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Yu H, He H, Liang X, Lin H, Sun D, Fan J. Robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer: The more experienced the bedside assistant, the better? Heliyon 2024; 10:e31741. [PMID: 38841439 PMCID: PMC11152684 DOI: 10.1016/j.heliyon.2024.e31741] [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: 02/23/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Background Aim to investigate the impact of bedside assistant's work experience and learning curve on the short-term safety and efficacy in robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer. Methods Our research retrospectively retrieved 120 cases of early-stage cervical cancer patients who underwent robotic-assisted laparoscopic radical hysterectomy at the First Affiliated Hospital of Guangxi Medical University. According to the different work experiences of the two bedside assistants (BA), patients were divided into a research group (inexperienced BA 1) and a control group (experienced BA 2). Furthermore, the learning curves of these BAs were plotted separately and divided into two distinct phases by cumulative summation: the first learning phase and the second master phase. Result In terms of work experience, comparing BA 1 with BA 2 who was more experienced, although the average operative time was prolonged by 29 min (P<0.001), it did not increase the incidence of operative complication [24.4 % VS 29.1 %, P = 0.583], positive resection margin [4.9 % VS 7.6 %, P = 0.714], intraoperative organ damage [0 % VS 2.5 %, P = 0.546] and there was no significant difference in the number of lymph nodes [19 VS 15, P = 0.103]. Additionally, comparing two distinct phases of the same bedside assistant, there was no significant increasing rate in terms of operative complication, positive resection margin, intraoperative organ damage, and the number of lymph nodes (P>0.05) neither BA 1 nor BA 2, except for a slight extension of operative time about 20 min in learning phase (P<0.05). Conclusion In robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer, work inexperience and the learning phase of BA only result in a slight extension of operative time, without causing worse short-term surgical outcomes.
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Affiliation(s)
- Hang Yu
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Haijing He
- Department of Gynecology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China
| | - Xuzhi Liang
- 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
| | - Dan Sun
- 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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Yin Z, Cui Z, Kang S, Ji M, Li D, Chen B, Zhan X, Li W, Liu P, Chen C. Laparoscopic versus open radical hysterectomy in FIGO 2018 early-stage cervical adenocarcinoma: Long-term survival outcomes after propensity score matching. J Obstet Gynaecol Res 2023; 49:2849-2859. [PMID: 37658744 DOI: 10.1111/jog.15785] [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: 05/03/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To compare the long-term survival outcomes of laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in International Federation of Gynecology and Obstetrics (FIGO) 2018 early-stage cervical adenocarcinoma. METHODS Based on the clinical diagnosis and treatment for cervical cancer in mainland China (Four C) database, the medical records of 1098 patients with FIGO 2018 early-stage cervical adenocarcinoma were retrospectively reviewed. Long-term and short-term survival outcomes of the two groups were compared using a multivariate Cox regression model and the log-rank method in the whole study population and after propensity score matching. RESULTS There was no difference in disease-free survival (hazard ratio [HR] 0.921, 95% confidence interval [CI]: 0.532-1.595, p = 0.770) and overall survival (HR 1.168, 95% CI: 0.526-2.592, p = 0.702) between LRH (n = 468) and ORH (n = 468) in the risk-adjusted analysis. LRH resulted in significantly lower estimated blood loss (342.7 vs. 157.5 mL, p < 0.001) and shorter postoperative anal exhaust time (2.8 vs. 2.5 days, p < 0.001) in risk-adjusted analysis. The overall rates of intraoperative complications (2.4% vs. 4.3%, p = 0.100) and postoperative complications (7.5% vs. 6.2%, p = 0.437) showed no significant difference between the two groups. However, the LRH group had a significantly higher incidence of ureter injury (0.4% vs. 2.4%, p = 0.012) and great vessel injury (0.0% vs. 0.9%, p = 0.045) compared to the other group. No statistical variation in the site of recurrence was observed between the two groups (p = 0.613). CONCLUSIONS LRH has comparable survival outcomes with ORH and was associated with earlier recovery in FIGO 2018 early-stage adenocarcinoma of the uterine cervix. However, the LRH group had higher risk of ureter injury and great vessel injury.
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Affiliation(s)
- Zhaohong Yin
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhumei Cui
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shan Kang
- Department of Gynecology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Donglin Li
- Department of Obstetrics and Gynecology, Guizhou People's Hospital, Guiyang, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Xuemei Zhan
- Department of Obstetrics and Gynecology, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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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.
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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
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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: 4] [Impact Index Per Article: 2.0] [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.
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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
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5
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Zhang F, Song X. Laparoscopic Versus Abdominal Radical Hysterectomy for Cervical Cancer: A Meta-analysis of Randomized Controlled Trials. Am J Clin Oncol 2022; 45:465-474. [PMID: 36256872 PMCID: PMC9624383 DOI: 10.1097/coc.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Laparoscopic radical hysterectomy (LRH) and open abdominal radical hysterectomy (ARH) have been used for cervical cancer treatment. We aimed to perform a meta-analysis to compare the efficacy and safety of LRH and ARH in the treatment of cervical cancer to provide reliable evidence to the clinical cervical cancer treatment. METHODS Two investigators independently searched PubMed and other databases for randomized controlled trials (RCTs) comparing LRH and ARH for cervical cancer treatment up to May 31, 2022. The risk of bias assessment tool recommended by Cochrane library was used for quality assessment. RevMan 5.3 software was used for meta-analysis. RESULTS Fourteen RCTs with a total of 1700 patients with cervical cancer were finally included. Meta-analyses indicated that compared with ARH, LRH reduced the intraoperative blood loss (mean difference [MD]=-58.08; 95% CI, -70.91, -45.24), the time to first passage of flatus (MD=-14.50; 95% CI, -16.55, -12.44) (all P <0.05), and increase the number of lymph nodes removed (MD=3.47; 95% CI, 0.51, 6.43; P =0.02). There were no significant differences in the duration of surgery (MD=27.62; 95% CI, -6.26, 61.49), intraoperative complications (odd ratio [OR]=1.10; 95% CI, 0.17, 7.32), postoperative complications (OR=0.78; 95% CI, 0.33, 1.86), relapse rate (OR=1.45; 95% CI, 0.56, 3.74), and survival rate (OR=0.75; 95% CI, 0.52, 1.08) between LRH group and ARH group (all P >0.05). CONCLUSIONS LRH has more advantages over ARH in the treatment of cervical cancer. Still, the long-term effects and safety of LRH and ARH need more high-quality, large-sample RCTs to be further verified.
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Bogani G, Di Donato V, Scambia G, Raspagliesi F, Chiantera V, Sozzi G, Golia D’Augè T, Muzii L, Benedetti Panici P, D’Oria O, Vizza E, Giannini A. Radical Hysterectomy for Early Stage Cervical Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811641. [PMID: 36141917 PMCID: PMC9517651 DOI: 10.3390/ijerph191811641] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 05/21/2023]
Abstract
Radical hysterectomy and plus pelvic node dissection are the primary methods of treatment for patients with early stage cervical cancer. During the last decade, growing evidence has supported the adoption of a minimally invasive approach. Retrospective data suggested that minimally invasive surgery improves perioperative outcomes, without neglecting long-term oncologic outcomes. In 2018, the guidelines from the European Society of Gynaecological Oncology stated that a "minimally invasive approach is favored" in comparison with open surgery. However, the phase III, randomized Laparoscopic Approach to Cervical Cancer (LACC) trial questioned the safety of the minimally invasive approach. The LACC trial highlighted that the execution of minimally invasive radical hysterectomy correlates with an increased risk of recurrence and death. After its publication, other retrospective studies investigated this issue, with differing results. Recent evidence suggested that robotic-assisted surgery is not associated with an increased risk of worse oncologic outcomes. The phase III randomized Robotic-assisted Approach to Cervical Cancer (RACC) and the Robotic Versus Open Hysterectomy Surgery in Cervix Cancer (ROCC) trials will clarify the pros and cons of performing a robotic-assisted radical hysterectomy (with tumor containment before colpotomy) in early stage cervical cancer.
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Affiliation(s)
- Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-3803933116
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00182 Rome, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, 90127 Palermo, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, 90127 Palermo, Italy
| | - Tullio Golia D’Augè
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Ottavia D’Oria
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy
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7
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Yang N, Fan X, Wang L, Zhu P, Xu P. Safety and efficacy of a modified technique of laparoscopic radical hysterectomy for cervical cancer. J Obstet Gynaecol Res 2022; 48:2879-2887. [PMID: 36059077 DOI: 10.1111/jog.15407] [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: 02/22/2022] [Revised: 07/18/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
AIM Objective to investigate the feasibility, safety, and short-term efficacy of laparoscopic radical hysterectomy without uterine lifter combined with self-locking nylon band. METHODS The clinical data of 152 patients who underwent a laparoscopic radical hysterectomy in the Department of gynecology and oncology of Changzhou maternal and child health hospital from January 2017 to June 2020 were analyzed retrospectively, including 97 patients who used uterine lifter (traditional laparoscopic radical hysterectomy) and 55 patients who underwent operation without uterine lifter but combining with self-locking nylon band (modified laparoscopic radical hysterectomy). The differences in operation time, intraoperative blood loss, the width of excised parauterine tissue, the length of the excised vaginal wall, postoperative pathology and short-term prognosis between the two groups were compared and analyzed. RESULTS There were no significant differences between the two groups in operation time, intraoperative blood loss, the width of parauterine tissue, and the length of the vaginal wall (p > 0.05). There were no significant differences in the number of lymph nodes, pelvic lymph node metastasis rate and depth of cervical interstitial infiltration between the two groups (p > 0.05), the infiltration rate of lymphatic vascular space in the traditional group was higher than that in the improved group (p < 0.05). CONCLUSION It is feasible and safe for laparoscopic radical hysterectomy without uterine lifter combining with a self-locking nylon band to seal the vaginal wall. The uterine lifter may lead to lymphatic vascular space infiltration of tumor cells.
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Affiliation(s)
- Ni Yang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Xiang Fan
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Li Wang
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Pengfeng Zhu
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Peizhen Xu
- Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
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8
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Leitao MM, Zhou QC, Brandt B, Iasonos A, Sioulas V, Lavigne Mager K, Shahin M, Bruce S, Black DR, Kay CG, Gandhi M, Qayyum M, Scalici J, Jones NL, Paladugu R, Brown J, Naumann RW, Levine MD, Mendivil A, Lim PC, Kang E, Cantrell LA, Sullivan MW, Martino MA, Kratz MK, Kolev V, Tomita S, Leath CA, Boitano TKL, Doo DW, Feltmate C, Sugrue R, Olawaiye AB, Goldfeld E, Ferguson SE, Suhner J, Abu-Rustum NR. The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecol Oncol 2022; 166:417-424. [PMID: 35879128 PMCID: PMC9933771 DOI: 10.1016/j.ygyno.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. METHODS This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. RESULTS We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5). CONCLUSION This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.
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Affiliation(s)
- Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America.
| | - Qin C Zhou
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Benny Brandt
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Vasileios Sioulas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Katherine Lavigne Mager
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Mark Shahin
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Shaina Bruce
- Abington Jefferson Hospital, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Abington, PA, United States of America
| | - Destin R Black
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America; Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Carrie G Kay
- Willis-Knighton Physician Network, Shreveport, LA, United States of America
| | - Meeli Gandhi
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Maira Qayyum
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA, United States of America
| | - Jennifer Scalici
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Nathaniel L Jones
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Rajesh Paladugu
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States of America
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - R Wendel Naumann
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Monica D Levine
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Alberto Mendivil
- Gynecologic Oncology Associates, Hoag Cancer Center, Newport Beach, CA, United States of America
| | - Peter C Lim
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Elizabeth Kang
- Center of Hope, University of Nevada School of Medicine, Reno, NV, United States of America
| | - Leigh A Cantrell
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Mackenzie W Sullivan
- University of Virginia, Department of OB/GYN, Division of Gynecologic Oncology, Charlottesville, VA, United States of America
| | - Martin A Martino
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Melissa K Kratz
- Lehigh Valley Cancer Institute, Allentown, PA, United States of America
| | - Valentin Kolev
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Shannon Tomita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Charles A Leath
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Teresa K L Boitano
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - David W Doo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Colleen Feltmate
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Ronan Sugrue
- Brigham and Women's Hospital, Boston, MA, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Ester Goldfeld
- Department of Obstetrics, Gynecology and Reproductive Services, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Jessa Suhner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai West/Mount Sinai Morningside, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, United States of America
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9
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Baiocchi G, Ribeiro R, Dos Reis R, Lopes A, Zanvettor PH. ASO Author Reflections: Minimally Invasive Radical Hysterectomy in Cervical Cancer: A Brazilian Multicentric Cohort Study (CIRCOL). Ann Surg Oncol 2021; 29:1161-1162. [PMID: 34586522 DOI: 10.1245/s10434-021-10875-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Reitan Ribeiro
- Department of Gynecologic Oncology, Erasto Gaertner Hospital PPGTS/Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Andre Lopes
- Department of Gynecologic Oncology, Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brazil
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