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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.
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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.
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Coronado PJ, Gracia M. Robotic radical hysterectomy after conization for patients with small volume early-stage cervical cancer. Best Pract Res Clin Obstet Gynaecol 2024; 92:102434. [PMID: 38134716 DOI: 10.1016/j.bpobgyn.2023.102434] [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: 08/21/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
Laparoscopy and robotics are recommended for managing gynecological cancer, as they are associated with lower morbidity and comparable outcomes to open surgery. However, in the case of early cervical cancer, new evidence suggests worse oncological outcomes with these approaches compared to open surgery, though the limited number of robotic cases makes it challenging to draw definitive conclusions for this particular approach. The prior conization has been proposed as a strategy to reduce the risk of tumor spillage and contamination during minimally invasive (MIS) radical hysterectomy (RH). Retrospective studies have indicated that undergoing conization before RH is linked to a reduced risk of recurrences, especially in cervical tumors measuring less than 2 cm. Nevertheless, these studies lack the statistical power needed to definitively establish conization as a recommended step before RH. Furthermore, these studies do not have enough cases utilizing the robotic approach and specific conclusions cannot be drawn from this technique. The question of whether a subset of cases would benefit from preoperative conization and whether conization should be performed to recommend MIS over open surgery remains unanswered. Prospective clinical trials involving women diagnosed with early-stage cervical cancer <2 cm, randomized between undergoing conization before robotic RH or without prior conization are mandatory to assess the role of conization before robotic RH in cervical cancer.
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Affiliation(s)
- Pluvio J Coronado
- Women's Health Institute, San Carlos Clinic Hospital, IdISSC, School of Medicine, Complutense University, Madrid, Spain.
| | - Myriam Gracia
- Gynecology Oncology Unit, University Hospital La Paz, Madrid, Spain.
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Liang X, He H, Li Y, Chen S, Zhao J, Yang B, Lin H, Zeng H, Wei L, Yang J, Fan J. An optimized robotic surgical technique for cervical cancer: investigating whether the use of the pulling robotic arm has better surgical outcomes. Front Oncol 2023; 13:1159081. [PMID: 37483489 PMCID: PMC10358761 DOI: 10.3389/fonc.2023.1159081] [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: 02/05/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The evidence for adopting the 3rd robotic arm (RA) called the pulling RA rather than a uterine manipulator to manipulate the uterus in the robotic radical hysterectomy (RRH) for cervical cancer is still limited. We present a single-center retrospective experience comparing using the pulling RA to replace a uterine manipulator vs. using a uterine manipulator to manipulate the uterus in RRH. Methods 106 patients diagnosed with IA, IB1-IB2 and IIA1 cervical cancer were retrospectively included for intraoperative and postoperative parameters analysis. 50 patients received RRH by adopting the pulling RA instead of a uterine manipulator to pull the uterus (3-RA RRH group), and another 56 patients were performed RRH with a uterine manipulator (2-RA RRH group). RRH with the pulling RA consisted of a camera arm, 3 RAs including a pulling RA, and 2 conventional assistant arms (3-RA RRH group). In comparison, RRH with a uterine manipulator included 2 RAs and 2 conventional assistant arms (2-RA RRH group). Besides, 3-RA' RRH group was selected from the 25th-50th cases in the 3-RA RRH group based on the learning curve and was compared with the 2-RA RRH group in terms of intraoperative and postoperative parameters. Results The patients' early post-operative complication (≤7 days) (p=0.022) and post-operative anemia (p < 0.001) of the 3-RA RRH were significantly lower than that in the 2-RA RRH group. The results of comparing the 2-RA RRH group with the 3-RA' RRH group were consistent with the aforementioned results, except for the operative time (220.4 vs. 197.4 minutes, p=0.022) and hospital stay (7.8 vs. 8.7 days, p=0.034). The median follow-up in the 3-RA RRH and 2-RA RRH groups was 29 and 50 months till March 2023. The 3-RA RRH and 2-RA RRH groups' recurrence rates were 2% (1/50) and 5.4% (3/56), respectively. The mortality in the 3-RA RRH and 2-RA RRH groups was 2% (1/50) and 3.5% (2/56), respectively. Conclusion Our study suggested that replacing the uterine manipulator via the 3rd RA is viable; the results showed comparable surgical outcomes between the two methods. Thus, 3-RA RRH could be considered a well-executed surgical option in well-selected patients.
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Affiliation(s)
- Xuzhi Liang
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Haijing He
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Yingjin Li
- Department of Glandular Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Sibang Chen
- Department of Gynecology, International Peace Maternal and Child Health Hospital of China Welfare Society, Shanghai, China
| | - Jinche Zhao
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Bing Yang
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Huisi Lin
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Hao Zeng
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Liuyi Wei
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Jiahuang Yang
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Jiangtao Fan
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
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Aubrey C, Pond GR, Helpman L, Vicus D, Elit L, Plante M, Lau S, Kwon JS, Altman AD, Willows K, Feigenberg T, Sabourin J, Samouelian V, Bernard L, Cockburn N, Saunders NB, Piedimonte S, Teo-Fortin LA, Kim SR, Sadeq N, Jang JH, Shamiya S, Nelson G. Oncologic Outcomes of Surgically Treated Cervical Cancer with No Residual Disease on Hysterectomy Specimen: A 4C (Canadian Cervical Cancer Collaborative) Working Group Study. Curr Oncol 2023; 30:1977-1985. [PMID: 36826114 PMCID: PMC9955159 DOI: 10.3390/curroncol30020153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Minimally invasive surgery for the treatment of macroscopic cervical cancer leads to worse oncologic outcomes than with open surgery. Preoperative conization may mitigate the risk of surgical approach. Our objective was to describe the oncologic outcomes in cases of cervical cancer initially treated with conization, and subsequently found to have no residual cervical cancer after hysterectomy performed via open and minimally invasive approaches. This was a retrospective cohort study of surgically treated cervical cancer at 11 Canadian institutions from 2007 to 2017. Cases initially treated with cervical conization and subsequent hysterectomy, with no residual disease on hysterectomy specimen were included. They were subdivided according to minimally invasive (laparoscopic/robotic (MIS) or laparoscopically assisted vaginal/vaginal hysterectomy (LVH)), or abdominal (AH). Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Chi-square and log-rank tests were used to compare between cohorts. Within the total cohort, 238/1696 (14%) had no residual disease on hysterectomy specimen (122 MIS, 103 AH, and 13 VLH). The majority of cases in the cohort were FIGO 2018 stage IB1 (43.7%) and underwent a radical hysterectomy (81.9%). There was no statistical difference between stage, histology, and radical vs simple hysterectomy between the abdominal and minimally invasive groups. There were no significant differences in RFS (5-year: MIS/LVH 97.7%, AH 95.8%, p = 0.23) or OS (5-year: MIS/VLH 98.9%, AH 97.4%, p = 0.10), although event-rates were low. There were only two recurrences. In this large study including only patients with no residual cervical cancer on hysterectomy specimen, no significant differences in survival were seen by surgical approach. This may be due to the small number of events or due to no actual difference between the groups. Further studies are warranted.
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Affiliation(s)
- Christa Aubrey
- Division of Gynecologic Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
- Correspondence: ; Tel.: +1-780-432-8337
| | - Gregory R. Pond
- Department of Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Limor Helpman
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Danielle Vicus
- Division of Gynecologic Oncology, Sunnybrook Health Science Center, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Laurie Elit
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Marie Plante
- Division of Gynecologic Oncology, Centre Hospitalier Universite de Quebec, Laval University, Quebec City, QC G1R 2J6, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Janice S. Kwon
- Division of Gynecologic Oncology, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Alon D. Altman
- Division of Gynecologic Oncology, Winnipeg Women’s Hospital, University of Manitoba, Winnipeg, MB R3E 0L8, Canada
| | - Karla Willows
- Division of Gynecologic Oncology, Queen Elizabeth II Health Science Center, Dalhousie University, Halifax, NS B3K 4N1, Canada
| | - Tomer Feigenberg
- Division of Gynecologic Oncology, Trillium Health Partners, Mississauga, University of Toronto, Toronto, ON L5B 1B8, Canada
| | - Jeanelle Sabourin
- Division of Gynecologic Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Vanessa Samouelian
- Division of Gynecologic Oncology, Centre Hospitalier de l’Universite de Montreal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Laurence Bernard
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Norah Cockburn
- Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Nora-Beth Saunders
- Division of Gynecologic Oncology, Winnipeg Women’s Hospital, University of Manitoba, Winnipeg, MB R3E 0L8, Canada
| | - Sabrina Piedimonte
- Division of Gynecologic Oncology, Sunnybrook Health Science Center, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Ly-Ann Teo-Fortin
- Division of Gynecologic Oncology, Centre Hospitalier Universite de Quebec, Laval University, Quebec City, QC G1R 2J6, Canada
| | - Soyoun Rachel Kim
- Division of Gynecologic Oncology, Sunnybrook Health Science Center, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Noor Sadeq
- Division of Gynecologic Oncology, Queen Elizabeth II Health Science Center, Dalhousie University, Halifax, NS B3K 4N1, Canada
| | - Ji-Hyun Jang
- Division of Gynecologic Oncology, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Sarah Shamiya
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB T5H 3V9, Canada
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2, Canada
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