterectomy for Early-stage Cervical Cancer in a Consecutive Series without Case Selection. Ann Surg Oncol 2014; 21:3030-5. [DOI: 10.1245/s10434-014-3707-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Indexed: 11/18/2022]
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Robot-assisted total preservation of the pelvic autonomic nerve with extended systematic lymphadenectomy as part of nerve-sparing radical hysterectomy for cervical cancer. Int J Gynecol Cancer 2014; 23:1133-8. [PMID: 23792607 DOI: 10.1097/igc.0b013e31829b10db] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate our short-term clinical outcomes of robot-assisted autonomic nerve-sparing extended systematic lymphadenectomy as part of nerve-sparing radical hysterectomy. METHODS Between March 2011 and June 2012, we observed prospectively 28 consecutive patients who underwent robot-assisted autonomic nerve-sparing extended systematic lymphadenectomy, including the superior and inferior gluteal, presacral (subaortic), common iliac, and lower para-aortic nodes. RESULTS The predominant International Federation of Gynecology and Obstetrics stage was IB1 (15 patients), followed by IB2 (5 patients), IA2 (3 patients), IIA1 (3 patients), and IIA2 (2 patients). The mean ± SD total operating time was 308.8 ± 54.9 minutes, and the mean ± SD console time was 280.0 ± 46.0 minutes. The mean ± SD blood loss was 102.7 ± 153.8 mL. The mean ± SD acquired pelvic lymph node was 27.1 ± 9.3, the mean ± SD extended lymph node was 19.2 ± 9.6, and the mean ± SD total lymph node was 46.3 ± 14.5. A total of 10 patients (35.7%) had nodal metastasis; among them, 6 patients (21.4%) had single pelvic nodal metastasis, 3 patients (10.7%) had concurrent pelvic and extended nodal metastasis, and one patient (3.6%) had single extended nodal metastasis. No intraoperative complications that required treatment occurred; however, ureterovaginal fistula was identified in 4 patients (14.3%) and ureter stricture in 4 patients (14.3%) after radiotherapy. After a median follow-up of 10 months (range, 1-16 months), there was no pelvic recurrence; however, one patient had recurrence at transposition site of ovary. CONCLUSIONS With the advantage of delicate movement of robot instrument, robot-assisted systematic extended lymphadenectomy with total preservation of pelvic autonomic nerves did not compromise the radicality, and its surgical technique was feasible and safe. By using this approach, we could harvest more lymph nodes and have a high rate of metastatic nodes without disturbing voiding function; however, there was increased rate of urological complications. Moreover, long-term survival benefit after an extended systematic lymphadenectomy must be evaluated.
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Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon's initial experience. Int J Gynecol Cancer 2014; 23:1145-9. [PMID: 23748178 DOI: 10.1097/igc.0b013e31829a5db0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare the initial surgical outcomes and learning curve of nerve-sparing robotic radical hysterectomy (RRH) with nerve-sparing total laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in the first 50 cases. METHODS Between January 2008 and March 2012, 50 consecutive patients underwent nerve-sparing RRH. These patients were compared with a historic cohort of the first 50 consecutive patients who underwent nerve-sparing TLRH. RESULTS Both groups were similar with respect to patients and tumor characteristics. The mean operating time in the RRH group was significantly longer than that in the TLRH group (230.1 ± 35.8 vs 211.2 ± 46.7 minutes; P = 0.025). The mean blood loss for the robotic group was significantly lower compared with the laparoscopic group (54.9 ± 31.5 vs 201.9 ± 148.4 mL; P < 0.001). There was no significant difference in the mean pelvic lymph nodes between the 2 groups (25.0 ± 9.9 vs 23.1 ± 10.4; P = 0.361). The mean days to normal residual urine were 9.6 ± 6.4 in RRH and 11.0 ± 6.2 in TLRH (P = 0.291). The incidence of intraoperative complication was profoundly lower in RRH compared with that of TLRH (0% vs 8%; P = 0.041). Moreover, no intraoperative transfusion was required in RRH, whereas 4 (8%) were required in TLRH (P = 0.041). In both groups, we found no evidence of a learning effect during the first 50 cases. CONCLUSIONS During the first 50 cases, surgical outcomes and complication rates of nerve-sparing RRH were found to be comparable to those of nerve-sparing TLRH. Moreover, the mean blood loss and intraoperative complication rate in the robotic group were significantly lower than those in the laparoscopic group. Surgical skills for nerve-sparing TLRH easily and safely translated to nerve-sparing RRH in case of experienced laparoscopic surgeon.
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Uzan C, Nikpayam M, Merlot B, Gouy S, Belghiti J, Haie-Meder C, Nickers P, Narducci F, Morice P, Leblanc E. Colpohystérectomie élargie par laparoscopie après curiethérapie préopératoire pour cancer du col utérin (stade 1B1) : faisabilité et résultats. ACTA ACUST UNITED AC 2013; 41:571-7. [DOI: 10.1016/j.gyobfe.2013.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Indexed: 11/16/2022]
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Tahmasbi Rad M, Wallwiener M, Rom J, Sohn C, Eichbaum M. Learning curve for laparoscopic staging of early and locally advanced cervical and endometrial cancer. Arch Gynecol Obstet 2013; 288:635-42. [PMID: 23503936 PMCID: PMC3742954 DOI: 10.1007/s00404-013-2787-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/28/2013] [Indexed: 11/30/2022]
Abstract
Background Laparoscopic staging is rapidly evolving as an important surgical approach in the field of gynecology oncology. However, the specific learning curve associated with this approach remains poorly investigated. This study aimed to evaluate the learning curve for laparoscopic staging of uterine cancers. Methods A series of 28 consecutive laparoscopic hysterectomies with or without pelvic and/or para-aortic lymph node sampling for the treatment of early and locally advanced endometrial or cervical cancer were performed between July 2008 and January 2011. The analyses of the learning curves of the institution were performed for 20 patients who had undergone pelvic lymphadenectomy and/or para-aortal lymph node sampling. The learning curve period has also been compared with the last 26 patients who received laparotomy staging (“open” group) due to the same diagnosis and by the same surgical team. To assess the short- and long-term outcomes, we used validated questionnaires to record the clinical and follow-up results, any complaints or subjective reports from the patients, and details of their quality of life. All data were collected prospectively in a database and reviewed retrospectively. The learning was evaluated using the cumulative sum (CUSUM) method. Results The CUSUM learning curve consisted of two distinct phases: phase 1 (the initial 9 cases) and phase 2 (the subsequent cases) which presented the mastery phase, with the operative time of 397.7 ± 63.5 versus 300.6 ± 19.4 min (p < 0.0001). The significance of the difference between the two phases and “open” group changed in terms of number of lymph nodes retrieved, intra-operative blood loss and hospital stay. The conversion rate of phase 1 was higher than phase 2 [2 (22.2 %) respectively 1 (9 %)]. Conclusions This series confirms previous study findings concerning the feasibility and the safety of laparoscopic staging and provides information for surgeons in single centers considering adopting an endoscopic strategy to monitor the different aspects of outcomes during the implementation process for internal benchmarking. The operative outcome of laparoscopic staging intervention improves with experience. The data reported in this article suggest that after a learning curve of 9 patients, a relevant improvement at least regarding the duration of the operation can be achieved for experienced surgeons who start performing laparoscopic staging of uterine cancers. However, due to the limited number of patients as well as number of para-aortic lymph node sampling procedures, further studies are required for firm conclusions to be drawn.
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Affiliation(s)
- Morva Tahmasbi Rad
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.
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Uzan C, Merlot B, Gouy S, Belghiti J, Haie-Meder C, Nickers P, Fabrice N, Morice P, Leblanc E. Laparoscopic Radical Hysterectomy after Preoperative Brachytherapy for Stage IB1 Cervical Cancer: Feasibility, Results, and Surgical Implications in a Large Bicentric Study of 162 Consecutive Cases. Ann Surg Oncol 2012; 20:872-80. [DOI: 10.1245/s10434-012-2630-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Indexed: 11/18/2022]
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Hwang JH, Yoo HJ, Joo J, Kim S, Lim MC, Song YJ, Park SY. Learning curve analysis of laparoscopic radical hysterectomy and lymph node dissection in early cervical cancer. Eur J Obstet Gynecol Reprod Biol 2012; 163:219-23. [DOI: 10.1016/j.ejogrb.2012.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/13/2012] [Accepted: 05/02/2012] [Indexed: 11/25/2022]
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