1
|
Urabe S, Hata T, Kobayashi E, Ishii Y, Ushimaru Y, Takeda M, Sekido Y, Hata T, Hamabe A, Ogino T, Miyoshi N, Uemura M, Yamamoto H, Doki Y, Eguchi H, Nakajima K. Development of novel rectal/uterine clamping device. Sci Rep 2024; 14:22960. [PMID: 39362951 PMCID: PMC11450202 DOI: 10.1038/s41598-024-75103-y] [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: 07/13/2024] [Accepted: 10/01/2024] [Indexed: 10/05/2024] Open
Abstract
We developed a novel clamping device for laparoscopic surgery, free from conventional pinch structure, capable of uniformly occluding any ductal organ. This study aimed to evaluate performance of the new clamper compared to the pinch-type clamper. The new clamper consists of two metal bars with ties at each end, which enables parallel clamping. A resected porcine stomach was used, with an infusion tube at the anal end to increase intra-luminal pressure. The oral side of the stomach was clamped with either the new clamper or the pinch-type clamper, and their performances were evaluated in qualitative and semi-quantitative manner. Qualitative evaluation involved imaging the clamping site at intra-gastric pressures from 0 to 15 mmHg using microfocus computed tomography. The new clamper showed no gap even under increased intra-luminal pressure, while the pinch-type clamper showed a gap on the distal side. Quantitative evaluation measured bursting pressure under continuous air insufflation. Air leakages were observed in the new clamper at higher intra-luminal pressures than in the pinch-type clamper (46.1 mmHg vs. 13.6 mmHg, P < 0.01). Our new clamping device showed superior performance in preclinical setting compared to the conventional pinch-type clamper. We are currently working on its design freezing and aiming for early commercialization.
Collapse
Affiliation(s)
- Shoichiro Urabe
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Suite 0802, BioSystems Bldg., 1-3, Yamadaoka, Osaka, 565-0871, Osaka, Japan
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taishi Hata
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Suite 0802, BioSystems Bldg., 1-3, Yamadaoka, Osaka, 565-0871, Osaka, Japan
| | - Eiji Kobayashi
- Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita, Japan
| | | | - Yuki Ushimaru
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Suite 0802, BioSystems Bldg., 1-3, Yamadaoka, Osaka, 565-0871, Osaka, Japan
| | - Mitsunobu Takeda
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Sekido
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Hamabe
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Osaka University Graduate School of Medicine, Suite 0802, BioSystems Bldg., 1-3, Yamadaoka, Osaka, 565-0871, Osaka, Japan.
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| |
Collapse
|
2
|
Dehne S, Kirschner L, Strowitzki MJ, Kilian S, Kummer LC, Schneider MA, Michalski CW, Büchler MW, Weigand MA, Larmann J. Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery. J Clin Anesth 2024; 96:111495. [PMID: 38733708 DOI: 10.1016/j.jclinane.2024.111495] [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: 08/17/2023] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
STUDY OBJECTIVE Higher levels of carbon dioxide (CO2) increase the invasive abilities of colon cancer cells in vitro. Studies assessing target values for end-tidal CO2 concentrations (EtCO2) to improve surgical outcome after colorectal cancer surgery are lacking. Therefore, we evaluated whether intraoperative EtCO2 was associated with differences in recurrence-free survival after elective colorectal cancer (CRC) surgery. DESIGN Single center, retrospective analysis. SETTING Anesthesia records, surgical databases and hospital information system of a tertiary university hospital. PATIENTS We analyzed 528 patients undergoing elective resection of colorectal cancer at Heidelberg University Hospital between 2009 and 2018. INTERVENTIONS None. MEASUREMENTS Intraoperative mean EtCO2 values were calculated. The study cohort was equally stratified into low-and high-EtCO2 groups. The primary endpoint measure was recurrence-free survival until last known follow-up. Groups were compared using Kaplan-Meier analysis. Cox-regression analysis was used to control for covariates. Sepsis, reoperations, surgical site infections and cardiovascular events during hospital stay, and overall survival were secondary outcomes. MAIN RESULTS Mean EtCO2 was 33.8 mmHg ±1.2 in the low- EtCO2 group vs. 37.3 mmHg ±1.6 in the high-EtCO2 group. Median follow-up was 3.8 (Q1-Q3, 2.5-5.1) years. Recurrence-free survival was higher in the low-EtCO2 group (log-rank-test: p = .024). After correction for confounding factors, lower EtCO2 was associated with increased recurrence-free survival (HR = 1.138, 95%-CI:1.015-1.276, p = .027); the hazard for the primary outcome decreased by 12.1% per 1 mmHg decrease in mean EtCO2. 1-year and 5-year survival was also higher in the low-EtCO2 group. We did not find differences in the other secondary endpoints. CONCLUSIONS Lower intraoperative EtCO2 target values in CRC surgery might benefit oncological outcome and should be evaluated in confirmative studies.
Collapse
Affiliation(s)
- Sarah Dehne
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Lina Kirschner
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Moritz J Strowitzki
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Samuel Kilian
- Heidelberg University, Medical Faculty Heidelberg, Institute of Medical Biometry, Heidelberg, Germany
| | - Laura Christine Kummer
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Martin A Schneider
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Christoph W Michalski
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Markus W Büchler
- Heidelberg University, Medical Faculty Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany
| | - Markus A Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Jan Larmann
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany.
| |
Collapse
|
3
|
Chang SH, Huang KG, Yang LY, Pan YB, Lai CH, Chou HH. Comparison of outcomes of laparotomic and minimally invasive radical hysterectomy in women with early-stage cervical cancer. J Gynecol Oncol 2024; 35:e60. [PMID: 38425140 PMCID: PMC11390246 DOI: 10.3802/jgo.2024.35.e60] [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: 08/22/2023] [Revised: 01/03/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This study compared the outcomes of laparotomic radical hysterectomy (LRH) and minimally invasive radical hysterectomy (MISRH) in patients with early-stage cervical cancer. METHODS The clinical data of patients with early-stage cervical cancer who underwent LRH or MISRH (laparoscopic/robotic) at Chang Gung Memorial Hospital, Linkou Branch, from 2002 to 2017 were retrospectively reviewed. The surgical safety (operation time, blood loss, blood transfusion rate, length of postoperative stay, and perioperative complications), overall survival (OS), disease-free survival (DFS), and recurrence pattern were analyzed. Propensity score matching (PSM) at a 3:1 ratio was performed to balance prognostic variables. RESULTS Of the 760 patients (entire cohort), 614 underwent LRH and 146 underwent MISRH. After PSM, 394 and 140 patients were included in the LRH and MISRH groups, respectively. The 5-year OS rate was significantly lower in the MISRH group than in the LRH group (85.6% vs. 93.2%, p=0.043), and the 5-year DFS rate (p=0.21) did not differ significantly. After PSM, the 5-year OS rates did not differ significantly between the MISRH and LRH groups (87.1% vs. 92.1%, p=0.393). The MISRH group had a significantly shorter operation time (p<0.001), lower intraoperative blood loss (p<0.001), lower blood transfusion rate (p<0.001), and shorter postoperative stay (p<0.001) but a significantly higher rate of intraoperative bladder injury (p<0.001) than the LRH group. CONCLUSION After PSM, MISRH is associated with nonsignificantly lower OS but a significantly higher risk of intraoperative urological complications than LRH.
Collapse
Affiliation(s)
- Shu-Han Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Division of Clinical Trial, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Bin Pan
- Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
| |
Collapse
|
4
|
Lim L, Slee A, Lim PC. Feasibility and early oncologic outcomes of Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC) for the treatment of clinical stage IB cervical cancer: A tumor containment technique. Gynecol Oncol Rep 2024; 54:101437. [PMID: 39021507 PMCID: PMC467087 DOI: 10.1016/j.gore.2024.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Minimally invasive radical hysterectomy (MIRH) has been reported to have a four-fold increase in recurrence compared to open radical hysterectomy (ORH) for the treatment of early-stage cervical cancer. The cause for the inferior outcomes with MIRH is unclear. However, the use of a uterine manipulator and the lack of tumor containment strategies may contribute to tumor seeding in previous MIRH approaches. Objective Determine the feasibility and early oncologic outcomes of a novel robotic-assisted surgical technique for the treatment of early-stage cervical cancer, Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC). Methods Retrospective cohort study. Results Twenty-six patients between 2018 and 2022 underwent the TIRRHVC procedure after being counseled on the risks and benefits of ORH and TIRRHVC; these 26 patients' demographics, clinical, surgical, and oncologic outcomes were reviewed retrospectively. Seventeen patients (65.4 %) had clinical stage IB1 and 9 (34.6 %) were IB2 cervical cancer according to FIGO 2018 guidelines. Following hysterectomy and lymphadenectomy, 4 patients were upstaged. The average pathologic tumor size was 2.66 cm (0 cm - 5.6 cm); 65 % of tumors were > 2 cm. There were no intraoperative complications. There were 13 postoperative complications, including 10 urinary tract infections. Eleven patients (42.3 %) received adjuvant therapy. The average follow-up period was 2.8 years (IQR 2.3-3.6). Only one patient has recurred at 3.6 years. One patient expired from causes unrelated to gynecologic cancer. The 3-year disease free survival is 95.5 %. Conclusion These promising early oncologic outcomes are encouraging that TIRRHVC may be a treatment option that offers the benefits of minimally invasive surgery without compromising oncologic outcomes.
Collapse
Affiliation(s)
- Lauren Lim
- University of Nevada, Reno School of Medicine, United States
| | - April Slee
- University College London, United Kingdom
| | - Peter C. Lim
- University of Nevada, Reno School of Medicine, United States
- Center of Hope, Reno, Nevada, United States
| |
Collapse
|
5
|
Kamata M, Fusegi A, Kurihara N, Abe A, Nomura H, Kanao H. Effects of tumor spillage prevention in laparoscopic radical hysterectomy for early-stage cervical cancer: a propensity score-matched analysis. J Gynecol Oncol 2024; 36:36.e22. [PMID: 39028154 DOI: 10.3802/jgo.2025.36.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/08/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE Minimally invasive radical hysterectomy has a worse prognosis than open surgery, but the reasons for the poor prognosis remain unclear. Tumor spillage occurs when the tumor is exposed to the surgical field and has been suggested to be related to a poor prognosis. This study aimed to compare the prognostic value of tumor spillage in laparoscopic radical hysterectomy and evaluate whether tumor spillage prevention improves oncological safety. METHODS We compared the prognosis of patients who underwent laparoscopic radical hysterectomy between December 2014 and November 2021 with or without tumor spillage prevention, including surgeries without prevention and those with failed prevention. Prevention consisted of vaginal cuff formation or closure of the vaginal canal with clips to prevent tumor exposure at the time of colpotomy. The primary endpoint was disease-free survival, which was adjusted using propensity scores to compare patients. RESULTS In total, 165 patients received tumor spillage prevention, and 61 did not or failed to receive such prevention. The median follow-up was 4.4 years. Patients who did not undergo prevention or failed prevention had significantly shorter disease-free survival than those who did (hazard ratio [HR]=3.54; 95% confidence interval [CI]=1.23-10.23). The same trend was observed after adjusting for propensity score matching. Patients who did not or failed to receive prevention were more likely to experience local recurrence (HR=4.01; 95% CI=1.13-14.24). CONCLUSION Tumor spillage prevention was associated with longer disease-free survival in laparoscopic radical hysterectomy.
Collapse
Affiliation(s)
- Mayumi Kamata
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Fusegi
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Nozomi Kurihara
- Department of Clinical Planning and Strategy, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
6
|
Zhao X, Liu Y, Niu J, Shi Y. A phase III randomized clinical trial comparing laparoscopic radical hysterectomy based on open state with abdominal radical hysterectomy in patients with early-stage cervical cancer. Trials 2024; 25:471. [PMID: 38992720 PMCID: PMC11238402 DOI: 10.1186/s13063-024-08318-z] [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: 05/02/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, The standard treatment recommendation for women with early cervical cancer is radical hysterectomy with pelvic lymph node dissection, however, articles published in recent years have concluded that the treatment outcome of laparoscopic surgery for cervical cancer is inferior to that of open surgery. Thus, we choose a surgically new approach; the laparoscopic cervical cancer surgery in the open state is compared with the traditional open cervical cancer surgery, and we hope that patients can still have a good tumor outcome and survival outcome. This trial will investigate the effectiveness of laparoscopic cervical cancer surgery in the open-state treatment of early-stage cervical cancer. METHOD AND DESIGN This will be an open-label, 2-armed, randomized, phase-III single-center trial of comparing laparoscopic radical hysterectomy based on open state with abdominal radical hysterectomy in patients with early-stage cervical cancer. A total of 740 participants will be randomly assigned into 2 treatment arms in a 1:1 ratio. Clinical, laboratory, ultrasound, and radiology data will be collected at baseline, and then at the study assessments and procedures performed at baseline and 1 week, 6 weeks, and 3 months, and follow-up visits begin at 3 months following surgery and continue every 3 months thereafter for the first 2 years and every 6 months until year 4.5. The primary aim is the rate of disease-free survival at 4.5 years. The secondary aims include treatment-related morbidity, costs and cost-effectiveness, patterns of recurrence, quality of life, pelvic floor function, and overall survival. CONCLUSIONS This prospective trial aims to show the equivalence of the laparoscopic cervical cancer surgery in the open state versus the transabdominal radical hysterectomy approach for patients with early-stage cervical cancer following a 2-phase protocol. TRIAL REGISTRATION ChiCTR2300075118. Registered on August 25, 2023.
Collapse
Affiliation(s)
- Xin Zhao
- Liaoning Province, Shenyang Women's and Children's Hospital, Shenyang City, China
| | - Yansong Liu
- Liaoning Province, Shenyang Women's and Children's Hospital, Shenyang City, China
| | - Jumin Niu
- Liaoning Province, Shenyang Women's and Children's Hospital, Shenyang City, China
| | - Yulin Shi
- Liaoning Province, Shenyang Women's and Children's Hospital, Shenyang City, China.
| |
Collapse
|
7
|
Song YL, Li RZ, Feng BJ, Lu YH, Wang LF, Wang ZY, Pei KG, Sun LF, Li R. Survival after minimally invasive radical hysterectomy with protective colpotomy for early-stage cervical cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108240. [PMID: 38457858 DOI: 10.1016/j.ejso.2024.108240] [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: 08/31/2023] [Revised: 01/09/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
Minimally invasive surgery on treatment of early-stage cervical cancer is debatable. Traditional approaches of colpotomy are considered responsible for an inferior oncological outcome. Evidence on whether protective colpotomy could optimize minimally invasive technique and improve prognoses of women with early-stage cervical cancer remains limited. We produced a systematic review and meta-analysis to compare oncological outcomes of the patients treated by minimally invasive radical hysterectomy with protective colpotomy to those treated by open surgery according to existing literature. We explored PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to December 2022. Inclusion criteria were: (1) randomized controlled trials or observational studies published in English, (2) studies comparing minimally invasive radical hysterectomy with protective colpotomy to abdominal radical hysterectomy in early-stage cervical cancer, and (3) studies comparing survival outcomes. Two reviewers performed the screening, data extraction, and quality assessment independently. A total of 8 retrospective cohort studies with 2020 women were included in the study, 821 of whom were in the minimally invasive surgery group, and 1199 of whom were in the open surgery group. The recurrence-free survival and overall survival in the minimally invasive surgery group were both similar to that in the open surgery group (pooled hazard ratio, 0.88 and 0.78, respectively; 95% confidence interval, 0.56-1.38 and 0.42-1.44, respectively). Minimally invasive radical hysterectomy with protective colpotomy on treatment of early-stage cervical cancer had similar recurrence-free survival and overall survival compared to abdominal radical hysterectomy. Protective colpotomy could be a guaranteed approach to modifying minimally invasive technique.
Collapse
Affiliation(s)
- Yue-Lin Song
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Rui-Zhe Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China; Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Bo-Jie Feng
- West China School of Medicine of Sichuan University, Chengdu, China
| | - Yu-Han Lu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li-Fei Wang
- Department of Obstetrics and Gynecology, Deyang People's Hospital, Deyang, China
| | - Zhao-Yun Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Kai-Ge Pei
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li-Fei Sun
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| | - Rui Li
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| |
Collapse
|
8
|
Sun HY, Zhao W, Zhao XW, Kang S. Tumor-free strategies during total laparoscopic hysterectomy for a woman with early-stage high-risk endometrial cancer. Asian J Surg 2024; 47:1843-1844. [PMID: 38182514 DOI: 10.1016/j.asjsur.2023.12.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Hai-Yan Sun
- Department of Obstetrics and Gynaecology, Hebei Medical University, Fourth Hospital, Shijiazhuang, China
| | - Wei Zhao
- Department of Obstetrics and Gynaecology, Hebei Medical University, Fourth Hospital, Shijiazhuang, China
| | - Xi-Wa Zhao
- Department of Obstetrics and Gynaecology, Hebei Medical University, Fourth Hospital, Shijiazhuang, China.
| | - Shan Kang
- Department of Obstetrics and Gynaecology, Hebei Medical University, Fourth Hospital, Shijiazhuang, China.
| |
Collapse
|
9
|
Yoon HJ, Kwon BS, Rho HJ, Lee TH, Jeong DH, Kim KH, Suh DS, Song YJ. Comparison of survival outcome of open, total laparoscopic, and laparoscopy-assisted radical vaginal hysterectomy for stage IB2 cervical cancer patients: A multicenter retrospective study. Medicine (Baltimore) 2024; 103:e37426. [PMID: 38457577 PMCID: PMC10919498 DOI: 10.1097/md.0000000000037426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
The aim of this study was to compare survival outcomes of 3 different radical hysterectomy (RH) types, namely total abdominal radical hysterectomy (TARH), total laparoscopic radical hysterectomy (TLRH), and laparoscopy-assisted radical vaginal hysterectomy (LARVH), in patients with FIGO stage IB2 cervical cancer. We retrospectively identified a cohort of patients who underwent RH for cervical cancer between 2010 and 2017. Patients with stage IB2 cervical cancer were included and were classified into TARH, TLRH, and LARVH treatment groups. Survival outcomes were estimated by the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards models were fit to estimate the independent association of RH technique with outcome. 194 patients were included in this study: 79 patients in the TARH group, 55 in the TLRH group, and 60 in the LARVH group. No significant differences were found in clinicopathological characteristics between the 3 RH groups. On comparing survival outcomes with TARH, both TLRH and LARVH showed no significant difference in terms of 5-year overall survival (TARH vs TLRH, P = .121 and TARH vs LARVH, P = .436). Conversely, compared to the TARH group, 5-year progression-free survival (PFS) was significantly worse in the TLRH group (P = .034) but not in the LARVH group (P = .288). Multivariate analysis showed that TLRH surgical approach (hazard ratio, 3.232; 95% confidence interval, 1.238-8.438; P = .017) was an independent prognostic factor for PFS in patients with IB2 cervical cancer. Our study suggests that in patients with FIGO stage IB2 cervical cancer, among the minimally invasive RH approaches, TLRH and LARVH, only TLRH approach was associated with worse PFS when compared with the TARH approach.
Collapse
Affiliation(s)
- Hyung Joon Yoon
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Byung Su Kwon
- Department of Obstetrics and Gynecology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hyun Jin Rho
- College of Medicine, University of Ulsan, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Tae Hwa Lee
- Department of Obstetrics and Gynecology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Dae Hoon Jeong
- Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea
| |
Collapse
|
10
|
Zhu X, Ye L, Fu Y, You B, Lu W. Radical Hysterectomy With Preoperative Conization in Early-Stage Cervical Cancer: A Systematic Review and Pairwise and Network Meta-Analysis. J Minim Invasive Gynecol 2024; 31:193-199. [PMID: 38016630 DOI: 10.1016/j.jmig.2023.11.019] [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: 08/10/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The investigation of the role of preoperative conization in cervical cancer aiming to explore its potential clinical significance. DATA SOURCES Cochrane Library, Embase, PubMed, and Web of Science, up to April 28, 2023. METHODS OF STUDY SELECTION (1) Observational cohort studies, (2) studies comparing radical hysterectomy with preoperative conization (CO) vs radical hysterectomy without preoperative conization (NCO) in patients with early-stage cervical cancer, and (3) studies comparing disease-free survival outcomes. TABULATION, INTEGRATION, AND RESULTS Two reviewers independently extracted the data and assessed the quality of the studies. The meta-analysis used combined hazard ratios along with their corresponding 95% confidence intervals to compare CO and NCO. We conducted a Bayesian network meta-analysis using Markov chain Monte Carlo methods to compare minimally invasive CO, open CO, minimally invasive NCO, and open NCO. Our study included 15 retrospective trials, 10 of which were used to traditional pairwise meta-analysis and 8 for network meta-analysis. The NCO group exhibited a notably higher probability of cancer recurrence than the CO group (hazard ratio, 0.52; 95% confidence interval, 0.41-0.65). In the network meta-analysis, minimally invasive NCO showed the worst survival outcome. CONCLUSION Preoperative conization seems to be a protective factor in decreasing recurrence risk, assisting clinicians in predicting survival outcomes for patients with early-stage cervical cancer. It may potentially aid in selecting suitable candidates for minimally invasive surgery in clinical practice.
Collapse
Affiliation(s)
- Xinbin Zhu
- Department of Gynecologic Oncology (Zhu, You, and Dr. Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Lele Ye
- Women's Reproductive Health Laboratory of Zhejiang Province (Drs. Ye and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Yunfeng Fu
- Medical Centre for Cervical Diseases (Dr. Fu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology (Drs. Fu and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Bingbing You
- Department of Gynecologic Oncology (Zhu, You, and Dr. Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Weiguo Lu
- Department of Gynecologic Oncology (Zhu, You, and Dr. Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China; Women's Reproductive Health Laboratory of Zhejiang Province (Drs. Ye and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology (Drs. Fu and Lu), Women's Hospital School of Medicine Zhejiang University, Hangzhou, China.
| |
Collapse
|
11
|
Yoo JG, Lee SJ, Nam EJ, No JH, Park JY, Song JY, Shin SJ, Yun BS, Park ST, Lee SH, Suh DH, Kim YB, Lee TS, Bae JM, Lee KH. Clinical practice guidelines for cervical cancer: the Korean Society of Gynecologic Oncology guidelines. J Gynecol Oncol 2024; 35:e44. [PMID: 38389404 PMCID: PMC10948982 DOI: 10.3802/jgo.2024.35.e44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 02/24/2024] Open
Abstract
This fifth revised version of the Korean Society of Gynecologic Oncology practice guidelines for the management of cervical cancer incorporates recent research findings and changes in treatment strategies based on version 4.0 released in 2020. Each key question was developed by focusing on recent notable insights and crucial contemporary issues in the field of cervical cancer. These questions were evaluated for their significance and impact on the current treatment and were finalized through voting by the development committee. The selected key questions were as follows: the efficacy and safety of immune checkpoint inhibitors as first- or second-line treatment for recurrent or metastatic cervical cancer; the oncologic safety of minimally invasive radical hysterectomy in early stage cervical cancer; the efficacy and safety of adjuvant systemic treatment after concurrent chemoradiotherapy in locally advanced cervical cancer; and the oncologic safety of sentinel lymph node mapping compared to pelvic lymph node dissection. The recommendations, directions, and strengths of this guideline were based on systematic reviews and meta-analyses, and were finally confirmed through public hearings and external reviews. In this study, we describe the revised practice guidelines for the management of cervical cancer.
Collapse
Affiliation(s)
- Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - So-Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang, Korea
| | - Sung Taek Park
- Department of Obstetrics and Gynecology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - San-Hui Lee
- Department of Obstetrics and Gynecology, Wonju Severance Christian Hospital, Yonsei University College of Medicine, Wonju, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Man Bae
- Department of Obstetrics and Gynecology, Hanyang University Medical Center, Seoul, Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
12
|
Chen J, Heng J, Zheng B, Zeng T, Wang H, Wang P, Lin Y, Gao W, Chen C, Tan L, Fu J. Carbon dioxide gas-induced pneumothorax versus one-lung ventilation in minimally invasive esophagectomy: a multicenter propensity score matching cohort study. Int J Surg 2024; 110:1376-1382. [PMID: 38051934 PMCID: PMC10942216 DOI: 10.1097/js9.0000000000000968] [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: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Carbon dioxide gas-induced pneumoperitoneum might be the reason for the shorter postoperative survival of patients with malignant tumors. Whether CO 2 gas-induced pneumothorax has unfavorable impacts on the surgical and oncological outcomes of minimally invasive esophagectomy remains unclear. METHODS Between 2010 and 2016, a total of 998 patients with squamous cell carcinoma of the esophagus who received video-assisted surgery were registered from three large-volume medical centers. The overall survival (OS) and disease-free survival (DFS) were compared after using propensity score-matched and inverse probability-weighted methods. In addition, the tumor-relapse state was evaluated, and the relapse pattern was compared. RESULTS A total of 422 and 576 minimally invasive esophagectomies with intraoperative one-lung ventilation and CO 2 -induced pneumothorax were enrolled, respectively. The 5-year OS and DFS were similar between the CO 2 -induced pneumothorax (64.2% and 64.7%) and one-lung ventilation (65.3% and 62.4%) groups following propensity matching. The inverse probability weighting revealed similarly equal survival results in the two groups. The 5-year relapse rates were 35.1% and 30.6% in the one-lung ventilation and CO 2 -induced pneumothorax groups, respectively. Moreover, the relapse patterns were not significantly different between the two groups. CONCLUSION The results of this study suggested that the use of intraoperative one-lung ventilation and CO 2 -induced pneumothorax have similar oncological outcomes; therefore, the two methods are both viable options in esophagectomy.
Collapse
Affiliation(s)
- Junying Chen
- Department of Thoracic Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
- Guangdong Esophageal Cancer Institute, Guangzhou, Guangdong
| | - Jiao Heng
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Shanghai, People’s Republic of China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian Province
| | - Taidui Zeng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian Province
| | - Hao Wang
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Shanghai, People’s Republic of China
| | | | - Yaobin Lin
- Department of Thoracic Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
- Guangdong Esophageal Cancer Institute, Guangzhou, Guangdong
| | | | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian Province
| | - Lijie Tan
- Department of Thoracic Surgery, Fudan University Zhongshan Hospital, Shanghai, People’s Republic of China
| | - Jianhua Fu
- Department of Thoracic Surgery
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center
- Guangdong Esophageal Cancer Institute, Guangzhou, Guangdong
| |
Collapse
|
13
|
Shvygin A, Manning-Geist BL, Sonoda Y. Fertility-sparing and minimally invasive surgery for early-stage cervical cancer. J Surg Oncol 2024; 129:112-116. [PMID: 38032090 DOI: 10.1002/jso.27540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Anna Shvygin
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Beryl L Manning-Geist
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
14
|
Zouridis A, Kehoe ST, Soleymani Majd H. Should laparoscopy be revisited in the management of stage II endometrial cancer in the post-LACC era? Minerva Obstet Gynecol 2023; 75:553-558. [PMID: 36847526 DOI: 10.23736/s2724-606x.23.05258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND A recent randomized trial showed that laparoscopy had poorer outcomes compared with open surgery for early-stage cervical cancer. Whether this is of concern in endometrial cancer, when the cervix is involved has received little attention. This study aimed to investigate whether there is any difference on overall and cancer specific survival between patients treated with laparoscopy and laparotomy for stage II endometrial cancer. METHODS Data from patients with histologically proven stage II endometrial cancer who were treated between 2010 and 2019 in a single cancer center were reviewed. Demographic, histopathological characteristics and treatment modalities were recorded. Recurrence rate, cancer specific and overall survival were compared between patients that were treated with laparoscopic and open surgery. RESULTS From 47 patients with stage II disease, 33 (70%) were treated with laparoscopy and 14 (30%) with open surgery. There was no difference on age (P=0.86), BMI (P=0.76), Comorbidity Index Score (P=0.96), upstaging/upgrading after surgery (P=0.41), performance of lymphadenectomy (P=0.74), histological type (P=0.32), LVSI (P=0.15), depth of myometrial invasion (P=0.07), postoperative hospital stay (P=0.18) and administration of adjuvant treatment (P=0.11) between the two groups. Recurrence rate (P=0.756), overall (P=0.606) and cancer specific survival (P=0.564) were also comparable between laparoscopy and laparotomy groups. CONCLUSIONS Laparoscopic and open surgery seem to have comparable outcomes for stage II endometrial cancer. The oncological safety of laparoscopy for stage II endometrial cancer should be further investigated with a randomized controlled trial.
Collapse
Affiliation(s)
- Andreas Zouridis
- Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sean T Kehoe
- Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- St Peter's College, Oxford, UK
| | - Hooman Soleymani Majd
- Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK -
| |
Collapse
|
15
|
Tang X, Zhou S, Zhang X, Hua K, He Y, Wang P, Teng Y, Feng W. Comparison of the survival outcomes of laparoscopic, abdominal and gasless laparoscopic radical hysterectomy for early-stage cervical cancer: trial protocol of a multicenter randomized controlled trial (LAGCC trial). Front Oncol 2023; 13:1287697. [PMID: 38023150 PMCID: PMC10679326 DOI: 10.3389/fonc.2023.1287697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Radical hysterectomy (RH) is considered a cornerstone in the treatment of early-stage cervical cancer. However, the debate surrounding the optimal surgical approach, whether minimally invasive or open surgery, remains controversial. The objective of this trial is to evaluate the survival outcomes of cervical cancer patients who undergo different surgical approaches. Methods This study is designed as a prospective, multicenter, open, parallel, and randomized controlled trial. A total of 500 patients diagnosed with stage IA1 with LVSI, IA2, IB1, or IB2 (2018 FIGO) will be recruited. Recruitment of participants started in November 2020. The participants will be randomly assigned to one of three groups: conventional laparoscopic RH, gasless laparoscopic RH, or abdominal RH. The primary endpoint of this trial is the 2-year disease-free survival (DFS) rate. The secondary endpoints will include the 2-year overall survival (OS) rate, 5-year DFS/OS, recurrence rates, operation time, intraoperative blood loss, surgery-related complications, and impact on quality of life (QoL). Discussion We expect this trial to provide compelling and high-quality evidence to guide the selection of the most appropriate surgical approach for early-stage cervical cancer. Clinical trial registration Chinese Clinical Trial Register, identifier ChiCTR2000035515.
Collapse
Affiliation(s)
- Xiaoyan Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Shan Zhou
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yuan He
- Office of Clinical Epidemiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ping Wang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Yincheng Teng
- Department of Gynecology and Obstetrics, Shanghai Sixth People Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Feng
- Department of Gynecology and Obstetrics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
16
|
Corrado G, Anchora LP, Bruni S, Sperduti I, Certelli C, Chiofalo B, Giannini A, D'Oria O, Bizzarri N, Legge F, Cosentino F, Turco LC, Vizza E, Scambia G, Ferrandina G. Patterns of recurrence in FIGO stage IB1-IB2 cervical cancer: Comparison between minimally invasive and abdominal radical hysterectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107047. [PMID: 37862783 DOI: 10.1016/j.ejso.2023.107047] [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: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/26/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Aim of our study was to evaluate whether the different laparotomic (ARH) or minimally invasive (laparoscopic and robotic) approaches (MIS) in FIGO stage IB1-IB2 cervical cancer, present different patterns of recurrence of the disease. The secondary endpoint of the study was the evaluation of the variables most involved with the risk of relapse and therefore lower DFS and OS. MATERIAL AND METHODS The study enrolled patients with definitive histological diagnosis of squamous or adenocarcinoma stage IB1-IB2 cervical cancer who underwent minimally invasive or abdominal radical hysterectomy from 2001 to 2018. RESULTS The study enrolled 360 patients and 59 patients (16.4 %) reported a disease relapse. The data showed that ARH group was not associated with different recurrence patterns than MIS group (p = 0.14). Moreover, there was no statistically significant difference regarding DFS (p = 0.52) and OS (p = 0.29) between the ARH group and the MIS group. CONCLUSIONS MIS, in FIGO stage IB1-IB2 cervical cancer, is not associated with different relapse patterns compared to ARH, nor with a higher risk of distance metastasis and finally, without significant difference in term of DFS and OS. More studies are needed to determine the factors that modify the site of relapse.
Collapse
Affiliation(s)
- Giacomo Corrado
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy.
| | - Luigi Pedone Anchora
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Simone Bruni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Scientific Direction, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Camilla Certelli
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Giannini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Ottavia D'Oria
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Francesco Cosentino
- Department of Gynecologic Oncology, Gemelli Molise, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Luigi Carlo Turco
- Department of Gynecologic Oncology, Gemelli Molise, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | | | | |
Collapse
|
17
|
Wang Y, Ma B, Li W, Li P. The efficacy of pre-operative conization in patients undergoing surgical treatment for early-stage cervical cancer: A meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106995. [PMID: 37527959 DOI: 10.1016/j.ejso.2023.106995] [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: 05/03/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Minimal invasive surgery (MIS) has been reported to increase the risk of cancer relapse and death compared with traditional open surgery in patients with early-stage cervical cancer (CC). Pre-operative conization is a protective procedure that as developed to reduce the risk caused by MIS. METHODS Relevant publications were identified by searching medical databases prior to the December 31, 2022. The primary aim of this meta-analysis was to evaluate the efficacy of pre-operative conization on disease-free survival (DFS) in early-stage CC. The secondary objective was to assess the efficacy of pre-operative conization on overall survival (OS) in early-stage CC. RESULTS Twelve studies were eligible for analysis. The pooled result of pre-operative conization showed a significantly improved DFS when compared with non-conization patients (HR, 0.28; 95% CI, 0.19-0.41), furthermore, pre-operative conization improved DFS by 75% (HR, 0.25; 95% CI, 0.13-0.46) in stage IB1 patients. In patients who underwent MIS, pre-operative conization also led to a significant improvement in DFS when compared with non-conization patients (HR, 0.21; 95% CI, 0.09-0.54). However, in patients who underwent pre-operative conization, MIS increased the risk of recurrence by 34% when compared with open abdominal radical hysterectomy (HR, 1.34; 95% CI, 0.41-4.38), although this difference was not statistically significant. Finally, the OS of early-stage CC was not significantly affected by surgical approach or conization. CONCLUSION Pre-operation conization represents a protective effect and can improve DFS when compared with non-conization in early-stage CC, especially in stage IB CC. There was no statistical evidence to indicate that pre-operation conization could improve OS. High-quality randomized controlled trials are required to verify these results.
Collapse
Affiliation(s)
- Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Bin Ma
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Wenya Li
- Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China
| | - Peiwen Li
- Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China.
| |
Collapse
|
18
|
Kita M, Butsuhara Y, Hisamatsu Y, Yokoe T, Okada H. Pneumovaginoscopy-assisted radical hysterectomy for early-stage cervical cancer: a novel bidirectional approach for tumor spillage prevention and R0 resection. J Gynecol Oncol 2023; 34:e80. [PMID: 37477103 PMCID: PMC10627754 DOI: 10.3802/jgo.2023.34.e80] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study evaluated the feasibility and outcomes of pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fascia-oriented and nerve-sparing surgical approach. METHODS This retrospective observational cohort study examined the operative outcomes and prognoses of patients who underwent PVRH (n=59) for up to stage IIA cervical cancer. The basic procedure was Kyoto B2 (Viper Type II nerve-sparing) radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal (open or laparoscopic) approaches. In all cases, pneumovaginoscopy (PV) was used to create a vaginal cuff and dissect the paracolpium and paracervical endopelvic fascia to minimize nerve damage. RESULTS Thirty-eight (64.4%) patients had stage IB1 cancer. Seven (11.9%) had vaginal invasion (stage IIA1, n=4; IIA2, n=3). The abdominal approach was open in 38 cases and laparoscopic in 21. Adjuvant therapy was administered to 24 patients (41%); one patient received concurrent chemoradiotherapy for gastric-type adenocarcinoma. There were three (6.1%) intraoperative complications (CO2 gas embolism [n=1], sigmoid colon musculosa injury [n=1], and ureteral injury [n=1]) and 8 (14%) postoperative complications (lymphedema with cellulitis [n=4], vaginal cuff dehiscence [n=1], sub-ileus [n=1], symptomatic lymphocyst [n=l], and ureterovaginal fistula [n=1]). The median urination recovery period was 3 days. Microscopic R0 was achieved in all cases. The median follow-up was 44.5 (2-122) months, and no recurrence occurred. CONCLUSION PVRH is a new fascia-oriented and nerve-sparing surgery for early-stage cervical cancer. Further, it has favorable operative outcomes and good prognoses, similar to those of adjacent pelvic surgery such as trans-anal total mesorectal excision and radical prostatectomy.
Collapse
Affiliation(s)
- Masato Kita
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan.
| | - Yusuke Butsuhara
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| | - Yoji Hisamatsu
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| | - Takuya Yokoe
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| | - Hidetaka Okada
- Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan
| |
Collapse
|
19
|
Lv X, Ding B, Xu J, Shen Y. Effect of modified radical laparoscopic hysterectomy versus open radical hysterectomy on short-term clinical outcomes in early-stage cervical cancer: a single-center, prospective, randomized controlled trial. World J Surg Oncol 2023; 21:167. [PMID: 37270549 DOI: 10.1186/s12957-023-03044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The long-term prognosis of minimally invasive surgery and open surgery for early cervical cancer is controversial. This study mainly discusses the feasibility and effectiveness of the endocutter in radical laparoscopic hysterectomy for early cervical cancer. METHODS A single-center, prospective, randomized controlled trial of modified radical laparoscopic hysterectomy on patients with FIGO stage IA1 (lymphovascular invasion), IA2, and IB1 cervical cancer, between January 2020 and July 2021. Patients were randomly assigned into laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) groups. The ORH group used right-angle sealing forceps for vaginal stump closure, whereas the LRH group used endoscopic staplers. The primary outcomes included the evaluation of the patient's perioperative indicators, as well as short- and long-term complications. Recurrence and overall survival were considered secondary outcomes. RESULTS As of July 2021, 17 patients were enrolled in the laparoscopic surgery group and 17 in the open surgery group. The hospitalization time of the laparoscopic group was significantly shorter than those of the open group (15 min vs. 9 min, P < 0.001). The vaginal stump closure time in the laparoscopic group was longer than that in the open surgery group, and the difference was statistically significant (P < 0.001). Post-operative catheter removal (P = 0.72), drainage tube removal time (P = 0.27), number of lymph node dissections (P = 0.72), and incidence of intraoperative and post-operative complications between the two groups (P > 0.05). The median blood loss in the laparoscopic group was 278 ml, and it was 350 ml in the laparotomy group. The intraoperative blood transfusion rate was lower in the laparoscopic group; however, these differences did not reach statistical significance (P = 0.175). Vaginal margin pathology and peritoneal lavage cytology were negative, and all the patient's vaginal stumps healed without infection. The median follow-up time of the laparoscopic group was 20.5 months, and it was 22 months for the open surgery group. There was no recurrence in all patients during the follow-up period. CONCLUSIONS Modified LRH with endocutter closure of the vaginal stump is an effective approach and not inferior to ORH in treating patients with early-stage cervical cancer. TRIAL REGISTRATION ChiCTR2000030160, date of registration February 26, 2020 ( https://www.chictr.org.cn/showprojen.aspx?proj=49809 ).
Collapse
Affiliation(s)
- Xin Lv
- School of Medicine, Southeast University, Nanjing, China
| | - Bo Ding
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - JingYun Xu
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yang Shen
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
- Institute of Sports and Health, 211112, 99 Lize Road, Max Science Park, Building 3, 7th & 8th Floor, Nanjing, China.
| |
Collapse
|
20
|
Kim NR, Kim SI, Suh DH, Kim HS, Kim K, Chung HH, No JH, Kim YB, Kim JW, Park NH, Song YS, Choi CH, Lee M. Survival outcomes of laparoscopic versus open radical hysterectomy in early cervical cancer with incidentally identified high-risk factors. Gynecol Oncol 2023; 174:224-230. [PMID: 37229880 DOI: 10.1016/j.ygyno.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Previously, we suggested that patients with cervical cancer (CC) with tumors ≤2 cm on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). Here, we aim to investigate whether LRH deteriorates the prognosis of patients with incidentally identified high-risk factors; lymph node metastasis (LNM) or parametrial invasion (PMI). METHODS We identified patients with 2009 FIGO stage IB1 CC who underwent Type C LRH or open radical hysterectomy (ORH) at three tertiary hospitals between 2000 and 2019. Those with a tumor ≤2 cm on preoperative MRI who were not suspicious of LNM or PMI preoperatively were included, while those who were indicated to receive adjuvant treatment but did not actually receive it were excluded. Survival outcomes were compared between the LRH and ORH groups in the overall population, then narrowed down to those with LNM, and then to those with PMI. RESULTS In total, 498 patients were included: 299 in the LRH group and 199 in the ORH group. The LRH and ORH groups showed similar 3-year progression-free survival (PFS) (94.0% vs. 93.6%; P = 0.615) and 5-year overall survival (OS) rates (97.2% vs. 96.8%; P = 0.439). On pathologic examination, 49 (9.8%) and 16 (3.2%) patients had LNM and PMI, respectively, and 10 (2.0%) had both. In the LNM subgroup, 5-year PFS rate was not significantly different between the LRH and ORH groups (73.2% vs. 91.7%; P = 0.169). In the PMI subgroup, no difference in PFS was observed between the two groups (P = 0.893). CONCLUSIONS LRH might not deteriorate recurrence and mortality rates in CC patients with tumors ≤2 cm when adjuvant treatment is appropriately administered, even if pathologic LNM and PMI are incidentally identified.
Collapse
Affiliation(s)
- Nae Ry Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
21
|
Wang R, Hu Y, Xia H, Zhu X. Does the Use of a Uterine Manipulator or Intracorporeal Colpotomy Confer an Inferior Prognosis in Minimally Invasive Surgery-Treated Early-stage Cervical Cancer? J Minim Invasive Gynecol 2023; 30:156-163. [PMID: 36410659 DOI: 10.1016/j.jmig.2022.11.009] [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: 08/07/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To identify whether the use of a uterine manipulator (UM) or intracorporeal colpotomy conferred inferior short-term survival among patients treated for early-stage cervical cancer. DESIGN Retrospective cohort study. SETTING Tertiary university-based hospital. PATIENTS 1169 patients with stage IB1 to IB2 cervical cancer. INTERVENTIONS All patients underwent minimally invasive radical hysterectomy and pelvic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS A total of 1169 patients diagnosed with preoperative stage IB1 to IB2 cervical cancer were primarily treated with surgery from 2018 to 2019. The eligible patients had a median age of 48 years (range, 23-76 years), and the median follow-up time was 34 months (range, 3.57-50.87 months). The 2-year overall survival rate of the patients with pathologic stage IB1 and IB2 was 99.8% and 98.8%, respectively, according to the 2018 International Federation of Gynecology and Obstetrics staging system. Univariable analysis revealed that the UM group had a 7.6-times higher risk of death than that of the manipulator-free group (p = .006), but multivariable analysis clarified that only tumor size (p = .016; hazard ratio, 2.285; 95% confidence interval, 1.166-4.479) and parametrial involvement (p = .003; hazard ratio, 3.556; 95% confidence interval, 1.549-8.166) were independent risk factors for overall survival. There was no statistically significant difference in survival between patients who underwent intracorporeal and protective colpotomy. CONCLUSION Short-term survival outcomes in women undergoing minimally invasive radical hysterectomy for treatment of early-stage cervical cancer did not differ when a UM was avoided or when a protective colpotomy was performed.
Collapse
Affiliation(s)
- Rongmin Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University (Drs. Wang, Hu, Xia and Zhu), Shanghai, China
| | - Yingying Hu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University (Drs. Wang, Hu, Xia and Zhu), Shanghai, China
| | - Hexia Xia
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University (Drs. Wang, Hu, Xia and Zhu), Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease (Drs. Xia and Zhu), Shanghai, China.
| | - Xiaoyong Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University (Drs. Wang, Hu, Xia and Zhu), Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine Related Disease (Drs. Xia and Zhu), Shanghai, China.
| |
Collapse
|
22
|
Ramirez PT, Pareja R, Viveros-Carreño D, Frumovitz M. Open radical hysterectomy: The new standard of care in early-stage cervical cancer. BJOG 2023. [PMID: 36681892 DOI: 10.1111/1471-0528.17408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/02/2022] [Accepted: 01/03/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Pedro T Ramirez
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Gynecologic Oncology, Astorga Clínica de Oncología, Medellín, Colombia
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.,Department of Gynecologic Oncology, Clínica Universitaria Colombia and Centro de tratamiento e investigación sobre el cáncer Luis Carlos Sarmiento Angulo, Bogotá, Colombia
| | - Michael Frumovitz
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
23
|
Huang Y, Cai J, Wang H, Dong W, Zhang Y, Wang S, He X, Guo J, Yang S, Wang Z. Survival after laparoscopic radical surgery for stage IA-IIB cervical cancer: 1316 consecutive cases from a national laparoscopic training center in China. Int J Clin Oncol 2023; 28:175-183. [PMID: 36376710 DOI: 10.1007/s10147-022-02262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND To investigate the survival of cervical cancer patients undergoing laparoscopic radical hysterectomy (LRH) in a minimally invasive gynecology center. METHODS A consecutive series of patients undergoing first LRH for cervical cancer from May 2008 to December 2017 at a national laparoscopic training center was retrospectively analyzed. The overall survival (OS) and progression-free survival (PFS) were compared between groups. RESULTS In total, 1316 women with FIGO (2009) stage IA-IIB cervical cancer received LRH. Among them, 1114 (84.7%) were followed up for 3 months or longer; the median follow-up period was 48 months (range 3-144 months). In patients with stage IA, IB1 (≤ 2 cm), IB1 (> 2 cm), IB2, IIA1 and IIA2-IIB tumors, the 4-year PFS rates were 98.6, 94.5, 87.4, 65.6, 80.0 and 67.4%, respectively, and the 4-year OS rates were 98.6, 96.8, 91.1, 77.4, 85.6 and 76.2%, respectively. The 4-year PFS and OS were as high as 96.2 and 97.5%, respectively, in patients with squamous cell carcinoma of 2 cm or smaller in diameter. A stable high 4-year OS and PFS was achieved after completing 100 LRHs. In patients operated on by the same surgeon, an improvement in survival was observed after 40 LRHs. CONCLUSION Favorable oncologic outcomes can be achieved in patients with IA-IB1 cervical cancer after LRH in a center with a high surgery volume.
Collapse
Affiliation(s)
- Yuhui Huang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jing Cai
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Weihong Dong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yuan Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shaohai Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Xiaoqi He
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jianfeng Guo
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shouhua Yang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Zehua Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| |
Collapse
|
24
|
Fusegi A, Kanao H, Tsumura S, Murakami A, Abe A, Aoki Y, Nomura H. Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review. J Gynecol Oncol 2023; 34:e5. [PMID: 36424702 DOI: 10.3802/jgo.2023.34.e5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022] Open
Abstract
Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons' skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons' inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.
Collapse
Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Shiho Tsumura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Murakami
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
25
|
Kong TW, Lee J, Yum SH, Kim J, Son JH, Chang SJ, Ryu HS. Spillage and displacement of indocyanine green-stained tissues from uterine cervix to pelvic peritoneum: A proof of concept study for colpotomy approach in minimally invasive surgery. Taiwan J Obstet Gynecol 2023; 62:119-122. [PMID: 36720522 DOI: 10.1016/j.tjog.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To analyze peritoneal spillage and displacement of indocyanine green (ICG)-stained tissues from uterine cervix to pelvis during intracorporeal/vaginal colpotomy in laparoscopic-assisted hysterectomy. MATERIALS AND METHODS Eleven patients undergoing laparoscopic-assisted hysterectomy were included. One patient with an incidental diagnosis of endometrial cancer was excluded. Of the 10 patients, five underwent intracorporeal colpotomy (IC) and five received vaginal colpotomy (VC) during laparoscopic-assisted hysterectomy. Approximately 5 cm of resected round ligament from each patient was stained with ICG and cut to 1.0 × 1.0 cm in size. Four to five fragments of ICG-stained tissues were placed and sutured on the uterine cervix before colpotomy. During and after colpotomy, serial pictures under white and fluorescence light were taken to document peritoneal spillage and displacement of ICG-stained tissues to the pelvic peritoneum. RESULTS Peritoneal spillage of ICG occurred in the entire IC group. Displacement of ICG-stained tissues from uterine cervix to pelvic peritoneum were visualized in three (60%) patients undergoing IC. In the five patients who received VC, peritoneal spillage of ICG and displacement of ICG-stained tissue to pelvic peritoneum did not occur. There were no perioperative complications. CONCLUSIONS IC in minimally invasive radical hysterectomy should not be performed because peritoneal spillage of ICG and displacement of ICG-stained tissues from uterine cervix to pelvis frequently occurs during IC. Therefore, specific measures to prevent tumor exposure during colpotomy should be implemented in cervical cancer patients.
Collapse
Affiliation(s)
- Tae-Wook Kong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jimin Lee
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sun Hyung Yum
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jeeyeon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joo-Hyuk Son
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Hee-Sug Ryu
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| |
Collapse
|
26
|
Kobayashi E, Kakuda M, Ueda Y, Kimura T. Overview of laparoscopic surgery for cervical cancer in Japan: Updates after the laparoscopic approach to cervical cancer trial. J Obstet Gynaecol Res 2023; 49:90-102. [PMID: 36318924 DOI: 10.1111/jog.15465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 01/15/2023]
Abstract
Laparoscopic radical hysterectomy (LRH) for cervical cancer has been reported to be similar oncologic outcome compared to abdominal radical hysterectomy (ARH) in many retrospective studies. In Japan, LRH has been covered by insurance since April 2018. In 2018, the same year that LRH became covered by insurance, Ramirez et al. at MD Anderson Cancer Center reported the results of a large phase III laparoscopic approach to cervical cancer trial (LACC trial) on the prognosis of open versus laparoscopic/robot-assisted minimally invasive radical hysterectomy. The results showed that minimally invasive approaches were associated with a higher rate of recurrence and death. At this point, it is not clear what is wrong with LRH and why it has a poorer prognosis compared to ARH. In this report, after the LACC report, we would like to review the current status of minimally invasive surgery for cervical cancer and future directions.
Collapse
Affiliation(s)
- Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mamoru Kakuda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
27
|
Mei Y, He L, Zhang Q, Chen Y, Zheng J, Xiao X, Lin Y. The comparison of gasless and traditional robot-assisted transvaginal natural orifice transluminal endoscopic surgery in hysterectomy. Front Med (Lausanne) 2023; 10:1117158. [PMID: 36936202 PMCID: PMC10019594 DOI: 10.3389/fmed.2023.1117158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Study objective To describe the surgical technique and compare the operative outcomes of gasless and traditional robot-assisted transvaginal natural orifice transluminal endoscopic surgery (GR-vNOTES vs. TR-vNOTES) in hysterectomy. Methods The patients undergoing hysterectomy via GR-vNOTES or TR-vNOTES between February 2020 and January 2022 in our hospital were included. Clinical data regarding patient demographics, operative time, blood loss, complications, and postoperative hospital stays were collected and analyzed. Results Five cases underwent hysterectomy via GR-vNOTES, and nine cases via TR-vNOTES. The baseline demographics and operative outcomes were not significantly different in GR-vNOTES and TR-vNOTES groups. There was no conversion to multiport robotic laparoscopy, conventional laparoscopy or laparotomy. No complications were seen in both groups, except two cases had fever postoperatively in the TR-vNOTES group. For those with early stage cervical/endometrial cancer, no recurrence or metastasis was observed in the follow-up of six months. Conclusion Both GR-vNOTES and TR-vNOTES were feasible and safe for hysterectomy. GR-vNOTES was a promising alternative to TR-vNOTES in hysterectomy.
Collapse
|
28
|
Li X, Pei X, Li H, Wang Y, Zhou Y, Wei Z, Yin Z. Comparative single-center study between modified laparoscopic radical hysterectomy and open radical hysterectomy for early-stage cervical cancer. World J Surg Oncol 2022; 20:392. [PMID: 36503552 PMCID: PMC9743762 DOI: 10.1186/s12957-022-02866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Since the release of the LACC trial results in 2018, the safety of laparoscopic radical hysterectomy (LRH) for cervical cancer has received huge attention and heated discussion. We developed modified laparoscopic radical hysterectomy (MLRH) incorporating a series of measures to prevent tumor spillage, which has been performed in our center since 2015. OBJECTIVE Present study retrospectively analyzed relevant indicators of MLRH and evaluated disease-free survival (DFS) primarily in the treatment of early cervical cancer compared with open surgery. METHODS Patients with 2014 International Federation of Gynecology and Obstetrics clinical stages 1B1 and 2A1 cervical cancer who underwent radical hysterectomy in the gynecological department of our hospital from October 2015 to June 2018 were enrolled retrospectively in this study. Patients were divided into two groups based on the surgical procedure: open radical hysterectomy (ORH) group (n = 336) and MLRH group (n = 302). Clinical characteristics, surgical indices, and survival prognosis were analyzed, including 2.5-year overall survival (OS) rate, 2.5-year DFS rate, recurrence rate, and recurrence pattern. RESULTS Compared to the ORH group, the MLRH group exhibited a longer operative time, longer normal bladder function recovery time, less intraoperative blood loss volume, and more harvested pelvic lymph nodes (P < 0.05). No significant differences were observed in postoperative complications, the 2.5-year OS, 2.5-year DFS, and recurrence rate between the two groups (P > 0.05); however, the recurrence pattern was significantly different (P < 0.05). The MLRH group mainly exhibited local single metastasis (7/11), whereas the ORH group mainly exhibited distant multiple metastases (14/16). Stratified analysis revealed that overall survival rate was higher in the MLRH group than in the ORH group in patients with stage 1B1 and middle invasion (P < 0.05). CONCLUSION MLRH does not show a survival disadvantage in the treatment of early-stage cervical cancer when compared with open surgery. In addition, MLRH shows a survival advantage in patients with stage 1B1 and middle 1/3 invasion. Considering this is a retrospective study, further prospective study is necessary for more sufficient data support. TRIAL REGISTRATION Present research is a retrospective study. The study had retrospectively registered on Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), and the registered number is ChiCTR1900026306.
Collapse
Affiliation(s)
- Xuqing Li
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Xueting Pei
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Hongyan Li
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Yan Wang
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Youwei Zhou
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Zhaolian Wei
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China ,grid.186775.a0000 0000 9490 772XNHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
| | - Zongzhi Yin
- grid.412679.f0000 0004 1771 3402Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China ,grid.186775.a0000 0000 9490 772XAnhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, Anhui China
| |
Collapse
|
29
|
Hoegl J, Viveros-Carreño D, Palacios T, Gallego-Ardila A, Rauh-Hain JA, Estrada EE, Noll F, Krause K, Baiocchi G, Minig L, Grillo-Ardila CF, Pareja R. Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis. Int J Gynecol Cancer 2022; 32:1497-1504. [PMID: 36351746 DOI: 10.1136/ijgc-2022-003937] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To assess the incidence of peritoneal carcinomatosis in patients undergoing minimally invasive or open radical hysterectomy for cervical cancer. METHODS The MEDLINE (accessed through Ovid), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials, and Scopus databases were searched for articles published from inception up to April 2022. Articles published in English were considered. The included studies reported on patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA squamous cell carcinoma, adenocarcinoma, and/or adenosquamous carcinoma of the cervix who underwent primary surgery. Studies had to report at least one case of peritoneal carcinomatosis as a recurrence pattern, and only studies comparing recurrence after minimally invasive surgery versus open surgery were considered. Variables of interest were manually extracted into a standardized electronic database. This study was registered in PROSPERO (CRD42022325068). RESULTS The initial search identified 518 articles. After the removal of the duplicate entries from the initial search, two authors independently reviewed the titles and abstracts of the remaining 453 articles. Finally, 78 articles were selected for full-text evaluation; 22 articles (a total of 7626 patients) were included in the analysis-one randomized controlled trial and 21 observational retrospective studies. The most common histology was squamous cell carcinoma in 60.9%, and the tumor size was <4 cm in 92.8% of patients. Peritoneal carcinomatosis pattern represented 22.2% of recurrences in the minimally invasive surgery approach versus 8.8% in open surgery, accounting for 15.5% of all recurrences. The meta-analysis of observational studies revealed a statistically significant higher risk of peritoneal carcinomatosis after minimally invasive surgery (OR 1.90, 95% CI 1.32 to 2.74, p<0.05). CONCLUSION Minimally invasive surgery is associated with a statistically significant higher risk of peritoneal carcinomatosis after radical hysterectomy for cervical cancer compared with open surgery.
Collapse
Affiliation(s)
- Jorge Hoegl
- Obstetrics and Gynecology. Division of Gynecological Oncology, Hospital General del Este "Dr. Domingo Luciani", Caracas, Bolivarian Republic of Venezuela
| | - David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia.,Gynecologic Oncology, Clínica Universitaria Colombia and Centro de tratamiento e investigación sobre cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Tatiana Palacios
- Hospital Infantil Universitario de San Jose. Fundación Universitaria de Ciencias de la Salud - FUCS, Bogotá, Colombia
| | - Andres Gallego-Ardila
- Vicerrectoría de Investigación, Fundación Universitaria de Ciencias de la Salud FUCS, Bogota, Colombia
| | - Jose Alejandro Rauh-Hain
- The University of Texas MD Anderson Cancer Center Department of Gynecologic Oncology and Reproductive Medicine, Houston, Texas, USA
| | | | - Florencia Noll
- Ginecología Oncológica, Hospital Sanatorio Allende, Cordoba, Argentina
| | - Kate Krause
- The University of Texas MD Anderson Cancer Center Research Medical Library, Houston, Texas, USA
| | - Glauco Baiocchi
- Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
| | - Lucas Minig
- Gynecologic Oncology, Valencian Institute of Oncology (IVO), Valencia, Spain
| | - Carlos Fernando Grillo-Ardila
- Universidad Nacional de Colombia Departamento de Obstetricia y Ginecología, Bogota, Colombia.,Grupo de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología, Bogota, Colombia
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia .,Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin, Colombia
| |
Collapse
|
30
|
Ramirez PT. Peritoneal carcinomatosis: minimally invasive surgery is primarily to blame. Int J Gynecol Cancer 2022; 32:1505-1506. [PMID: 36368705 DOI: 10.1136/ijgc-2022-004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
31
|
Ding Y, Zhang X, Qiu J, Li C, Hua K. Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer. Arch Gynecol Obstet 2022; 307:1901-1909. [PMID: 36329212 PMCID: PMC10147815 DOI: 10.1007/s00404-022-06816-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
To evaluate association of preoperative conization with recurrences after laparoscopic radical hysterectomy (LRH) for FIGO 2018 stage IB1 cervical cancer.
Methods
This is a retrospective single-center study. Patients who underwent LRH for cervical cancer with squamous, adenosquamous and adenocarcinoma subtype from January 2014 to December 2018 were reviewed. All patients were restaged according to the 2018 FIGO staging system. Those who were in FIGO 2018 stage IB1 met the inclusion criteria. General characteristics and oncologic outcomes including recurrence-free survival (RFS) were analyzed.
Results
A total of 1273 patients were included in the analysis. 616 (48.4%) patients underwent preoperative biopsy, and 657 (51.6%) patients underwent conization. Residual disease was observed in 822 (64.6%) patients. During a median follow-up of 50.30 months, 30 (2.4%) patients experienced recurrence. The univariate analysis showed that patients who had larger tumor diameter, the presence of residual tumor at final pathology, and underwent adjuvant treatment had a significant higher risk of recurrence (P < 0.01). Conversely, patients who underwent conization were significantly less likely to experience recurrence (P = 0.001). In the multivariate analysis, the independent risk factor associated with an increased risk of recurrence was resident macroscopic tumor (HR: 38.4, 95% CI 4.20–351.64, P = 0.001). On the contrary, preoperative conization was associated with a significantly lower risk of recurrence (HR: 0.26; 95% CI 0.10–0.63, P = 0.003). The Kaplan–Meier curves showed patients who underwent conization had improved survival over those who underwent biopsy (5 year RFS: 98.6 vs 95.1%, P = 0.001). The 5 year RFS of patients with residual tumor was significantly different (R0: 99.2%, R1: 97.4%, R2: 93.6%, P < 0.001), especially the patients with residual macroscopic tumor after conization (R0: 99.5%, R1: 99.0%, R2:92.4%, P = 0.006).
Conclusion
Preoperative conization and the absence of residual tumor at the time of surgery might play a protective role in patients with FIGO 2018 IB1 cervical cancer following LRH, which support the theory of the influence of intraoperative tumor spread during radical hysterectomy. Further prospective evidence is needed.
Collapse
Affiliation(s)
- Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai, 200090, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai, 200090, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai, 200090, China
| | - Chunbo Li
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai, 200090, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, No. 128 Shenyang Road, Shanghai, 200090, China.
| |
Collapse
|
32
|
Ronsini C, Köhler C, de Franciscis P, La Verde M, Mosca L, Solazzo MC, Colacurci N. Laparo-assisted vaginal radical hysterectomy as a safe option for minimal invasive surgery in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2022:S0090-8258(22)00580-7. [PMID: 36150915 DOI: 10.1016/j.ygyno.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Radical hysterectomy and pelvic lymphadenectomy are considered the standard treatment for early-stage cervical cancer (ECC). Minimal Invasive approach to this surgery has been debated after the publication of a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC trial). It demonstrated poorer oncological outcomes for Minimal Invasive Surgery in ECC. However, the reasons are still an open debate. Laparo-Assisted Vaginal Hysterectomy (LAVRH) seems to be a logical option to Abdominal Radical Hysterectomy (ARH). This meta-analysis has the aim to prove it. METHODS Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the Pubmed database and Scopus database were systematically searched in January 2022 since early first publications. No limitation of the country was made. Only English article were considered. The studies containing data about Disease-free Survival (DFS) and/or Overall Survival (OS) and/or Recurrence Rate (RcR) were included. RESULTS 18 studies fulfilled inclusion criteria. 8 comparative studies were enrolled in meta-analysis. Patients were analyzed concerning surgical approach (Laparo-Assisted Vaginal Radical Hysterectomy) and compared with ARH Oncological outcomes such as DFS and OS were considered. 3033 patiets were included. Meta-analysis highlighted a non-statistic significant difference between LARVH and ARH (RR 0.82 [95% CI 0.55-1.23] p = 0.34; I2 = 0%; p = 0.96). OS was feasible only for 3 studies (RR 1.14 [95% CI 0.28-4.67] p = 0.43; I2 = 0 p = 0.86). Data about the type of recurrences (loco-regional vs distant) were collected. CONCLUSION LARVH does not appear to affect DFS and OS in ECC patients. The proposed results seem to be comparable with the open approach group of the LACC trial, which today represents the reference standard for the treatment of this pathology. More studies will be needed to test the safety and efficacy of LARVH in the ECC.
Collapse
Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Christhardt Köhler
- Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany; Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany.
| | - Pasquale de Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Cristina Solazzo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
33
|
Terada S, Terai Y, Tanaka Y, Tanaka T, Tsunetoh S, Ohmichi M. Postsurgical urodynamic study of total laparoscopic nerve-sparing radical hysterectomy for uterine cervical cancer. J Obstet Gynaecol Res 2022; 48:2863-2871. [PMID: 35934761 DOI: 10.1111/jog.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/13/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the impact on urodynamic results between the laparoscopic nerve-sparing radical hysterectomy (LRH) following a step-by-step procedure and abdominal nerve-sparing radical hysterectomy (ARH) for patients with uterine cervical cancer. METHODS This retrospective study enrolled 76 patients with cervical cancer: 35 in the LRH group and 41 in the ARH group. We analyzed their postoperative bladder function in a urodynamics study and examined the volume of resected pelvic nerves contained in parametrial sections using S-100 antibody staining. RESULTS Estimated blood loss and hospital stay after operation for the LRH group were significantly better than those in the ARH group (p < 0.0001). As well, the number of harvested lymph nodes was significantly higher in the LRH group (p = 0.044). There was no difference in perioperative complications between the two groups in this study. The 5-year disease-free survival rates and overall survival rates were 91.2% and 94.0% in the LRH group and 87.8% and 95.1% in the ARH group, both respectively. Although the median residual urine volume were no statistical differences between the LRH group and the ARH group, the recovery of postoperative bladder function (uroflowmetry) in the LRH group rapidly reached presurgery levels at 1 month, and the LRH group had a smaller number of s-100 antibody stained nerves contained the parametrial sections. CONCLUSION We demonstrated that LRH following a step-by-step procedure could achieve a higher level of prevention of damage to the bladder branch of the pelvic splanchnic nerve plexus and thus restore bladder function more rapidly.
Collapse
Affiliation(s)
- Shinichi Terada
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimichi Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Satoshi Tsunetoh
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| |
Collapse
|
34
|
Aoki Y, Kanao H, Fusegi A, Omi M, Okamoto S, Tanigawa T, Nomura H, Omatsu K, Tonooka A. Indocyanine green-guided sentinel lymph node mapping during laparoscopic surgery with vaginal cuff closure but no uterine manipulator for cervical cancer. Int J Clin Oncol 2022; 27:1499-1506. [PMID: 35705758 DOI: 10.1007/s10147-022-02197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymph node metastasis is a critical prognostic factor in cervical cancer. Considering the potential complications of lymphadenectomy and desirability of avoiding systemic lymphadenectomy, accurate intraoperative prediction of the existence of lymph node metastasis is important in patients undergoing surgery for cervical cancer. We evaluated the feasibility and value of indocyanine green (ICG) use for sentinel lymph node (SLN) mapping during laparoscopic surgery performed for cervical cancer. METHODS This single-center cohort study included 77 patients undergoing a new laparoscopic radical surgery method with pelvic lymphadenectomy for early-stage cervical cancer. The surgery, performed without using a uterine manipulator, included creation of a vaginal cuff. Bilateral ICG-guided SLN mapping and rapid histopathological examination were performed, and results were analyzed in relation to final histopathologic diagnoses. RESULTS The SLN pelvic side-specific detection rate was 93.5%, sensitivity (SLN-positive cases/SLN-detected pelvic lymph node-positive cases) was 100%, intraoperative negative predictive value (NPV) was 97.8%, and final pathological NPV was 100%. The detection rate was significantly lower for tumors ≥ 2 cm in diameter than for tumors < 2 cm in diameter. Micrometastases were missed by intraoperative examination in 3 cases. CONCLUSION The high NPV suggests the feasibility and usefulness of ICG-based SLN mapping plus rapid intraoperative examination for identification of metastatic SLNs. Use of ICG-based mapping for intraoperative identification of SLNs in patients undergoing this new laparoscopic surgery method for early-stage cervical cancer was particularly effective for tumors < 2 cm in diameter. However, incorporating a search for micrometastases into rapid intraoperative histopathologic examination may be necessary.
Collapse
Affiliation(s)
- Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Sanshirou Okamoto
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Terumi Tanigawa
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kohei Omatsu
- Department of Gynecologic Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akiko Tonooka
- Department of Clinical Pathology, Cancer Institute Hospital, Tokyo, Japan
| |
Collapse
|
35
|
Protective effect of pre-operative conization in patients undergoing surgical treatment for early-stage cervical cancer. Gynecol Oncol 2022; 166:57-60. [PMID: 35618539 DOI: 10.1016/j.ygyno.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of pre-operative conization on disease-free survival (DFS) in early-stage cervical cancer. METHODS In this population-based cohort study we analysed from clinical cancer registries to determine DFS of women with International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB1 cervical cancer with respect to conization preceding radical hysterectomy performed between January 2010 and December 2015. RESULTS Out of 993 datasets available for the analysis, 235 patients met the inclusion criteria of the current study. The median follow-up was 5.4 years. During the study period, 28 (11.9%) recurrences were observed. All of these occurred in patients with FIGO stage IB1. For further evaluation, patients with FIGO IB1 tumors <2 cm were further analysed and divided into two groups, based on pre-operative conization. Pre-operative conization was associated with a reduced rate of recurrence (p = 0.007), with only three (5.2%) recurrences in this group (CO) compared to 25 recurrences (21.0%) in the group without conization (NCO) preceding radical hysterectomy. DFS was estimated at 79.0% and 94.8% in NCO and CO, respectively (p = 0.008). After adjustment for other prognostic covariates, conization remained a favourable prognostic factor for DFS (HR 0.27; 95% CI 0.08-0.93, p = 0.037). Lymph node involvement was the only unfavourable factor (HR 4.38; 95% CI 1.36-14.14, p = 0.014) in the multivariable analysis. CONCLUSIONS Pre-operative conization is associated with improved DFS in early-stage cervical cancer independently of the surgical approach.
Collapse
|
36
|
Xu M, Huo C, Huang C, Liu Y, Ling X, Xu G, Lin Z, Lu H. Round ligament suspension and vaginal purse-string suture: Newly optimized techniques to prevent tumor spillage in laparoscopic radical trachelectomy for cervical cancer. J Obstet Gynaecol Res 2022; 48:1867-1875. [PMID: 35537684 DOI: 10.1111/jog.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/09/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to investigate the surgical techniques and clinical feasibility of nonuterine manipulator and enclosed colpotomy to avoid cancer cell spillages in laparoscopic radical trachelectomy (LRT) for patients with early-stage cervical cancer. METHODS We performed the newly optimized surgical techniques of round ligament suspension and vaginal purse-string suture in LRT in 12 patients with early-stage cervical cancer from May 2019 to October 2020. Surgical information and postoperative results were recorded. RESULTS All 12 patients successfully underwent LRT with round ligament suspension and vaginal purse-string suture, and no conversion to laparotomy was required. The median operation time was 268.5 min (range 200-320 min), including 5 min of round ligament suspension, and the median blood loss was 20 mL (range 5-50 mL). The median number of pelvic lymph nodes removed was 27 (range 19-35), and median amounts of paracervical tissue was 24 mm (range 21-26 mm) and vaginal tissue was 18 mm (range 16-26 mm). No intraoperative complication or serious postoperative complications were reported. CONCLUSION Round ligament suspension and vaginal purse-string suture techniques are feasible and effective in LRT. They can replace uterine manipulator and unprotected colpotomy with satisfactory perioperative outcomes.
Collapse
Affiliation(s)
- Miaochun Xu
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chuying Huo
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chunxian Huang
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yunyun Liu
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiaoting Ling
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guocai Xu
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhongqiu Lin
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huaiwu Lu
- Department of gynecological oncology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| |
Collapse
|
37
|
Survival Impact of Residual Cancer Cells in Intraoperative Peritoneal Washes following Radical Hysterectomy for Cervical Cancer. J Clin Med 2022; 11:jcm11092659. [PMID: 35566784 PMCID: PMC9102082 DOI: 10.3390/jcm11092659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: Residual cancer cells (RCCs) contribute to cancer recurrence either because of tumor spillage or undetectable pre-existing micrometastatic tumor clones. We hypothesized that the pathologic evaluation of intraoperative peritoneal washes may reveal RCCs. The aim of this study was to evaluate the survival impact of RCCs identified in intraoperative peritoneal washes and their correlation with clinicopathologic parameters following radical hysterectomy for cervical cancer. Methods: A total of 229 patients with cervical cancer who underwent radical hysterectomy with pelvic and/or paraaortic lymphadenectomy were included. The intraoperative peritoneal washes after surgery were filtered through a strainer and the presence of tumor cells in the residual aspirate was determined. Univariate and multivariate analyses of clinicopathological parameters were performed to identify predictors of recurrence. Results: RCCs in intraoperative peritoneal washes were identified in 19 patients (8.3%). Multivariate analysis revealed that deep stromal invasion (hazard ratio [HR], 13.32; 95% confidence interval [CI], 1.81–98.27; p = 0.0111), lymph node metastasis (HR, 2.00; 95% CI, 1.01–3.99; p = 0.0482), and neoadjuvant chemotherapy (HR, 2.34; 95% CI, 1.89–4.61; p = 0.0139) were associated with tumor recurrence. However, the presence of RCCs was not associated with tumor recurrence (HR, 2.60; 95% CI, 0.74–9.11; p = 0.1352). Multiple logistic regression analysis revealed that RCCs were associated with neoadjuvant chemotherapy (odds ratio [OR], 0.22; 95% CI, 0.05–0.99; p = 0.0488) and large tumor size (OR, 4.16; 95% CI, 0.77–22.48; p = 0.0981). Conclusions: Although the presence of RCCs in intraoperative peritoneal washes do not significantly impact survival outcomes, there was a tendency of inferior survival outcomes in patients with RCCs. RCCs were associated with neoadjuvant chemotherapy and large tumor size.
Collapse
|
38
|
Ronsini C, Köhler C, De Franciscis P, La Verde M, Mosca L, Solazzo MC, Colacurci N. Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2022; 166:188-195. [PMID: 35513934 DOI: 10.1016/j.ygyno.2022.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radical hysterectomy and pelvic lymphadenectomy are considered the standard treatment for early-stage cervical cancer (ECC). Minimal Invasive approach to this surgery has been debated after the publication of a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC trial). It demonstrated poorer oncological outcomes for Minimal Invasive Surgery in ECC. However, the reasons are still an open debate. Laparo-Assisted Vaginal Hysterectomy (LAVRH) seems to be a logical option to Abdominal Radical Hysterectomy (ARH). This meta-analysis has the aim to prove it. METHODS Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the Pubmed database and Scopus database were systematically searched in January 2022 since early first publications. No limitation of the country was made. Only English article were considered. The studies containing data about Disease-free Survival (DFS) and/or Overall Survival (OS) and/or Recurrence Rate (RcR) were included. RESULTS 19 studies fulfilled inclusion criteria. 9 comparative studies were enrolled in meta-analysis. Patients were analyzed concerning surgical approach (Laparo-Assisted Vaginal Radical Hysterectomy) and compared with ARH Oncological outcomes such as DFS and OS were considered. 3196 patiets were included for the review. Meta-analysis of 1988 0f them highlighted a non-statistic significant difference between LARVH and ARH (RR 0.8 [95% CI 0.55-1.16] p = 0.24; I2 = 0%; p = 0.98). OS was feasible only for 4 studies (RR 0.84 [95% CI 0.23-3.02] p = 0.79; I2 = 0 p = 0.44). Sub-analysis for tumor with a maximum diameter greater than 2 cm was performed. Data about the type of recurrences (loco-regional vs distant) were collected. CONCLUSION LARVH does not appear to affect DFS and OS in ECC patients. The proposed results seem to be comparable with the open approach group of the LACC trial, which today represents the reference standard for the treatment of this pathology. More studies will be needed to test the safety and efficacy of LARVH in the ECC.
Collapse
Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Christhardt Köhler
- Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany; Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany.
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Cristina Solazzo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
39
|
Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: A retrospective database cohort study. Ann Med Surg (Lond) 2022; 77:103507. [PMID: 35638032 PMCID: PMC9142398 DOI: 10.1016/j.amsu.2022.103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/13/2022] [Accepted: 03/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recent studies comparing minimally invasive versus open radical hysterectomy in patients with early-stage cervical cancer have reported a worse overall survival with minimally invasive surgery (MIS). However, in the patients with microscopic disease, there was no survival difference and the optimal surgical approach for microscopic cervical cancer remains unclear. Methods Using the National Cancer Database, we identified a cohort of women who underwent hysterectomy as the primary treatment for stage IA1/IA2 cervical cancer between January 2010 and December 2016. Using multivariable logistic regression, our primary outcome was to compare overall survival between the open and MIS groups. The data was stratified for simple and radical hysterectomies. Secondary endpoint was comparison of readmission rates and length of stay (LOS). Results We identified 6230 patients with stage IA1 and IA2 cervical cancer that underwent hysterectomy as primary treatment. 4054 of these women (65%) underwent MIS. There was no difference in age, lympho-vascular invasion, number of lymph nodes retrieved and histology between the two groups. In the overall cohort, there was no difference in survival between the open and the MIS group (Hazard ratio for the open group 1.23; CI 0.92–1.63). Post-operative radiation therapy was more common in the open group (5.24% vs 4.09%, p value < 0.02). The mean LOS (1.35 days vs 3.08 days) was shorter in MIS group (p value < 0.0001). No difference was found in the readmission rates (60% for the MIS group vs 55% for the open group; p value 0.14). Conclusions Our data suggest that MIS is associated with similar overall survival and shorter length of hospital stay compared to the open hysterectomy in women with stage IA cervical cancer. Based on this large data set, MIS appears to be a safe and effective surgical approach for women with stage IA1/IA2 cervical cancer. Our study is the largest analysis to date on the use of MIS in stage-IA cervical cancer. There was no difference in overall survival between MIS and open surgery for stage IA cervical cancer. MIS was associated with a shorter length of stay. No difference was found in readmission rates. The two groups were similar for lympho-vascular invasion, number of lymph nodes retrieved, histology, and age.
Collapse
|
40
|
Retrospective Comparison of Laparoscopic versus Open Radical Hysterectomy for Early-Stage Cervical Cancer in a Single Tertiary Care Institution from Lithuania between 2009 and 2019. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040553. [PMID: 35454391 PMCID: PMC9031924 DOI: 10.3390/medicina58040553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: A great debate within the academic arena was evoked by the LACC study, giving rise to doubt regarding the oncological outcomes of the laparoscopic approach for early-stage cervical cancer. This encouraged us to conduct a retrospective analysis of CC treatment surgical approaches applied to the patients at tertiary level Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania, between 2009 and 2019. Materials and Methods: The retrospective study was carried out to evaluate the outcomes after 28 laparoscopic and 62 laparotomic radical hysterectomies for early cervical cancer in a single tertiary care institution performed during the period 2009–2019. For statistical analysis of patients’ parameters, SPSS v. 17.0 was applied, together with the Kaplan–Meier method with a long-rank test and the Cox proportional hazard regression model used for bi-variate analysis determining OS outcomes between MIS and open-surgery groups. Results: After computing data with the Cox regression model, there was no significant difference of the 36-months overall survival between laparoscopy and laparotomy groups, as opposed to the LACC study. Conclusions: Our tertiary institution faces a considerable challenge, and we acknowledge the limitations of the study and also feel a responsibility to follow the latest guidelines. Currently, it appears that the most substantial attention should be focused on the cessation of uterine manipulator use as well as laparoscopic technique learning curves.
Collapse
|
41
|
Yang EJ, Kim NR, Lee AJ, Shim SH, Lee SJ. Laparotomic radical hysterectomy versus minimally invasive radical hysterectomy using vaginal colpotomy for the management of stage IB1 to IIA2 cervical cancer: Survival outcomes. Medicine (Baltimore) 2022; 101:e28911. [PMID: 35212297 PMCID: PMC8878615 DOI: 10.1097/md.0000000000028911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
This study compared survival outcomes for patients with stage IB1 to IIA2 (International Federation of Gynecology and Obstetrics stage 2009) cervical cancer who underwent open radical hysterectomy (ORH) versus those who underwent minimally invasive radical hysterectomy (MIRH) using vaginal colpotomy (VC).Data for 550 patients who were diagnosed with cervical cancer at our institution during the period August 2005 to September 2018 was retrospectively reviewed. Of these, 116 patients who underwent radical hysterectomy (RH) were selected after applying the exclusion criteria. All MIRH patients underwent VC. Clinicopathological characteristics and survival outcomes between the ORH and MIRH groups were compared using appropriate statistical testing.Ninety one patients were treated with ORH and 25 with MIRH during the study period. Among the MIRH patients, 18 underwent laparoscopy-assisted radical vaginal hysterectomy and 7 underwent laparoscopic RH. Preoperative conization was performed more frequently in MIRH patients than in ORH patients (44% vs 22%, respectively, P = .028). The incidence of lymph node invasion was higher in the ORH group than in MIRH group (37.4% vs 12.0% respectively; P = .016). Following RH, ORH patients underwent adjuvant treatment more frequently than MIRH patients (71.4% vs 56.0%, respectively, P = .002). There were no significant differences between ORH and MIRH patients for either progression-free survival (PFS) (91.3% vs 78.7%, respectively; P = .220) or 5-year overall survival (OS) (96.6% vs 94.7%, respectively, P = .929). In univariate analysis, lympho-vascular space invasion was the only clinicopathological feature associated with decreased PFS. No other clinicopathological factors was significantly associated with PFS or OS in univariate and multivariate analyses.Despite a higher incidence of unfavorable prognostic factors in ORH patients, their survival outcomes were not different to those of MIRH patients with VC.
Collapse
|
42
|
Enhanced Recovery after Surgery (ERAS) Protocol for Early Discharge within 12 Hours after Robotic Radical Hysterectomy. J Clin Med 2022; 11:jcm11041122. [PMID: 35207395 PMCID: PMC8874658 DOI: 10.3390/jcm11041122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022] Open
Abstract
To evaluate safety of quick discharge after robotic radical hysterectomy (RRH) in a tertiary hospital which has the enhanced recovery after surgery (ERAS) protocol. Among 94 consecutive cervical cancer patients who had undergone RRH, operative outcomes and the rate of unexpected visit after surgery were analyzed retrospectively. Patients were categorized as a surgery-to-discharge time of ≤12 h (early discharge [ED]) or >12 h (late discharge [LD]). About 77% (n = 72) of analyzed 94 patients discharged within 12 h after RRH. The ED group had significant correlation with shorter duration for urinary catheter required, less operative blood loss, and less voiding difficulty after long-term follow up compared to the LD group. There was no difference of perioperative complications and unexpected visit between the two groups. Performing nerve sparing (NS) RRH was only independent predictor for ED (p = 0.043, hazard ratio for LD = 0.22, confidence interval = 0.05–0.95). In conclusion, the ED within 12 h after RRH was safe in the setting of ERAS protocol. The NS-RRH could avoid the delay of genitourinary function recovery after surgery which caused LD. It can become the reasonable clinical pathway to discharge early patients who undergo NS-RRH with ERAS protocol.
Collapse
|
43
|
Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned? Curr Oncol 2022; 29:1093-1106. [PMID: 35200592 PMCID: PMC8871281 DOI: 10.3390/curroncol29020093] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) emerged as the mainstay in the surgical management of cervical cancer, bringing advantages such as lower operative morbidity and shorter hospital stay compared to open surgery while maintaining comparable oncologic outcomes in numerous retrospective studies. However, in 2018, a prospective phase III randomized controlled trial, “Laparoscopic Approach to Carcinoma of the Cervix (LACC)”, unexpectedly reported that MIS was associated with a statistically significant poorer overall survival and disease-free survival compared to open surgery in patients with early-stage cervical cancer. Various hypotheses have been raised by the authors to try to explain these results, but the LACC trial was not powered to answer those questions. In this study, through an exhaustive literature review, we wish to explore some of the potential causes that may explain the poorer oncologic outcomes associated with MIS, including the type of MIS surgery, the size of the lesion, the impact of CO2 pneumoperitoneum, prior conization, the use of uterine manipulator, the use of protective measures, and the effect of surgical expertise/learning curve.
Collapse
|
44
|
He F, Yuan S, Chen X, Zhang S, Han Y, Lin T, Xu B, Huang S, Pan Z. Effect of modified no-touch laparoscopic radical hysterectomy on outcomes of early stage cervical cancer: A retrospective cohort study. Cancer Med 2022; 11:2224-2232. [PMID: 35156771 PMCID: PMC9160811 DOI: 10.1002/cam4.4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/19/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives We aimed to compare the prognosis of modified no‐touch laparoscopic radical hysterectomy (MLRH) and laparoscopic radical hysterectomy (LRH) on survival in patients with early stage cervical cancer. Materials and Methods The clinicopathological data of patients with stage IB1 and IIA1 cervical cancer, who underwent radical surgery between 2014 and 2019, were retrospectively reviewed. The 5‐year disease‐free survival (DFS) and overall survival (OS) were compared between the MLRH and LRH groups using the Kaplan–Meier method. Independent prognostic factors for 5‐year DFS and OS were identified using multivariate, forward, stepwise Cox proportional hazards regression models. Results A total of 223 patients with stage IB1 and IIA1 cervical cancer were included. Kaplan–Meier analysis revealed that the 5‐year DFS and OS rates in the MLRH (n = 81) group were significantly higher than those in the LRH group (n = 142) (DFS, 94.5% vs. 78.8%, p = 0.007; OS, 96.7% vs. 87.6%, p = 0.033). No significant differences were identified between the two groups in terms of operative time, blood loss, transfusion requirement, and intraoperative or postoperative complications. MLRH was an independent prognostic factor associated with increased 5‐year DFS (adjusted hazard ratio [HR], 0.202; 95% confidence interval [CI], 0.069–0.594; p = 0.004) and 5‐year OS (adjusted HR, 0.163; 95% CI, 0.035–0.748; p = 0.020). Conclusion The oncologic outcomes were superior with MLRH than with LRH in patients with stage IB1 and IIA1 cervical cancer. Contact of cervical tumor cells with the pelvic cavity likely explains the worse prognosis associated with LRH.
Collapse
Affiliation(s)
- Fangjie He
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Songhua Yuan
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Xia Chen
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Siyou Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Yubin Han
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Tiecheng Lin
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Bingnan Xu
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Shimin Huang
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| | - Zhiyin Pan
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, China
| |
Collapse
|
45
|
Zhang M, Dai W, Si Y, Shi Y, Li X, Jiang K, Shen J, Ying L. Comparison of Minimally Invasive Versus Abdominal Radical Hysterectomy for Early-Stage Cervical Cancer: An Updated Meta-Analysis. Front Oncol 2022; 11:762921. [PMID: 35141141 PMCID: PMC8818747 DOI: 10.3389/fonc.2021.762921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlthough minimally invasive surgery (MIS) was commonly used to treat patients with early-stage cervical cancer, its efficacy remained controversial.MethodsWe systematically searched PubMed, Web of Science, and Cochrane Library databases until March 2021 to compare the prognosis of early-stage cervical cancer patients who underwent MIS (laparoscopic or robot-assisted radical hysterectomy) or ARH. The primary outcomes included rates of 3- and 5-year disease-free survival (DFS) and overall survival (OS). The study protocol was registered in PROSPERO: CRD42021258116.ResultsThis meta-analysis included 48 studies involving 23346 patients (11220, MIS group; 12126, ARH group). The MIS group had a poorer medium-term (3-year) DFS (HR=1.08, 95% CI: 1.01-1.16, p=0.031) than the ARH group, without significant difference in medium-term OS as well as long-term (5-year) DFS and OS. Subgroup analysis of 3-year prognosis revealed that although patients in Western countries who underwent MIS had shorter DFS than those who underwent ARH (HR=1.10, p=0.024), no difference was observed in DFS among those in Asian countries. Moreover, MIS was linked to poorer 3-year DFS in patients with stage I cervical cancer (HR=1.07, p=0.020). Notably, subgroup analysis of 5-year prognosis revealed that patients with tumor size ≥2 cm undergoing MIS exhibited a shorter DFS than those who underwent ARH (HR=1.65, p=0.041).ConclusionPatients with early-stage cervical cancer undergoing MIS may have a poorer prognosis than those undergoing ARH. Therefore, applying MIS in early-stage cervical cancer patients should be conducted with caution.Systematic Review RegistrationThe study protocol was registered in PROSPERO: CRD42021258116.
Collapse
Affiliation(s)
- Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuexiu Si
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiangyuan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jingyi Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Liying Ying
- Department of Obstetrics and Gynecology, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
- *Correspondence: Liying Ying,
| |
Collapse
|
46
|
Cervical conization before primary radical hysterectomy has a protective effect on disease recurrence in early cervical cancer: A two-center matched cohort study according to surgical approach. Gynecol Oncol 2021; 164:535-542. [PMID: 34969535 DOI: 10.1016/j.ygyno.2021.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To ascertain whether cervical conization before radical hysterectomy (RH) has a protective effect on survival outcomes in early cervical cancer, taking into account the surgical approach. METHODS From cervical cancer cohorts of two institutions, we identified node-negative, margin-negative, parametria-negative, 2009 FIGO stage IB1 cervical cancer patients who received primary Type C RH between July 2006 and June 2020. Patients were divided into conization group (n = 144) and control group (n = 434). We conducted three independent 1:1 propensity score matching processes for histology, lymphovascular space invasion, cervical tumor size, and surgical approach (all patients, those who underwent open surgery, and those who underwent minimally invasive surgery [MIS]). Survival outcomes were compared. RESULTS Overall, the conization group had less cervical tumor size and received MIS more frequently (P = 0.010) and adjuvant treatment less often (P = 0.002) versus the controls. After matching, the conization group showed significantly better disease-free survival (DFS) versus control (3-year DFS rate, 94.2% vs. 86.3%; P = 0.012), but similar overall survival. Among the open RH matched patients (n = 96), no difference in DFS was observed between the conization and control groups (P = 0.984). In contrast, among the MIS RH matched patients (n = 192), the conization group showed significantly better DFS versus control (3-year DFS rate, 95.7% vs. 82.9%; P = 0.005). In multivariate analysis adjusting for cervical tumor size and adjuvant treatment, conization was identified as an independent favorable prognostic factor for DFS (adjusted HR, 0.318; 95% CI, 0.134-0.754; P = 0.009). CONCLUSIONS Preoperative cervical conization might reduce the disease recurrence rate in early cervical cancer patients who undergo primary MIS RH.
Collapse
|
47
|
Fusegi A, Kanao H, Ishizuka N, Nomura H, Tanaka Y, Omi M, Aoki Y, Kurita T, Yunokawa M, Omatsu K, Matsuo K, Miyasaka N. Oncologic Outcomes of Laparoscopic Radical Hysterectomy Using the No-Look No-Touch Technique for Early Stage Cervical Cancer: A Propensity Score-Adjusted Analysis. Cancers (Basel) 2021; 13:cancers13236097. [PMID: 34885205 PMCID: PMC8657300 DOI: 10.3390/cancers13236097] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/04/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Minimally invasive radical hysterectomy is contraindicated in early stage cervical cancer cases because of poor prognosis. The no-look no-touch technique (NLNT) eliminates intraoperative tumor spillage and may improve survival outcomes. We evaluated oncologic outcomes of laparoscopic radical hysterectomy performed using NLNT. We compared the outcomes of abdominal radical hysterectomy and NLNT using inverse probability of treatment weighting. We found no significant differences in disease-free survival between the groups, even in patients with tumor sizes ≥ 2 cm. We also studied NLNT’s non-inferiority to abdominal radical hysterectomy by evaluating heterogeneity between the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial and those of our study. We did not observe significant heterogeneity, although there was a trend toward a lower hazard ratio in our study compared with the non-inferiority margin in the LACC trial. Laparoscopic radical hysterectomy using NLNT is a plausible alternative surgical treatment for early stage cervical cancer. Abstract We evaluated oncologic outcomes of laparoscopic radical hysterectomy using the no-look no-touch technique (NLNT). We analyzed patients with early stage (IA2, IB1, and IIA1, FIGO2008) cervical cancer treated between December 2014 and December 2019. The primary endpoint was disease-free survival (DFS). We compared the outcomes of the abdominal radical hysterectomy (ARH) and NLNT groups using a Cox model with inverse probability of treatment weighting (IPTW), according to propensity scores. We also evaluated NLNT’s non-inferiority to ARH using an evaluation of heterogeneity between the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial and our study. ARH and NLNT were performed in 118 and 113 patients, respectively. The median follow-up duration was 3.2 years. After IPTW adjustment, the 3-year DFS rates (NLNT 92.4%; ARH 94.0%) and overall survival rates did not differ significantly between the groups. Furthermore, the 3-year DFS rates for patients with tumor sizes ≥ 2 cm in the NLNT (85.0%) and ARH (90.3%) groups did not differ significantly. No significant heterogeneity was observed between the LACC trial and our study (I2 = 60.5%, p = 0.111), although there was a trend toward a lower hazard ratio in our study. Laparoscopic radical hysterectomy using NLNT provides a favorable prognosis for early stage cervical cancer.
Collapse
Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
- Correspondence: ; Tel.: +81-3-3520-0111
| | - Naoki Ishizuka
- Clinical Research Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Yuji Tanaka
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Tomoko Kurita
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Mayu Yunokawa
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Kohei Omatsu
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.F.); (H.N.); (Y.T.); (M.O.); (Y.A.); (T.K.); (M.Y.); (K.O.)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Naoyuki Miyasaka
- Department of Obstetrics and Gynecology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| |
Collapse
|
48
|
Lv H, Zhou T, Rong F. Proteomic analysis of the influence of CO 2 pneumoperitoneum in cervical cancer cells. J Cancer Res Ther 2021; 17:1253-1260. [PMID: 34850775 DOI: 10.4103/jcrt.jcrt_638_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective The effect of CO2 pneumoperitoneum (CDP) on the oncology outcomes of patients undergoing laparoscopic radical hysterectomy for cervical cancer remains unclear. In this study, we investigated the effects of CDP on the proliferation of cervical cancer cells and examined the molecular mechanism. Materials and Methods We established an in vitro CDP model to study the effects of CDP on the proliferation of cervical cancer cells by Cell Counting Kit-8 (CCK-8) assay, xenografted tumor assay. Tandem mass tag-based quantitative proteomics were used to study the proteomic changes in HeLa cells after CDP treatment. Western blot assay was used to detect the expressions of PI3K/Akt signaling pathway proteins. Results CDP increased cell proliferation after a short period of inhibition in vitro and promoted tumorigenesis in vivo. Proteomic analysis showed that the expression levels of 177 and 309 proteins were changed significantly 24 and 48 h after CDP treatment, respectively. The acidification caused by CO2 inhibited the proliferation of cervical cancer cells by inhibiting the phosphorylation of PI3K and Akt. Conclusions CDP promoted the proliferation of human cervical cancer cells after a short time of inhibition. The mechanism of which is related to the inhibition of phosphorylation of the PI3K/Akt signaling pathway.
Collapse
Affiliation(s)
- Hongtao Lv
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| | - Ting Zhou
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| | - Fengnian Rong
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jingshi Road, Jinan, Shandong Province, China
| |
Collapse
|
49
|
Imai K, Chikazawa K, Ito T, Kuwata T, Konno R. High rate of positive vaginal discharge cytology at the time of colpotomy in gynecologic cancer patients. Taiwan J Obstet Gynecol 2021; 60:1142-1143. [PMID: 34794755 DOI: 10.1016/j.tjog.2021.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ken Imai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Takaki Ito
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| |
Collapse
|
50
|
Fitzsimmons CK, Stephens AJ, Kennard JA, Manyam M, Pepe JW, Ahmad S, McKenzie ND, Kendrick JE, Holloway RW. Carcinomatosis in Early-Stage Cervical Cancer Treated with Robotic Radical Hysterectomy: Recurrence Patterns, Risk Factors, and Survival. Ann Surg Oncol 2021; 29:2006-2013. [PMID: 34757549 DOI: 10.1245/s10434-021-11052-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Minimally invasive radical hysterectomy has been associated with increased recurrence of disease and worse survival compared with open radical hysterectomy for early-stage cervical cancer. We evaluated patterns of recurrence and histopathologic risk factors in patients who underwent robotic radical hysterectomy (RRH). METHODS Patients who underwent RRH (4/2007-12/2018) were evaluated for specific locations of recurrent disease, disease-free survival, overall survival (OS), and histopathologic risk factors for recurrence. Inclusion criteria were follow-up ≥ 1 year, histology with adenocarcinoma, adenosquamous, or squamous carcinoma and clinical stage IA2 to IB ≤ 4-cm tumor size cervical cancers (FIGO-2018). RESULTS A total of 140 patients underwent RRH and 112 met criteria. Median tumor size was 2.1 cm [interquartile range (IQR): 1.1-3.3]. Median follow-up was 61 months (IQR: 36-102). Fifty (45%) patients underwent adjuvant radiation ± cisplatin with either Sedlis' or Peters' risk factors. There were 11 (9.8%) recurrences with median disease-free survival of 12 (IQR 8.5) months. All patients with recurrence had measured tumor size ≥ 2 cm (median tumor size 3-cm (IQR: 2.6-4.0). Tumor size > 2 cm was associated with Sedlis' intermediate-risk factors (p < 0.05) and Peters' high-risk factors (p < 0.05). Forty patients underwent preoperative conization, and two (5%) with deep positive margins in lesions > 2 cm recurred. Five (4.5%) of patients had carcinomatosis representing 45% of all recurrences. Carcinomatosis was associated with reduced OS compared with other recurrence patterns (22 months vs. 7.8 years, p < 0.05). CONCLUSIONS Carcinomatosis was observed in early-stage cervical cancers treated with RRH and was associated with reduced OS. All recurrences were associated with lesions ≥ 2 cm, and no recurrences were identified with negative conization margins.
Collapse
Affiliation(s)
| | - Amanda J Stephens
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Jessica A Kennard
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Madhavi Manyam
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Julie W Pepe
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA.
| | - Nathalie D McKenzie
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - James E Kendrick
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Robert W Holloway
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| |
Collapse
|