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Zeng WH, Liang Y, Zhou JQ, Lin HH, Huang LS, He DF, Wen JZ, Wu BM, Liu HC, Zhong YX, Lei NX, Yang HK. Comparison of the efficacy and safety of total laparoscopic hysterectomy without and with uterine manipulator combined with pelvic lymphadenectomy for early cervical cancer. J Obstet Gynaecol Res 2023; 49:2468-2474. [PMID: 37488971 DOI: 10.1111/jog.15749] [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: 02/19/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Some studies have reported that the prognosis of total laparoscopic hysterectomy (TLH) for early-stage cervical cancer (CC) is worse than that of open surgery. And this was associated with the use of uterine manipulator or not. Therefore, this study retrospectively analyzes the efficacy and safety of TLH without uterine manipulator combined with pelvic lymphadenectomy for early-stage CC. METHODS Fifty-eight patients with CC (stage IB1-IIA1) who received radical hysterectomy from September 2019 to January 2020 were divided into no uterine manipulator (n = 26) and uterine manipulator group (n = 32). Then, clinical characteristics were collected and intraoperative/postoperative related indicators were compared. RESULTS Patients in the no uterine manipulator group had significantly higher operation time and blood loss than in the uterine manipulator group. Notably, there was no significant difference in hemoglobin change, blood transfusion rate, number of pelvic nodules, anal exhaust time, complications and recurrence rate between the two groups. Additionally, patients in the uterine manipulator group were prone to urinary retention (15.6%) and lymphocyst (12.5%), while the no uterine manipulator group exhibited high probability of bladder dysfunction (23.1%) and urinary retention (15.4%). Furthermore, the 1-year disease-free survival rate and the 1-year overall survival rate were not significantly different between the two groups. CONCLUSION There was no significant difference in the efficacy and safety of TLH with or without uterine manipulator combined with pelvic lymphadenectomy in the treatment of patients with early-stage CC. However, the latter requires consideration of the negative effects of high operation time and blood loss.
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Affiliation(s)
- Wei-Hong Zeng
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Ye Liang
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Jing-Qing Zhou
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Hai-Hong Lin
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Li-Shan Huang
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Dan-Feng He
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Ji-Zhong Wen
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Bo-Ming Wu
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Hao-Chang Liu
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Yao-Xiang Zhong
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Nan-Xiang Lei
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Hai-Kun Yang
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
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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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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 ).
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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.
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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.
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Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - 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
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Liu B, Lin J, Liu W, Chen W, Lin W, Chen W. Recurrence and Survival Rates of Patients Who Undergo Minimally Invasive Surgery for Endometrial Carcinoma with Different Prognostic Risk Groups. J INVEST SURG 2023; 36:1-10. [DOI: 10.1080/08941939.2022.2126565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bin Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jie Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Wenju Liu
- Department of Gastrointestinal Surgical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Weiting Chen
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Wanzhen Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Wei Chen
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Kondo E, Yoshida K, Kubo-Kaneda M, Nii M, Okamoto K, Magawa S, Nimua R, Okumura A, Okugawa T, Yamawaki T, Nagao K, Yoshimura K, Watashige N, Yanoh K, Ikeda T. Does Vaginal Cuff Creation and Avoidance of a Uterine Manipulator Improve the Prognosis of Total Laparoscopic Radical Hysterectomy for Early Cervical Cancer? A Retrospective Multicenter Study. Cancers (Basel) 2022; 14:cancers14184389. [PMID: 36139549 PMCID: PMC9497318 DOI: 10.3390/cancers14184389] [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: 07/10/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022] Open
Abstract
Our goal was to compare the treatment outcomes of open-abdominal radical hysterectomy (O-RH) and total laparoscopic hysterectomy (TLRH) with vaginal cuff creation and without using a uterine manipulator in stage IB1-B2 (tumor size < 4 cm) cervical cancer cases. In this retrospective multicenter analysis, 94 cervical cancer stage IB1-B2 patients who underwent O-RH or TLRH in six hospitals in Japan between September 2016 and July 2020 were included; 36 patients underwent TLRH. Propensity score matching was performed because the tumor diameter was large, and positive cases of lymph node metastases were included in the O-RH group due to selection bias. The primary endpoint was progression-free survival (PFS) and recurrence sites of TLRH and O-RH. PFS and OS (overall survival) were not significant in both the TLRH (n = 27) and O-RH (n = 27) groups; none required conversion to laparotomy. The maximum tumor size was <2 and ≥2 cm in 12 (44.4%) and 15 (55.6%) patients, respectively, in both groups. Reportedly, the TLRH group had lesser bleeding than the O-RH group (p < 0.001). Median follow-up was 33.5 (2−65) and 41.5 (6−75) months in the TLRH and O-RH groups, respectively. PFS and OS were not significantly different between the two groups (TLRH: 92.6%, O-RH: 92.6%; log-rank p = 0.985 and 97.2%, 100%; p = 0.317, respectively). The prognosis of early cervical cancer was not significantly different between TLRH and O-RH. Tumor spillage was prevented by creating a vaginal cuff and avoiding the use of a uterine manipulator. Therefore, TLRH might be considered efficient.
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Affiliation(s)
- Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
- Correspondence: ; Tel.: +81-59-232-1111; Fax: +81-59-231-5202
| | - Kenta Yoshida
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Michiko Kubo-Kaneda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Kota Okamoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Ryo Nimua
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Asumi Okumura
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
| | - Toshiharu Okugawa
- Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Ise 516-8512, Mie, Japan
| | - Takaharu Yamawaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Ise Hospital, Ise 516-8512, Mie, Japan
| | - Kenji Nagao
- Department of Obstetrics and Gynecology, Yokkaichi Municipal Hospotal, Yokkaichi 510-8567, Mie, Japan
| | - Kouichi Yoshimura
- Department of Obstetrics and Gynecology, Mie Central Medical Center, Tsu 514-1101, Mie, Japan
| | - Naoki Watashige
- Department of Obstetrics and Gynecology, Saiseikai Matsusaka General Hospital, Matsusaka 515-8557, Mie, Japan
| | - Kenji Yanoh
- Department of Obstetrics and Gynecology, Suzuka General Hospital, Suzuka 513-8630, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Mie, Japan
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