1
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Zhang J, Zhou Y, Ye H, Chen C, Luo Y. Effect of laparoscopic-assisted transvaginal hysterectomy on wound complications in patients with early stage cervical cancer: A meta-analysis. Int Wound J 2024; 21:e14529. [PMID: 38069545 PMCID: PMC10961037 DOI: 10.1111/iwj.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 03/25/2024] Open
Abstract
Laparoscopic-assisted vaginal radical hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) have been widely applied to treat cervical carcinoma. But LARVH and ARH have not been fully investigated in treating cervical carcinoma after injury associated with injury. This research is intended to provide an up-to-date basis for comparing LARVH with ARH in early stage cervical carcinoma. Comparison between LARVH and ARH in cervical carcinoma was carried out through a combination of related research. Eligible articles from databases such as PubMed and Embase were screened using an established search strategy. This report covered the results of LARVH versus ARH in cervical carcinoma. The average difference and the 95% confidence interval (CI) were used for the combination of consecutive variables. The combination of categorical variables was performed with the odds ratio (OR) 95% confidence interval. Through the identification of 1137 publications, eight of them were chosen to be analysed. Among them, 363 were treated with LARVH and 326 were treated with ARH. Eight trials showed that LARVH was associated with a reduced risk of postoperative wound infection than ARH (OR, 0.23; 95% CI, 0.1-0.55, p = 0.0009). Five trials showed that there was no difference in the risk of postoperative bleeding after surgery (OR, 1.17; 95% CI, 0.42-3.29, p = 0.76). We also did not differ significantly in the duration of the surgery (OR, 1.79; 95% CI, -6.58 to 10.15, p = 0.68). So, the two surgical methods differ significantly only in the risk of postoperative wound infection.
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Affiliation(s)
- Jun Zhang
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
| | - Yuanhong Zhou
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
| | - Hong Ye
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
| | - Chuanqi Chen
- Department of Obstetrics and GynaecologyThe Central Hospital Of Enshi Tujia And Miao Autonomous PrefectureEnshiChina
| | - Youzhen Luo
- Department of GynecologyThe First College of Clinical Medical Science, China Three Gorges UniversityYichangChina
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2
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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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3
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Querleu D, Bizzarri N, Ianieri MM, Scambia G. Radical Vaginal Hysterectomy, Type B: An Educational Video, Cadaver Model. Ann Surg Oncol 2023; 30:4988-4989. [PMID: 37074519 DOI: 10.1245/s10434-023-13419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/15/2023] [Indexed: 04/20/2023]
Abstract
The radical vaginal hysterectomy popularized by Schauta1 has been virtually abandoned due to painful perineal incision, high rate of urinary dysfunction, and inability to perform lymph node assessment. However, this approach is still used and taught in a few centers outside its Austrian birthplace. In addition, a combined vaginal and laparoscopic approach, overcoming the flaws of the pure vaginal technique, was developed in the 1990s by French and German surgeons.2 After the publication of the Laparoscopic Approach to Cervical Cancer trial,3 the radical vaginal approach has found a very timely application with the closure of the vaginal cuff, aiming at avoiding cancer cell spillage.4 In addition, it is the basis to perform radical vaginal trachelectomy, or Dargent's operation, the best documented approach for the fertility-sparing management of stage IB1 cervical cancers. Today, the main obstacle to the rebirth of radical vaginal surgical surgery is the lack of teaching centers and the need of a specific learning curve that requires performing 20-50 surgeries.5,6 This educational video demonstrates that training is possible using a fresh cadaver model. A type B approach according to the Querleu-Morrow7 classification of radical vaginal hysterectomy, adapted according to surgeon's choice to stage IB1 or IB2 cervical cancer, is shown. Key specific steps such as the creation of a vaginal cuff and the identification of the ureter within the bladder pillar are highlighted. Fresh cadaver model is a method that spares the patients the risks of early learning curve while allowing the surgeon to acquire skills and keep offering the patient the benefit of the most specifically gynecological approach in cervical cancer surgery.
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Affiliation(s)
- Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Nicolo Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Manuel Maria Ianieri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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4
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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: 2] [Impact Index Per Article: 2.0] [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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5
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Guo X, Tian S, Wang H, Zhang J, Cheng Y, Yao Y. Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta-analysis. Int J Gynaecol Obstet 2023; 160:28-37. [PMID: 35373333 DOI: 10.1002/ijgo.14209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/04/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of five different approaches to cervical cancer surgery. METHODS We conducted a systematic search for comparative studies on different radical hysterectomy types for cervical cancer in PubMed, Embase, the Cochrane Library, and Web of Science databases. All included observational studies used survival analyses to compare clinical outcomes of patients undergoing different radical hysterectomy types. All studies were assessed by the Newcastle-Ottawa Scale with scores of at least seven points. We extracted the relevant data and conducted a network meta-analysis to compare clinical outcomes among five surgical approaches. RESULTS Thirty studies (n = 11 353) were included. Robotic surgery had the lowest blood loss volume and hospitalization duration; open surgery had the shortest operative time. Vaginal assisted laparoscopic surgery was associated with the highest number of resected lymph nodes and lowest rate of perioperative complications. Survival outcomes and tumor recurrence outcomes were similar among the approaches. CONCLUSION The current approaches to cervical cancer surgery have comparable efficacies.
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Affiliation(s)
- Xinmeng Guo
- College of Medicine, Nankai University, Tianjin, China
| | - Shuang Tian
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Jinning Zhang
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Yanfei Cheng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
| | - Yuanqing Yao
- College of Medicine, Nankai University, Tianjin, China.,Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China.,The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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6
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Leitao MM, Zhou QC, Brandt B, Iasonos A, Sioulas V, Lavigne Mager K, Shahin M, Bruce S, Black DR, Kay CG, Gandhi M, Qayyum M, Scalici J, Jones NL, Paladugu R, Brown J, Naumann RW, Levine MD, Mendivil A, Lim PC, Kang E, Cantrell LA, Sullivan MW, Martino MA, Kratz MK, Kolev V, Tomita S, Leath CA, Boitano TKL, Doo DW, Feltmate C, Sugrue R, Olawaiye AB, Goldfeld E, Ferguson SE, Suhner J, Abu-Rustum NR. The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecol Oncol 2022; 166:417-424. [PMID: 35879128 PMCID: PMC9933771 DOI: 10.1016/j.ygyno.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. METHODS This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. RESULTS We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5). CONCLUSION This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.
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Affiliation(s)
- Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America.
| | - Qin C Zhou
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Benny Brandt
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Vasileios Sioulas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Katherine Lavigne Mager
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Mark Shahin
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Shaina Bruce
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Destin R Black
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America; Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Carrie G Kay
- Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Meeli Gandhi
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Maira Qayyum
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Jennifer Scalici
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Nathaniel L Jones
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Rajesh Paladugu
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Monica D Levine
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Alberto Mendivil
- Gynecologic Oncology Associates, Hoag Cancer Center, Newport Beach, CA, United States of America
| | - Peter C Lim
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Elizabeth Kang
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Leigh A Cantrell
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Mackenzie W Sullivan
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Martin A Martino
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Melissa K Kratz
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Valentin Kolev
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Shannon Tomita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Charles A Leath
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Teresa K L Boitano
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - David W Doo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Colleen Feltmate
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Ronan Sugrue
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Ester Goldfeld
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Jessa Suhner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai West/Mount Sinai Morningside, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America
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7
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Querleu D, Hudry D, Narducci F, Rychlik A. Radical Hysterectomy After the LACC Trial: Back to Radical Vaginal Surgery. Curr Treat Options Oncol 2022; 23:227-239. [PMID: 35195838 DOI: 10.1007/s11864-022-00937-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT Classical radical vaginal hysterectomy first performed by Anton Pawlik in Prague in 1888 and popularized by Frederic Schauta is now a historical technique virtually abandoned due to painful perineal incision, a high rate of urinary dysfunction, and the inability to perform lymph node assessment. However, the heritage of this approach has been still used and taught in a few centers outside their Austrian birthplace. A combined vaginal and laparoscopic approach was developed in the 1990s by French and German surgeons who designed diverse surgical techniques for which a novel classification is proposed. All these techniques are different from the so-called laparoscopically assisted radical vaginal hysterectomy (LARVH), a term widely used for laparoscopic radical hysterectomies with vaginal extraction of the specimen. Interestingly, after the publication of the LACC trial (Laparoscopic Approach to Cervical Cancer), the radical vaginal approach has found a very timely application. The creation of a vaginal cuff before performing radical laparoscopic hysterectomy described in 2007 by Leblanc as "Schautheim" operation can be used as a protective maneuver to avoid tumor spillage and potentially overturn the negative outcome of minimally invasive surgery in early-stage cervical cancer. As a result, the combination of radical vaginal and laparoscopic steps of surgery is one possible evolution after the LACC trial that needs further investigation. The forgotten vaginal surgical technique needs a specific learning curve. The creation of a vaginal cuff should be mastered by every gynecological oncologist.
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Affiliation(s)
- Denis Querleu
- Department of Gynecologic Oncology, Policlinico Agostino Gemelli, Via della Pineta Sacchetti, 217, 00168, Rome, RM, Italy.,Department of Obstetrics and Gynecology, University Hospital of Strasbourg, 5 Avenue Molière, 67200, Strasbourg, France
| | - Delphine Hudry
- Department of Gynecologic Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Agnieszka Rychlik
- Department of Gynecologic Oncology, National Research Institute of Oncology, Wilhelma Konrada Roentgena 5, 02-781, Warsaw, Poland.
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8
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Brandt B, Levin G, Leitao MM. Radical Hysterectomy for Cervical Cancer: the Right Surgical Approach. Curr Treat Options Oncol 2022; 23:1-14. [PMID: 35167007 DOI: 10.1007/s11864-021-00919-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Radical hysterectomy with pelvic lymph node assessment is the standard initial therapy for early-stage cervical cancer. Radical hysterectomy via laparotomy (an "open" approach) was first described more than 100 years ago and has been the standard for decades. Minimally invasive surgery (MIS) has been increasingly adopted by many surgeons due to its reported perioperative benefits. MIS was deemed safe for radical hysterectomy for many years based on multiple retrospective publications. Recently, the Laparoscopic Approach to Cervical Cancer (LACC) trial reported that patients randomized to MIS had inferior oncologic outcomes. The results of the LACC trial and subsequent retrospective studies led multiple professional societies to state that open radical hysterectomy should remain the gold standard surgical approach. We acknowledge that the open approach for radical hysterectomy is an appropriate option for all cervical cancer patients eligible for surgical treatment. However, considering the limitations of the LACC trial and the available data from other retrospective studies, we feel the MIS approach should not be simply abandoned. There may still be a role for MIS in cervical cancer surgery for properly and carefully selected cases and with detailed counseling; surgeons should analyze their own outcomes closely in order to perform such counseling. Modification of surgical technique and maintaining proper oncologic surgical principles are key for MIS to remain a viable option. Tumor manipulation and contamination should be avoided. Transcervical uterine manipulators should not be used. Cervical and tumor containment prior to colpotomy, as is performed during an open approach, is required. This will all require validation in future trials. We await the results of ongoing randomized trials to further inform us. A one-size-fits-all approach may be short-sighted; we may need to decide treatment strategy based on the notion of the right surgical approach for the right patient by the right surgeon.
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Affiliation(s)
- Benny Brandt
- Department of Gynecologic Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mario M Leitao
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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9
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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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Oncological Results of Laparoscopically Assisted Radical Vaginal Hysterectomy in Early-Stage Cervical Cancer: Should We Really Abandon Minimally Invasive Surgery? Cancers (Basel) 2021; 13:cancers13040846. [PMID: 33671382 PMCID: PMC7923118 DOI: 10.3390/cancers13040846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/31/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Some recently published studies in early-stage cervical cancer patients have shown that minimally invasive surgery (MIS), including laparoscopic and robotic approaches, might offer lower survival rates than classic open surgery. We evaluated the oncological results of a series of patients treated by laparoscopically assisted radical vaginal hysterectomy (LARVH), an infrequently used MIS technique. We included 115 patients with early-stage cervical cancer (IA1 with lymphovascular invasion, IA2, IB1, and IIA < 2 cm; International Federation of Gynecology (FIGO), 2008). The 3- and 4.5-year disease-free survival rates were 96.7% and 93.5%, respectively, and the overall survival was 97.8% and 94.8%, respectively. These survival data are comparable with those reported with the open radical hysterectomy but presented the advantages of MIS. LARVH offers excellent disease control in women with early-stage cervical cancer and can be considered as an adequate MIS alternative to open radical hysterectomy. Abstract Background: Recent evidence indicates that some minimally invasive surgery approaches, such as laparoscopic and robotic-assisted radical hysterectomy, offer lower survival rates to patients with early-stage cervical cancer than open radical hysterectomy. We evaluated the oncological results of a different minimally invasive surgery approach, that of laparoscopically assisted radical vaginal hysterectomy (LARVH) in this setting. Methods: From January 2001 to December 2018, patients with early-stage cervical cancer were treated by LARVH. Colpotomy and initial closure of the vagina were performed following the Schauta operation, avoiding manipulation of the tumor. Laparoscopic sentinel lymph node (SLN) biopsy was performed in all cases. Women treated between 2001 and 2011 also underwent pelvic lymphadenectomy. Results: There were 115 patients included. Intraoperative complications occurred in nine patients (7.8%). After a median follow-up of 87.8 months (range 1–216), seven women (6%) presented recurrence. Four women died (mortality rate 3.4%). The 3- and 4.5-year disease-free survival rates were 96.7% and 93.5%, respectively, and the overall survival was 97.8% and 94.8%, respectively. Conclusion: LARVH offers excellent disease-free and overall survival in women with early-stage cervical cancer and can be considered as an adequate minimally invasive surgery alternative to open radical hysterectomy.
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Smith AJB, Jones TN, Miao D, Fader AN. Minimally Invasive Radical Hysterectomy for Cervical Cancer: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:544-555.e7. [PMID: 33359291 DOI: 10.1016/j.jmig.2020.12.023] [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: 10/30/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare recurrence rate, progression-free survival (PFS), and overall survival for early-stage cervical cancer after minimally invasive (MIS) vs abdominal radical hysterectomy. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Library databases. METHODS OF STUDY SELECTION We identified studies from 1990 to 2020 that included women with stage I or higher cervical cancer treated with primary radical hysterectomy and compared recurrence and/or PFS and overall survival with MIS vs abdominal radical hysterectomy. (The review protocol was registered with the International Prospective Register of Systematic Reviews: CRD4202173600). TABULATION, INTEGRATION, AND RESULTS We performed random-effects meta-analyses overall and by length of follow-up. Fifty articles on 40 cohort studies and 1 randomized controlled trial that included 22 593 women with cervical cancer met the inclusion criteria. Twenty percent of the studies had <36 months of follow-up, and 24% had more than 60 months of follow-up. The odds of PFS were worse for women undergoing MIS radical hysterectomy (odds ratio 1.54; 95% CI [confidence interval], 1.24-1.94; 14 studies). When limited to studies with longer follow-up, the odds of PFS were progressively worse with MIS radical hysterectomy (HR [hazard ratio] 1.48 for >36 months; 95% CI, 1.21-1.82; 10 studies; HR 1.69 for >48 months; 95% CI, 1.26-2.27; 5 studies; and HR 2.020 for >60 months; 95% CI, 1.36-3.001; 3 studies). For overall survival, the odds were not significantly different for MIS vs abdominal hysterectomy (odds ratio 0.94; 95% CI, 0.66-1.35; 14 studies) (HR 0.99 for >36 months; 95% CI, 0.66-1.48; 9 studies; HR 1.05 for >48 months; 95% CI, 0.57-1.94; 4 studies; and HR 1.35 for >60 months; 95% CI, 0.73-2.51; 3 studies). CONCLUSION In our meta-analysis of 50 studies, MIS radical hysterectomy was associated with worse PFS than open radical hysterectomy for early-stage cervical cancer. The emergence of this finding with longer follow-up highlights the importance of long-term, high-quality studies to guide cancer and surgical treatments.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Department of Gynecology and Obstetrics (Drs. Smith, Jones, Miao, and Fader), Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Tiffany Nicole Jones
- Department of Gynecology and Obstetrics (Drs. Smith, Jones, Miao, and Fader), Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Diana Miao
- Department of Gynecology and Obstetrics (Drs. Smith, Jones, Miao, and Fader), Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics (Drs. Smith, Jones, Miao, and Fader), Johns Hopkins School of Medicine, Baltimore, Maryland; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics (Dr. Fader), Johns Hopkins School of Medicine, Baltimore, Maryland
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12
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Hwang JH, Kim BW. Comparison of Survival Outcomes after Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Patients with Cervical Cancer. J Minim Invasive Gynecol 2020; 28:971-981.e3. [PMID: 33321255 DOI: 10.1016/j.jmig.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A meta-analysis was performed to compare survival outcomes including disease-free survival (DFS) between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in patients with cervical cancer. DATA SOURCES We searched PubMed, EMBASE, Google scholar, and the Cochrane library for studies published between December 2004 and May 2020. Manual searches of related articles and relevant bibliographies of published studies were also performed. METHODS OF STUDY SELECTION Two researchers independently extracted the data. Studies with survival outcome information were included. TABULATION, INTEGRATION, AND RESULTS A total of 36 eligible clinical trials were included in this meta-analysis. When all studies were pooled, the hazard ratio (HR) of LRH for the risk of DFS and overall survival (OS) compared with ARH was 1.24 (95% confidence interval [CI], 1.09-1.41; p = .001; I2 = 37.5%) and 1.27 (95% CI, 1.04-1.56; p = .020; I2 = 45.5%), respectively. In a subgroup analysis, significant harmful effects of DFS in patients with LRH increased in studies using the HR presented by the article (HR, 1.41; 95% CI, 1.21-1.64; p <.001), matched retrospective design (HR, 1.49; 95% CI, 1.19-1.88; p = .001), large-scale studies (HR, 1.34; 95% CI, 1.16-1.55; p <.001), and studies published after the Laparoscopic Approach to Cervical Cancer trial (HR, 1.46; 95% CI, 1.25-1.71; p <.001). However, LRH did not affect DFS (HR, 1.04; 95% CI, 0.59-1.81; p = .898) or OS (HR, 0.57; 95% CI, 0.31-1.05; p = .073) of patients with cervical cancer with cervical masses <2 cm. CONCLUSION This meta-analysis demonstrated that LRH was associated with higher recurrence rates than ARH. However, LRH showed similar recurrence and OS among patients with cervical masses <2 cm (Centre for Reviews and Dissemination 42020191713).
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (all authors)..
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (all authors)
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Comparison of long-term survival of total abdominal radical hysterectomy and laparoscopy-assisted radical vaginal hysterectomy in patients with early cervical cancer: Korean multicenter, retrospective analysis. Gynecol Oncol 2020; 159:642-648. [PMID: 33041070 DOI: 10.1016/j.ygyno.2020.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to compare survival outcomes of total abdominal radical hysterectomy (TARH) versus laparoscopy-assisted radical vaginal hysterectomy (LARVH) in stage IA2-IB2 cervical cancer. METHODS 812 patients who underwent RH between 2008 and 2017 were evaluated in 3 institutions. Progression-free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier method and compared by log-rank test. The clinical noninferiority of the LARVH to TARH was assessed with a margin of -7.2%. Noninferiority was demonstrated if the low limit of 95% confidence interval (CI) exceeded its predefined margin. RESULTS 258 patients were treated with TARH and 252 patients with LARVH. TARH and LARVH group had similar 5-year PFS (84.4% vs 86.6%, p = 0.467) and OS rates (85.8% vs 88.0%, p = 0.919). Noninferiority of LARVH to TARH were confirmed with 5-year PFS and OS difference rates of 2.2% (95% CI -2.9-7.3, p = 0.001) and 2.2% (95% CI -2.7-7.1, p = 0.001), respectively. In subgroup of patients with tumors size >2 cm, 5-year PFS (77.6% vs 79.0%, p = 0.682) and OS rates (79.2% vs 81.5%, p = 0.784) did not differ statistically between the two groups. Noninferiority of LARVH to TARH were also confirmed with 5-year PFS and OS difference rates of 1.4% (95% CI -7.0-9.8, p = 0.046) and 2.3% (95% CI -5.8-10.4, p = 0.027), respectively. CONCLUSION LARVH showed significant noninferiority for PFS and OS versus TARH in early cervical cancer, suggesting the potential oncologic safety of LARVH.
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Laparoscopic radical hysterectomy has higher risk of perioperative urologic complication than abdominal radical hysterectomy: a meta-analysis of 38 studies. Surg Endosc 2020; 34:1509-1521. [PMID: 31953731 DOI: 10.1007/s00464-020-07366-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/03/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A meta-analysis was performed to assess risks of intraoperative and postoperative urologic complications in laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). METHODS We searched Pubmed, EMBASE, and Cochrane library for studies published up to December, 2018. Manual searches of related articles and relevant bibliographies of published studies were also performed. Two researchers independently performed data extraction. Inclusion criteria of studies were: (1) had information of perioperative complications, and (2) had at least ten patients per group. RESULTS A total of 38 eligible clinical trials were collected. Intraoperative and postoperative urologic complications were reported by 34 studies and 35 studies, respectively. When all studies were pooled, odd ratios (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.40 [95% confidence interval (CI) 1.05-1.87]. The OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 1.01-1.80]. However, significant adverse effects of intraoperative urologic complications in LRH were not observed among articles published after 2012 (OR 1.12, 95% CI 0.77-1.62) in cumulative meta-analysis or subgroup analysis. The incidence of bladder injury was statistically higher than that of ureter injury (p = 0.001). In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. CONCLUSION LRH is associated with significantly higher risk of intraoperative and postoperative urologic complications than abdominal radical hysterectomy.
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15
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Brandt B, Sioulas V, Basaran D, Kuhn T, LaVigne K, Gardner GJ, Sonoda Y, Chi DS, Long Roche KC, Mueller JJ, Jewell EL, Broach VA, Zivanovic O, Abu-Rustum NR, Leitao MM. Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecol Oncol 2020; 156:591-597. [PMID: 31918996 DOI: 10.1016/j.ygyno.2019.12.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma. METHODS We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007-12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders. RESULTS We identified 196 evaluable cases-117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (53.2% vs. 33.3%, P = 0.006). Median follow-up was ~4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04). CONCLUSIONS MIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma.
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Affiliation(s)
- Benny Brandt
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | - Vasileios Sioulas
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | - Derman Basaran
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | - Theresa Kuhn
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | - Katherine LaVigne
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Kara C Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Vance A Broach
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.
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Sauer G, Kurzeder C, Schneider A. [Impact of surgical approach on prognosis in early-stage cervical cancer]. Strahlenther Onkol 2019; 195:274-276. [PMID: 30689029 DOI: 10.1007/s00066-019-01426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Georg Sauer
- Abteilung Gynäkologie und Geburtshilfe, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | | | - Achim Schneider
- MVZ im Fürstenberg-Karree, Institut für Zytologie Dysplasie, Hohenzollerndamm 123, 14199, Berlin, Deutschland
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Lee B, Kim K, Park Y, Lim MC, Bristow RE. Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13445. [PMID: 30544427 PMCID: PMC6310549 DOI: 10.1097/md.0000000000013445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In cervical cancer, the impact of hospital volume of laparoscopic radical hysterectomy (LRH) has not been investigated systematically as in ovarian cancer.The aim of this study was to investigate the impact of hospital care volume of LRH on treatment outcomes of patients with cervical cancer. METHODS The PubMed, Embase, and Cochrane Library databases were searched with the terms "cervical cancer," "radical hysterectomy," and "laparoscopy." The selection criteria included studies presenting operative outcomes and/or perioperative complications of LRH from high-volume hospitals (HVHs) (≥15 cases/year) and low-volume hospitals (LVHs) (<15 cases/year). Fifty-nine studies including 4367 cases were selected. Linear regression analysis weighted by the average annual case number in each study was performed to evaluate differences between the groups. RESULTS In HVH, a higher number of lymph nodes (24.5 vs 21.1; P = .037) were retrieved by LRH in older women (48.4 vs 44.5 years; P = .010) with tendencies of shorter operation time (224.4 vs 256.4 minutes; P = .096) and less blood loss (253.1 vs 322.2 mL; P = .080). Compared with LVH, HVH had fewer patients with stage IA disease (13.8 vs 24.4%; P = .003) and more patients with stage IIA disease (15.3 vs 7.1%; P = .052) with comparable 5-year overall survival (93.1 vs 88.6%; P = .112). CONCLUSION HVH is a prognostic factor for operative outcome and perioperative complications in patients with cervical cancer undergoing LRH. The exact effect of hospital volume on survival outcome needs to be evaluated.
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Affiliation(s)
- Banghyun Lee
- Department of Obstetrics and Gynecology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Kidong Kim
- Department of Obstetrics and Gynecology Gyeonggi-do
| | - Youngmi Park
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-Si
| | - Myong Cheol Lim
- Cancer Healthcare Research Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital, Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Robert E. Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA
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Zhang S, Ma L, Meng QW, Zhou D, Moyiding T. Comparison of laparoscopic-assisted radical vaginal hysterectomy and abdominal radical hysterectomy in patients with early stage cervical cancer: A retrospective study. Medicine (Baltimore) 2017; 96:e8005. [PMID: 28885364 PMCID: PMC6393076 DOI: 10.1097/md.0000000000008005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the safety and survival outcomes of early stage cervical cancer patients treated by laparoscopically assisted radical vaginal hysterectomy (LARVH) versus abdominal radical hysterectomy (ARH). METHODS Since March 2008 to July 2012, the patients with early stage cervical cancer undergoing LARVH or ARH in Beijing hospital have been entered into this study. Statistical analysis used Statistical Product and Service Solutions (SPSS) and significance was defined as P < .05. RESULT Forty-two patients were included in LARVH group and 35 patients in ARH group. Both groups were similar with respect to age, body mass index (BMI), histological diagnosis, and stage. There were no differences in operative time, vaginal length, and postoperative complications, but blood loss, rate of transfusion, length of catheterized, and length of hospital stay were significantly less in LARVH. Number of lymph node retrieved was less than ARH. No differences were seen regarding recurrence rate, length of disease free survival, overall survival, and mortality rate after a median follow up of 58.5 and 48.5 months. CONCLUSION LARVH is a suitable alternative to ARH for early-stage cervical cancer, which shows less blood loss, shorter catheterized and hospital stay, and similar survival outcomes.
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Zhang S, Wang S, Lv A, Huang S. Laparoscopically Assisted Radical Vaginal Hysterectomy for Early-Stage Cervical Cancer: A Systemic Review and Meta-Analysis. Int J Gynecol Cancer 2016; 26:1497-502. [PMID: 27400320 DOI: 10.1097/igc.0000000000000794] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare intraoperative and short-term postoperative outcomes and recurrence of laparoscopically assisted radical vaginal hysterectomy (LARVH) to abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer. METHODS A search of PubMed, EMBASE, and Cochrane library search trial (central) databases was conducted from database inception through December 2015. We included studies comparing surgical approaches with radical hysterectomy (LARVH vs ARH) in women with stages IA1 to IIB cervical cancer. Outcomes included blood loss, operative time, number of lymph nodes retrieved, intraoperative complications, hospital stay, and prognosis. RESULT Seven studies were included (4 prospective cohort studies and 3 case control studies) enrolling 794 women; 349 women were treated by LARVH, and 445 were treated by ARH. Laparoscopically assisted radical vaginal hysterectomy was associated with less blood loss (weight mean difference [WMD], -237.45; 95% confidence interval [CI], -453.42 to -21.47), wound-related complications (odds ratio, 0.17; 95% CI, 0.05-0.61), shorter hospital stay (WMD, -2.01; 95% CI, -2.52 to -1.51), and longer operative time (WMD, 48.95; 95% CI, 42.08 to 55.82) versus ARH. Laparoscopically assisted radical vaginal hysterectomy was comparable with ARH in number of lymph nodes retrieved, urinary-related complications, rectal injury, lymphedema, and all prognosis indicators. CONCLUSIONS The evidence suggests that LARVH is superior to ARH with lower blood loss, less wound-related complications, and shorter hospital stay. Laparoscopically assisted radical vaginal hysterectomy and ARH seem equivalent in number of lymph nodes retrieved, urinary-related complications, rectal injury, lymphedema, and prognosis.
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Affiliation(s)
- Sichen Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, China
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Brucker SY, Ulrich UA. Surgical Treatment of Early-Stage Cervical Cancer. Oncol Res Treat 2016; 39:508-14. [PMID: 27614875 DOI: 10.1159/000448794] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
Surgical treatment of cervical cancer has been a cornerstone in the management of this malignancy for more than 100 years. Today, for early-stage and low-risk cervical cancer, surgery is still considered the gold standard. If the preoperative assessment of the tumor reveals a situation prompting postoperative adjuvant radiochemotherapy, the latter should be planned as the primary treatment option, being preceded by staging laparoscopy including pelvic and paraaortic lymph node dissection. As an alternative to the open approach, the definitive surgical treatment should be either performed laparoscopically, or be laparoscopic-assisted, or laparoscopically robotic-assisted.
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Affiliation(s)
- Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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Kong TW, Chang SJ, Piao X, Paek J, Lee Y, Lee EJ, Chun M, Ryu HS. Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer. J Obstet Gynaecol Res 2015; 42:77-86. [DOI: 10.1111/jog.12840] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/07/2015] [Accepted: 07/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tae-Wook Kong
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Obstetrics and Gynecology; Ajou University School of Medicine; Suwon Korea
| | - Suk-Joon Chang
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Obstetrics and Gynecology; Ajou University School of Medicine; Suwon Korea
| | - Xianling Piao
- Ajou University Graduate School of Medicine; Suwon Korea
| | - Jiheum Paek
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Obstetrics and Gynecology; Ajou University School of Medicine; Suwon Korea
| | - Yonghee Lee
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Pathology; Ajou University School of Medicine; Suwon Korea
| | - Eun Ju Lee
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Radiology; Ajou University School of Medicine; Suwon Korea
| | - Mison Chun
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Radiation Oncology; Ajou University School of Medicine; Suwon Korea
| | - Hee-Sug Ryu
- Gynecologic Cancer Center; Ajou University School of Medicine; Suwon Korea
- Department of Obstetrics and Gynecology; Ajou University School of Medicine; Suwon Korea
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Comparison of laparoscopic versus abdominal radical hysterectomy for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. Int J Gynecol Cancer 2014; 24:280-8. [PMID: 24407571 DOI: 10.1097/igc.0000000000000052] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE There have been many comparative reports on laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. However, most of these studies included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 and small (tumor diameter ≤2 or 3 cm) IB1 disease. The purpose of this study was to compare the feasibility, morbidity, and recurrence rate of LRH and ARH for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. MATERIALS AND METHODS We conducted a retrospective analysis of 88 patients with FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. All patients had no evidence of parametrial invasion and lymph node metastasis in preoperative gynecologic examination, pelvic magnetic resonance imaging, and positron emission tomography-computed tomography, and they all underwent LRH or ARH between February 2006 and March 2013. RESULTS Among 88 patients, 40 patients received LRH whereas 48 underwent ARH. The mean estimated blood loss was 588.0 mL for the ARH group compared with 449.1 mL for the LRH group (P < 0.001). The mean operating time was similar in both groups (246.0 minutes in the ARH vs 254.5 minutes in the LRH group, P = 0.589). Return of bowel motility was observed earlier after LRH (1.8 vs 2.2 days, P = 0.042). The mean hospital stay was significantly shorter for the LRH group (14.8 vs 18.0 days, P = 0.044). There were no differences in histopathologic characteristics between the 2 groups. The mean tumor diameter was 44.4 mm in the LRH and 45.3 mm in the ARH group. Disease-free survival rates were 97.9% in the ARH and 97.5% in the LRH group (P = 0.818). CONCLUSIONS Laparoscopic radical hysterectomy might be a feasible therapeutic procedure for the management of FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. Further randomized studies that could support this approach are necessary to evaluate long-term clinical outcome.
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Rimbach S, Neis K, Solomayer E, Ulrich U, Wallwiener D. Current and Future Status of Laparoscopy in Gynecologic Oncology. Geburtshilfe Frauenheilkd 2014; 74:852-859. [PMID: 25278627 PMCID: PMC4175127 DOI: 10.1055/s-0034-1383075] [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: 08/12/2014] [Revised: 08/22/2014] [Accepted: 08/22/2014] [Indexed: 12/27/2022] Open
Abstract
Laparoscopy is playing an increasingly important role in gynecologic oncology. The benefits of minimally invasive surgery for oncology patients and the quality of this treatment are well documented. Outcomes and quality of minimally invasive surgical procedures to treat cervical cancer were evaluated based on retrospective and case-control studies; outcomes and quality after minimally invasive treatment für early-stage low-risk endometrial cancer were also assessed in prospective randomized studies. If indicated, laparoscopic lymphadenectomy is both technically feasible and oncologically safe. Adipose patients in particular benefit from minimally invasive procedures, where feasible. The potential role of laparoscopy in neoadjuvant therapy for ovarian cancer and in surgery for early-stage ovarian carcinoma is still controversially discussed and is currently being assessed in further studies. Using a minimally invasive approach in gynecologic oncology procedures demands strict adherence to oncological principles and requires considerable surgical skill.
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Affiliation(s)
- S. Rimbach
- Gynäkologie und Geburtshilfe, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - K. Neis
- Praxis Frauenärzte am Staden, Saarbrücken
| | - E. Solomayer
- Gynäkologie und Geburtshilfe, Univ.-klinik des Saarlandes, Homburg/Saar
| | - U. Ulrich
- Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
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Lanowska M, Brink-Spalink V, Mangler M, Grittner U, von Tucher E, Schneider A, Köhler C. Vaginal-assisted laparoscopic radical hysterectomy (VALRH) versus laparoscopic-assisted radical vaginal hysterectomy (LARVH) in the treatment of cervical cancer: surgical results and oncologic outcome. Arch Gynecol Obstet 2013; 289:1293-300. [PMID: 24362556 DOI: 10.1007/s00404-013-3121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the morbidity and survival rates of patients with early-stage cervical cancer treated by vaginal-assisted laparoscopic radical hysterectomy (VALRH) with pair-matched laparoscopic-assisted vaginal radical hysterectomy (LARVH) controls. METHODS One hundred nine patients who underwent VALRH for cervical cancer stage FIGO Ia1, L1 to IIb between 2007 and 2009 and 200 patients who underwent LARVH between 1994 and 2002 were analysed in their entirety and in a group of matched pairs. RESULTS In both groups, there was no conversion to laparotomy due to an intraoperative complication. Prevalence of blood transfusions was significantly lower in the VALRH group (2 vs. 39 patients; P < 0.001). Bladder function resumed sooner (P < 0.001), and patients were discharged earlier after VALRH (P < 0.001). There were no intraoperative injuries in the VALRH group. In the LARVH group, the most common intraoperative injury occurred to the bladder (7.0 %). Postoperatively, the most common complication in the VALRH group was ureterovaginal fistula (2.7 %) and fever (2.7 %) and in the LARVH ureterostenosis (3.5 %), uretero/bladder fistula (1 %), and fever (7 %). For patients with tumour stage Ib1 the 5-year recurrence-free survival was 92.8 % and 5-year overall survival 95.2 % following VALRH and 88.2 and 90.5 %, respectively, following LARVH. No significant difference in the survival rate was found (log rank, P = 0.740). CONCLUSION VALRH is a feasible and oncologically safe surgical option for patients with early-stage cervical cancer. We believe the complication rate is lowered in VALRH by the combination of the laparoscopic and vaginal approach.
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Affiliation(s)
- Malgorzata Lanowska
- Department of Gynecology, Charité-University Medicine Berlin, Campus Mitte and Benjamin Franklin, Charitéplatz 1, 10117, Berlin, Germany,
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Laparoscopically Assisted Vaginal Radical Hysterectomy: Systematic Review of the Literature. J Minim Invasive Gynecol 2013; 20:745-53. [DOI: 10.1016/j.jmig.2013.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/19/2013] [Accepted: 04/20/2013] [Indexed: 11/19/2022]
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Kucukmetin A, Biliatis I, Naik R, Bryant A. Laparoscopically assisted radical vaginal hysterectomy versus radical abdominal hysterectomy for the treatment of early cervical cancer. Cochrane Database Syst Rev 2013; 2013:CD006651. [PMID: 24085528 PMCID: PMC6457625 DOI: 10.1002/14651858.cd006651.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management for selected early-stage cervical cancer is radical hysterectomy. Traditionally, radical hysterectomy has been carried out via the abdominal route and this remains the gold standard surgical management of early cervical cancer. In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery. OBJECTIVES To compare the effectiveness and safety of laparoscopically assisted radical vaginal hysterectomy (LARVH) and radical abdominal hysterectomy (RAH) in women with early-stage (1 to 2A) cervical cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, and Cochrane Register of Controlled Trials (CENTRAL) Issue 7, 2013, MEDLINE, and EMBASE up to July 2013. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared laparoscopically assisted radical hysterectomy and radical abdominal hysterectomy, in adult women diagnosed with early (stage 1 to 2A) cervical cancer. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. MAIN RESULTS We found one RCT, which included 13 women, that met our inclusion criteria and this trial reported data on LARVH versus RAH.Women who underwent LARVH for treatment of early-stage cervical cancer appeared to have less blood loss compared with those who underwent RAH. The trial reported a borderline significant difference between the two types of surgery (median blood loss 400 mL (interquartile range (IQR): 325 to 1050) and 1000 mL (IQR: 800 to 1025) for LARVH and RAH, respectively, P value = 0.05). RAH was associated with significantly shorter operation time compared with LARVH (median: 180 minutes with LARVH versus 138 minutes with RAH, P value = 0.05).There was no statistically significant difference in the risk of perioperative complications in women who underwent LARVH and RAH. The trial reported two (29%) and four (57%) cases of intraoperative and postoperative complications, respectively, in the LARVH group and no (0%) reported cases of intraoperative complications and five (83%) cases of postoperative complications in the RAH group. There were no reported cases of severe perioperative complications.Bladder and bowel dysfunction of either a transient or chronic nature remain major morbidities after radical hysterectomy, and the one included study showed that there may be significantly less after LARVH. AUTHORS' CONCLUSIONS The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore, the absence of reliable evidence, regarding the effectiveness and safety of the two surgical techniques for the management of early-stage cervical cancer, precludes any definitive guidance or recommendations for clinical practice. The trial did not report data on long-term outcomes, but was at moderate risk of bias due to very low numbers of included women.
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Affiliation(s)
- Ali Kucukmetin
- Gynaecological Oncology, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, Tyne & Wear, UK, NE9 6SX
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[Impact of cervical cancer treatment on micturition and sexual function]. Actas Urol Esp 2013; 37:40-6. [PMID: 22728020 DOI: 10.1016/j.acuro.2012.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 03/11/2012] [Indexed: 01/23/2023]
Abstract
CONTEXT Cervical cancer is the second most common tumor in women worldwide and due to diagnostic and therapeutic advances, the overall survival rates at 5 years is approaching 70%. Disorders in micturition, defecation, sexuality and quality of life have been described, frequently caused by different treatments. Addressing these comorbidities in the medical follow-up is often limited or nonexistent. METHODS A systematic review of studies to identify the articles related with urogynecological sequels from cervical cancer treatment was carried out. SUMMARY OF EVIDENCE During radical hysterectomy, disruption of the autonomic nerve fibers which innervate the bladder appears to be the main cause of voiding dysfunction. Up to 36% of women report voiding dysfunction; from 10 to 80%, stress urinary incontinence (SUI), due to the decrease in urethral closure pressure. After radical hysterectomy and/or radiotherapy, vaginal shortening and stenosis after is often observed. Sexual function is altered in these women and those who are sexually active women after the surgery frequently report sexual dysfunction due to lack of lubrication and pain. CONCLUSIONS Voiding dysfunction and urinary incontinence are the most frequent urinary problems that occur in patients treated for cervical cancer. Systemic urogynecologic assessment of the symptoms suggestive of micturition dysfunctions during oncologic follow-up may be useful to detect the cases that can be evaluated and treated in an Urogynecology Unit.
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Urologic complication in laparoscopic radical hysterectomy: Meta-analysis of 20 studies. Eur J Cancer 2012; 48:3177-85. [DOI: 10.1016/j.ejca.2012.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 06/01/2012] [Accepted: 06/14/2012] [Indexed: 11/20/2022]
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Geetha P, Nair MK. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review. J Minim Access Surg 2012; 8:67-73. [PMID: 22837592 PMCID: PMC3401719 DOI: 10.4103/0972-9941.97584] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/19/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome. OBJECTIVE Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH) and comparing the results with abdominal radical hysterectomy (ARH). SEARCH STRATEGY Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31(st) 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy. SELECTION CRITERIA Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. DATA COLLECTION AND ANALYSIS Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes. RESULTS Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH. CONCLUSIONS Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may reduce the complications rate.
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Affiliation(s)
- Puliyath Geetha
- Department of Obstetrics and Gynaecology, SUT Academy of Medical Sciences, Post Vencode, Vattappara, Trivandrum, India
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Gottschalk E, Lanowska M, Chiantera V, Marnitz S, Schneider A, Brink-Spalink V, Hasenbein K, Koehler C. Vaginal-assisted laparoscopic radical hysterectomy: rationale, technique, results. JSLS 2012; 15:451-9. [PMID: 22643498 PMCID: PMC3340952 DOI: 10.4293/108680811x13176785203879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors conclude that vaginal-assisted laparoscopic radical hysterectomy is an oncologic viable alternative to abdominal radical hysterectomy, laparoscopic-assisted radical vaginal hysterectomy, totally laparoscopic radical hysterectomy, and robotic radical hysterectomy. Objective: Total laparoscopic radical hysterectomy (TLRH) makes it difficult to resect adequate vaginal cuff according to tumor size and to avoid tumor spread after opening the vagina. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is associated with higher risk for urologic complications. Methods: The vaginal-assisted laparoscopic radical hysterectomy (VALRH) technique comprises 3 steps: (1) comprehensive laparoscopic staging, (2) creation of a tumor-adapted vaginal cuff, and (3) laparoscopic transsection of parametria. We retrospectively analyzed data of 122 patients who underwent VALRH for early stage cervical cancer (n=110) or stage II endometrial cancer (n=12) between January 2007 and December 2009 at Charité University Berlin. Results: All patients underwent VALRH without conversion. Mean operating time was 300 minutes, and mean blood loss was 123cc. On average, 36 lymph nodes were harvested. Intra- and postoperative complication rates were 0% and 13.1%, respectively. Resection was in sound margins in all patients. After median follow-up of 19 months, disease-free survival and overall survival for all 110 cervical cancer patients was 94% and 98%, and for the subgroup of patients (n=90) with tumors ≤pT1b1 N0 V0 L0/1 R0, 97% and 98%, respectively. Conclusion: VALRH is a valid alternative to abdominal radical hysterectomy and LARVH in patients with early-stage cervical cancer and endometrial cancer stage II with minimal intraoperative complications and identical oncologic outcomes.
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Choi CH, Lee JW, Lee YY, Kim HJ, Song T, Kim MK, Kim TJ, Kim BG, Bae DS. Comparison of Laparoscopic-Assisted Radical Vaginal Hysterectomy and Laparoscopic Radical Hysterectomy in the Treatment of Cervical Cancer. Ann Surg Oncol 2012; 19:3839-48. [DOI: 10.1245/s10434-012-2406-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Indexed: 11/18/2022]
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Open Versus Laparoscopic Pelvic Lymph Node Dissection in Early Stage Cervical Cancer: No Difference in Surgical or Disease Outcome. Int J Gynecol Cancer 2012; 22:107-14. [DOI: 10.1097/igc.0b013e31822c273d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
ObjectiveThis study aimed to investigate in a retrospective study the effect of laparoscopic surgery, introduced in our center in 1994 as part of the standard treatment of early stage cervical cancer, on surgical and disease outcomes.Patients and MethodsA total of 169 women with cervical carcinoma stage IB1 (n = 150) or IB2 (n = 19) were included in the study. Seventy-six patients who underwent laparoscopic pelvic lymph node dissection (LPLND), followed either by open radical hysterectomy (n = 63) or, in case of positive lymph nodes, by primary chemoradiation (n = 13), were compared with an historic cohort of 93 patients who underwent a fully open, traditional Wertheim-Meigs procedure (WM). Recorded clinical characteristics of patients included age, International Federation of Gynecology and Obstetrics stage, histologic diagnosis, differentiation grade, tumor diameter, lymph node status, and adjuvant therapy. Operation time; lymph node yield; intraoperative, early, and late complications; site of recurrences; and disease-free and overall survival rates were analyzed and compared between groups.ResultsClinical characteristics did not differ between groups. Duration of total surgery time was longer in patients with LPLND followed by open radical hysterectomy compared with that in the WM group (P< 0.001). In patients with negative lymph nodes (n = 129), the number of resected nodes was higher (P= 0.002) in the LPLND (median, 26 nodes; range, 8–55 nodes) than in the WM group (median, 21 nodes; range, 7–50 nodes). In patients with positive lymph nodes (n = 40), no significant difference in the number of resected lymph nodes between the 2 groups (P= 0.904) was found. Intraoperative, early, and late complications did not differ between the 2 surgical procedures. The number of locoregional recurrences, but not of distant metastases, was significantly higher (P= 0.018) in the WM group compared with the LPLND group. No difference in disease-free or disease-specific survival was found between the LPLND and WM group, neither with nor without adjuvant or primary (chemo)radiation. A benefit in disease-free survival (P= 0.044), but not in disease-specific survival (P= 0.070), was found in the LPLND compared with the WM group in those patients who received adjuvant therapy or primary chemoradiation.ConclusionsIntroduction of a laparoscopic procedure in the surgical staging and treatment of cervical cancer patients did not have a detrimental effect on surgical or disease outcome, and this can be safely applied to the treatment of early stage cervical cancer.
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Marnitz S, Köhler C, Affonso RJ, Schneider A, Chiantera V, Tsounoda A, Vercellino F. Validity of Laparoscopic Staging to Avoid Adjuvant Chemoradiation following Radical Surgery in Patients with Early Cervical Cancer. Oncology 2012; 83:346-53. [DOI: 10.1159/000341659] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
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Koehler C, Gottschalk E, Chiantera V, Marnitz S, Hasenbein K, Schneider A. From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy. BJOG 2011; 119:254-62. [PMID: 22082331 DOI: 10.1111/j.1471-0528.2011.03202.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Radical hysterectomy with pelvic lymphadenectomy is the standard surgical treatment for patients with early stage cervical cancer. The majority of radical hysterectomies are performed with the open technique. However, laparoscopic, combined laparoscopic and vaginal, and robotic-assisted approaches may also be used. Compared with the abdominal radical hysterectomy (ARH), laparoscopic techniques are associated with less blood loss, shorter hospital stay, better cosmesis, and faster recovery. A further breakthrough in laparoscopic technique can only be made if safety and oncological clearance are comparable with ARH. We describe the technique and results of laparoscopic assisted radical vaginal hysterectomy and the transition to vaginal assisted laparoscopic radical hysterectomy.
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Affiliation(s)
- C Koehler
- Department of Gynaecology, Charité- Universitätsmedizin Berlin, Germany.
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Taylor SE, McBee WC, Richard SD, Edwards RP. Radical hysterectomy for early stage cervical cancer: laparoscopy versus laparotomy. JSLS 2011; 15:213-7. [PMID: 21902978 PMCID: PMC3148874 DOI: 10.4293/108680811x13022985132218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Laparoscopic radical hysterectomy appears to be a feasible alternative to laparotomy for early stage cervical cancer with similar surgical outcomes and lessened morbidity. Objectives: Gynecologic oncologists have recently begun using laparoscopic techniques to treat early stage cervical cancer. We evaluated a single institution's experience of laparoscopic radical hysterectomy and staging compared with laparotomy. Methods: A retrospective chart review identified stage IA2 and IB1 cervical cancer patients who underwent laparoscopic radical hysterectomy and pelvic lymph node dissection from July 2003 to April 2009. A 2:1 cohort of patients treated with laparotomy were matched by stage. Results: Nine laparoscopic patients (3 stage IA2, 6 stage IB1) with 18 matched controls (6 and 12) were identified. Demographics for each group were similar. None had positive margins or lymph nodes. An average of 11.2 vs.13.9 pelvic lymph nodes (P=0.237) were removed. Average operating time was 231.7 vs. 207.2 minutes (P=0.434), and average estimated blood loss was 161.1 vs. 394.4mL (P=0.059). Average length of stay was 2.9 vs. 5.5 days (P=0.012). No transfusions or operative complications were noted in the laparoscopic group vs. 3 each in the open group (P=0.194). No laparoscopic patients and 5 open patients had a postoperative wound infection (P=0.079). No recurrences were noted. Conclusions: Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity.
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Affiliation(s)
- Sarah E Taylor
- Magee-Womens Hospital of UPMC, Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, Pennsylvania 15213, USA.
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Roy M, Plante M. Place of Schauta's radical vaginal hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011; 25:227-37. [PMID: 21215702 DOI: 10.1016/j.bpobgyn.2010.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 10/08/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
Women affected by early stage invasive cancer of the cervix are usually treated by surgery. Radical abdominal hysterectomy with pelvic lymphadenectomy is the most widely used technique. Because the morbidity of the abdominal approach can be important, the radical vaginal hysterectomy has gained acceptance in gynaecologic oncology. New instrumentation in laparoscopy also opens the possibility of treating cervical cancer by laparoscopically assisted vaginal radical hysterectomy and also total laparoscopic radical hysterectomy. Before these techniques become widely accepted, it has to be shown that safety and efficacy are comparable with the 'standard' abdominal approach. In this chapter, we review the technique of radical vaginal hysterectomy with pelvic lymphadenectomy and evaluate results of published studies, comparing the abdominal, vaginal and laparoscopic approaches.
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Affiliation(s)
- Michel Roy
- Department of Gynaecology and Obstetrics, Laval University, Gynaecologic Oncology Division, Centre Hospitalier Universitaire de Québec (CHUQ), L'Hôtel-Dieu de Québec, 11 Côte du Palais, Quebec City, Canada G1R-2J6.
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