How to Select Early-Stage Cervical Cancer Patients Still Suitable for Laparoscopic Radical Hysterectomy: a Propensity-Matched Study

Anchora, Luigi Pedone; Turco, Luigi Calrlo; Bizzarri, Nicolò; Capozzi, Vito Andrea; Lombisani, Andrea; Chiàntera, Vito; Felice, Francesca De; Gallotta, Valerio; Cosentino, Francesco; Fagotti, Anna

doi:10.1245/s10434-019-08162-5

Cited by 65 publications

(46 citation statements)

References 30 publications

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“…As a result, we should consider whether the operation quality and survival outcome of patients who underwent LRH can be improved by culturing more mature laparoscopy skills of attending surgeons and by performing these procedures using a single experienced gynecology team. In contrast, some researchers have indicated that LRH has beneficial survival outcomes in select cervical cancer patients ( 32 , 33 ). In our study, we explored whether the results would differ in groups of patients with unique features.…”

Section: Discussionmentioning

confidence: 96%

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

Qin

Huang

et al. 2020

Front. Oncol.

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Objective To investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer. Methods This retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000–2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups. Results The ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups ( P = 0.122, adjusted HR = 0.449, 95% CI: 0.162–1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively ( P = 0.578, adjusted HR = 0.650, 95% CI: 0.143–2.961). The presence of more than two comorbidities led to poor OS ( P = 0.011). For patients with a BMI greater than 24 kg/m 2 , LRH was associated with better PFS ( P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006–2012, 2013–2015, and 2016–2018 in the LRH group ( P = 0.126 and P = 0.583). Conclusion Compared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.

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Section: Discussionmentioning

confidence: 96%

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

Qin

Huang

et al. 2020

Front. Oncol.

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“…Recent studies evaluated the oncological outcomes in patients with cervical tumors ≤ 20 mm [24][25][26]; in particular, the study of Anchora et al [27] [27]. However, in a retrospective study of 815 women with tumor size ≤ 20 mm, in whom radical hysterectomy was performed by MIS in 255 cases and open surgery in 560 cases, the MIS approach was noted to be independently associated with a higher likelihood of recurrence (adjusted HR, 6.31; 95% CI 1.24-31.9) [28].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrence after Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer: A Multicenter Retrospective Study

Ponce

Fernández-González

Coronado

et al. 2020

Cancers

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This retrospective analysis aimed to assess the risk factors for recurrence in patients diagnosed with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spain and Portugal between 2009 and 2018. A second primary objective was to audit the oncological outcomes according to quality indicators (QI) proposed by the European Society of Gynecology Oncology (ESGO). The study population included 239 women. After a median follow-up of 51 months, recurrence occurred in 26 patients (10.9%). Independent factors for recurrence were clinical tumor size > 20 mm (hazard ratio (HR) 2.37), adenocarcinoma as histological type (HR 2.51), positive pelvic lymph nodes (HR 4.83), tumor grade 2 (HR 4.99), tumor grade 3 (HR 8.06), and having not performed sentinel lymph node biopsy (SLNB) (HR 4.08). All 5 QI selected were surpassed by our results. In patients with early-stage cervical cancer undergoing robotic radical hysterectomy, clinicians should be aware that tumor grade 2 and 3, tumor size > 20 mm, adenocarcinoma, positive pelvic nodes, and lack of performance of SLNB are risk factors for recurrence. Fulfillment of QI targets of the ESGO might be considered as an objective oncological outcome indicator supporting the minimally invasive approach for early-stage cervical cancer treatment.

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“…Our meta-analysis included 28 studies enrolling 18,961 patients with cervical cancer. Based on our overall meta-analysis results, minimally invasive radical hysterectomy lowered the OS or DFS rate as compared with the open approach for patients with When compared to other prognostic stratification, the use of the tumor dimension appears to be the most reliable (46). And we also conducted subgroup based on tumor dimension.…”

Section: Discussionmentioning

confidence: 99%

“…However, with regard to the patients with tumor diameter smaller than 2 cm, we can't give a reasonable explanation for the non-significant difference between the two groups. And some authors explained that in case of larger tumors, the use of a uterine manipulator may squeeze them, which may result cancer spread (34,46).…”

Section: Discussionmentioning

confidence: 99%

Survival After Minimally Invasive vs. Open Radical Hysterectomy for Cervical Cancer: A Meta-Analysis

Wang

Ren

et al. 2020

Front. Oncol.

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Background: The comparison of survival outcomes between minimally invasive surgery and open surgery for cervical cancer patients remains controversial. We evaluated the survival outcomes of cervical cancer patients who underwent different surgical approaches. Methods: A literature search was performed in PubMed, Embase, and Cochrane databases up to February 2020, using the MESH terms "minimally invasive surgical procedures" and "Uterine Cervical Neoplasms." Included were all original comparative studies and trials both published and unpublished in English that were related to minimally invasive surgery and open surgery for cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage < IIB. Begg's and Egger's regressions were used to evaluate publication bias. Results: This meta-analysis included 28 studies enrolling 18,961 patients with cervical cancer. The overall analyses indicated that cervical cancer patients with FIGO 2009 stage < IIB who underwent minimally invasive surgery had a lower rate of OS (HR = 1.43, 95% CI = 1.06-1.92, P = 0.019) and DFS (HR = 1.50, 95% CI = 1.21-1.85, P < 0.001) than those who underwent open surgery. Moreover, minimally invasive surgery could lower OS (HR = 2.30, 95% CI = 1.50-3.52, P < 0.001) and DFS (HR = 1.94, 95% CI = 1.36-2.76, P < 0.001) of cervical cancer patients with FIGO 2009 stage ≤ IB1 compared to open surgery. However, there were no significant differences in OS (HR = 1.07, 95% CI = 0.65-1.76, P = 0.801) and DFS (HR = 1.20, 95% CI = 0.65-2.19, P = 0.559) in patients with tumors < 2 cm between the two groups. Conclusions: Minimally invasive radical hysterectomy was associated with poor survival outcomes compared to open surgery. Patients with FIGO 2009 stage ≤ IB1 cervical cancer who underwent minimally invasive surgery have lower OS and DFS rates than those who underwent open surgery. Therefore, open surgery should be performed for cervical cancer patients. However, patients with tumors < 2 cm might take the most advantage of minimally invasive surgery without increasing poor prognosis. There are some limitations in the meta-analysis, which needs further high-quality multicenter studies to confirm and update our findings.

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How to Select Early-Stage Cervical Cancer Patients Still Suitable for Laparoscopic Radical Hysterectomy: a Propensity-Matched Study

Cited by 65 publications

References 30 publications

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

Risk Factors for Recurrence after Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer: A Multicenter Retrospective Study

Survival After Minimally Invasive vs. Open Radical Hysterectomy for Cervical Cancer: A Meta-Analysis

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