Long-term oncological outcomes of minimally invasive radical hysterectomy for early-stage cervical cancer: A retrospective, single-institutional study in the wake of the LACC trial

AIM

The objective of this study was to investigate the long-term oncological outcomes of minimally invasive radical hysterectomy (MIRH) for the treatment of early-stage cervical cancer retrospectively in the wake of the laparoscopic approach to cervical cancer (LACC) trial.

METHODS

A total of 109 patients with stage IA1 with lymphovascular space involvement, IA2, and IB1 cervical cancers were included in this study. The surgical and oncological outcomes were retrospectively evaluated. All patients underwent type C MIRH with a no-touch isolation technique for cervical tumor.

RESULTS

The median number of resected pelvic lymph nodes was 36 (range, 14-94), and 10 patients (9.2%) had positive nodes. One patient (0.9%) had positive surgical margins. Forty-six patients (42%) underwent adjuvant therapy. The median follow-up time was 73 months (range, 30-146 months). Five patients (4.6%) developed recurrent disease, and 3 patients (2.8%) died of cervical cancer. The 5-year disease-free survival and overall survival rates were 96.3% and 97.2%, respectively. A comparison between patients with tumor diameter ≤ 2 cm (n = 59) and those with tumor diameter > 2 cm (n = 50) did not identify any significant differences, with 5-year disease-free survival 96.6% versus 94.0% and 5-year overall survival 98.3% versus 96.0%, respectively.

CONCLUSION

In this retrospective study, MIRH with a no-touch isolation technique for stage IA to IB1 cervical cancer was a safe approach in terms of oncological outcomes. However, every surgeon who treats early-stage cervical cancer should inform each patient of the results of the LACC trial because it has an exceedingly high impact.

[Development of gamete intrafallopian transfer with preincubated preovulatory oocytes (new GIFT) and analysis of clinical data]

We developed a new treatment, Gamete Intrafallopian Transfer with the preincubated oocyte (New GIFT) and applied this method to all kinds of infertility where the patient had at least one tube. We performed 114 New GIFTs and dealt with the factors which influenced the establishment of pregnancy. 1. The pregnancy rate was 37%/cycles (42/114), 42%/patients (42/100) and the abortion rate was 19% (8/42). These results show that the New GIFT was more efficient than the original GIFT. 2. The most important factor for the establishment of pregnancy among the semen parameters was sperm motility, especially at the time of insemination. The pregnancy rate increased as sperm motility became higher. The sperm count did not influence the pregnancy rate significantly except in severe cases of oligozoospermia. 3. The most important factor in oocyte assessment was the number of mature oocytes. The number of oocytes in the pregnant group was much more than that in the nonpregnant group, but the total number of follicles in the pregnant group was found to be from 3 to 7 follicles. No pregnancy occurred when the number of follicles was greater than 11. These results suggested that existence an optimum number of oocytes. Conditions of the corona-cumulus component complex closely related to the establishment of pregnancy. The pregnancy rate was about 60% when more than 2C (-) oocytes (almost all cumulus cells were dispersed) were transferred, but it was only 5% when only C (+) oocytes (hardly any cumulus cells were dispersed) were transferred. 4. The most effective luteal support regimen was the pill. The administration of progesterone induced a high percentage of abortions.