Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis

Ronsini, Carlo; Köhler, Christian; Franciscis, Pasquale De; Verde, Marco La; Mosca, Lavinia; Solazzo, Maria Cristina; Colacurci, Nicola

doi:10.1016/j.ygyno.2022.04.010

Cited by 24 publications

(26 citation statements)

References 47 publications

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“…Surgery is still the main treatment method for early cervical cancer, particularly laparoscopic minimally invasive surgery is currently a popular surgical method. However, combined with the prospective large-scale clinical study LACC trial (Laparoscopic Approach to Cervical Cancer) and meta-analysis ( 29 , 30 ), it was concluded that this surgical method did not benefit the survival of these patients. In our study, we mainly focus on RSS, primary site surgery and RLNS.…”

Section: Discussionmentioning

confidence: 99%

Nomogram models for the prognosis of cervical cancer: A SEER-based study

Jiang

et al. 2022

Front. Oncol.

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BackgroundCervical cancer (CC) is one of the most common cancers in women. This study aimed to investigate the clinical and non-clinical features that may affect the prognosis of patients with CC and to develop accurate prognostic models with respect to overall survival (OS) and cancer-specific survival (CSS).MethodsWe identified 11,148 patients with CC from the SEER (Surveillance, Epidemiology, and End Results) database from 2010 to 2016. Univariate and multivariate Cox regression models were used to identify potential predictors of patients’ survival outcomes (OS and CSS). We selected meaningful independent parameters and developed nomogram models for 1-, 3-, and 5-year OS and CSS via R tools. Model performance was evaluated by C-index and receiver operating characteristic curve. Furthermore, calibration curves were plotted to compare the predictions of nomograms with observed outcomes, and decision curve analysis (DCA) and clinical impact curves (CICs) were used to evaluate the clinical effectiveness of the nomograms.ResultsAll eligible patients (n=11148) were randomized at a 7:3 ratio into training (n=7803) and validation (n=3345) groups. Ten variables were identified as common independent predictors of OS and CSS: insurance status, grade, histology, chemotherapy, metastasis number, tumor size, regional nodes examined, International Federation of Obstetrics and Gynecology stage, lymph vascular space invasion (LVSI), and radiation. The C-index values for OS (0.831 and 0.824) and CSS (0.844 and 0.841) in the training cohorts and validation cohorts, respectively, indicated excellent discrimination performance of the nomograms. The internal and external calibration plots indicated excellent agreement between nomogram prediction and actual survival, and the DCA and CICs reflected favorable potential clinical effects.ConclusionsWe constructed nomograms that could predict 1-, 3-, and 5-year OS and CSS in patients with CC. These tools showed near-perfect accuracy and clinical utility; thus, they could lead to better patient counseling and personalized and tailored treatment to improve clinical prognosis.

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Section: Discussionmentioning

confidence: 99%

Nomogram models for the prognosis of cervical cancer: A SEER-based study

Jiang

et al. 2022

Front. Oncol.

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“…A recent systematic review and meta-analysis, including 3196 patients, aimed to prove the safety of Laparo-Assisted Vaginal Hysterectomy (LAVRH) in early-stage cervical cancer. LARVH does not affect DFS and OS in ECC patient, and showed overlapping results in the open surgery group [ 8 ]. A multicentric Italian study, considering the oncological outcome of patients with FIGO stage IA (positive lymphovascular space invasion)−IB1, tried to investigate the possible surgery-related factors associated with poorer oncologic outcomes in patients who underwent laparoscopic surgery; they concluded that tumor size (≥2 cm) represents the most important risk factor influencing the oncological outcomes [ 9 ].…”

Section: Minimally Invasive Surgery: Still a Safe Option?mentioning

confidence: 99%

New Advances in Cervical Cancer: From Bench to Bedside

D’Oria

Corrado

Laganà

et al. 2022

IJERPH

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Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) has emerged as the mainstay in the surgical management of early-stage cervical cancer, bringing advantages such as a lower operative morbidity and shorter hospital stay compared to open surgery, while maintaining comparable oncologic outcomes in numerous retrospective studies. Considering oncological patients, it is mandatory to assess the oncological outcomes and safety of this type of surgery. Moreover, there are different future outlooks on cervical cancer therapy, based on immunotherapy, target therapy, and poly-ADP-ribose polymerases (PARP) inhibitors in combination with each other, and in combination with standard chemotherapy and radiotherapy. The goal is to find an approach that is as personalized as possible.

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“…On the other hand, minimally invasive techniques deserve a separate discussion, where the RR of laparoscopic approaches has a peak of 31% in the study by Park et al 25 This funding aligns with the current scientific evidence regarding the best surgical approach for radical hysterectomy in tumors ≥ 2 cm. 8 , 60 Even if heterogeneity of the adopted therapy schemes and the completion surgeries makes a direct comparison almost impossible, the group of works on NACT FST showed, on average, higher RR (5.5–22.2%) compared with ART (0–12.9%). Moreover, the surgical approach could condition the pattern of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

et al. 2022

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Background Fertility-sparing treatments (FSTs) have played a crucial role in the management of early-stage cervical cancer (ECC). The guidelines have recognized various approaches, depending on the tumor stage and other risk factors such as histotype and lymphovascular positivity. Much more debate has centered around the boundary within which these treatments should be considered. Indeed, these are methods to be reserved for ECC, but tumor size may represent the most significant limitation. In particular, there is no consensus on the strategy to be adopted in the case of ECC ≥ 2 cm. Therefore, this systematic review was to collect the literature evidence regarding the management of these patients. Methods Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the Pubmed and Scopus databases was conducted in April 2022, from the date of the first publication. We made no limitation on the country. We included all studies containing data on disease-free survival, overall survival, recurrence rate (RR), or complete response rate (CRR) to chemotherapy. Results Twenty-six studies fulfilled the inclusion criteria, and 691 patients were analyzed regarding FST. Surgery-based FST showed an RR of between 0 and 42.9%, which drops to 12.9% after excluding the vaginal or minimally invasive approaches. Furthermore, papers regarding FST based on the neoadjuvant chemotherapy (NACT) approach showed a CRR of between 21.4 and 84.5%, and an RR of between 0 and 22.2% Conclusion This paper focused on the significant heterogeneity present in the clinical management of FST of ECC ≥ 2 cm. Nevertheless, from an oncological point of view, approaches limited to the minimally invasive or vaginal techniques showed the highest RR. Vice versa, the lack of standardization of NACT schemes and the wealth of confounders to be attributed to the histological features of the tumor make it difficult, if not impossible, to set a standard of treatment.

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Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis

Cited by 24 publications

References 47 publications

Nomogram models for the prognosis of cervical cancer: A SEER-based study

Nomogram models for the prognosis of cervical cancer: A SEER-based study

New Advances in Cervical Cancer: From Bench to Bedside

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

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