Laparoscopic Extrafascial Hysterectomy (Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer: Technical Aspects and Operative Outcomes

Favero, Giovanni; Pierobon, Juliana; Genta, Maria Luiza Nogueira Dias; Araújo, Magali; Miglino, Giovanni; Diz, Maria Del Carmen Pilar; Carvalho, Heloísa de Andrade; Fukushima, Júlia Tizue; Baracat, Edmund Chada; Carvalho, Jesus Paula

doi:10.1097/igc.0000000000000067

Cited by 25 publications

(15 citation statements)

References 31 publications

(36 reference statements)

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“…RD is recognized as a significant prognostic factor [ 15 ] due to its relation to incomplete response to CCRT and future local relapse. Favero et al [ 4 ] reported approximately 30% of the patients with complete clinical and radiologic response submitted to adjuvant hysterectomy had RD on histologic analysis of the specimen, and in 78% of these cases, histologic finding was AC, 50% of AC had pathologic residue disease. This was very similar to our results (47.0%), and the differences of recurrent pattern between the two groups also suggested that completion surgery is a rational method in control of regional and local recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…However, AC patients are associated with higher rate of lymph node metastasis [ 21 ]. In that case, previous study noted laparoscopic nodal staging before beginning of CCRT, although it would result in the execution of 2 surgical procedures and consequently, elevate morbidity [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many squamous cell carcinoma (SCC) can even be cured by CCRT [ 3 ]. Despite these improvements in SCC practice, emerging evidences suggest adenocarcinoma (AC) may be more radio-resistant [ 3 ] and nearly 50% of cases still have residual disease (RD) after CCRT [ 4 ]. RD after primary CCRT is directly associated to local recurrence.…”

Section: Introductionmentioning

confidence: 99%

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Extrafascial hysterectomy after concurrent chemoradiotherapy in locally advanced cervical adenocarcinoma

et al. 2016

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ObjectiveTo evaluate whether adjuvant simple hysterectomy after concurrent chemoradiotherapy (CCRT) improves progression-free survival (PFS) compared with current standard care in locally advanced cervical adenocarcinoma (LACAC).MethodsWe reviewed a cohort of 55 patients with LACAC (International Federation of Gynecology and Obstetrics [FIGO] stage IB2, IIA2, IIB, III without distant metastasis) diagnosed and treated with radical CCRT at Peking Union Medical College Hospital between January 2004 and October 2014. We compared 34 patients who underwent adjuvant extrafascial hysterectomy with 21 patients with standard care after CCRT. The primary outcome was PFS. Overall survivals (OS) between the two groups were also compared. Surgery feasibility, operative complications, and pathologic features after radiation therapy were also analyzed.ResultsPFS was significantly improved in surgery group (log-rank p=0.0097; hazard ratio [HR], 0.3431; 95% CI, 0.152 to 0.772), as were OS (log-rank p=0.0419; HR, 0.3667; 95% CI, 0.139 to 0.964). Analysis of stage IIB demonstrates a similar result. There were no severe complications related to postradiation surgery in this series. The mean blood loss was less in laparoscopic group than those in the open group (87 mL vs. 208 mL, p=0.036, Mann-Whitney U-test). Approximately 47% patients (16/34) had pathologic residue tumor on hysterectomy specimens. About 94% patients (32/34) got complete remission after adjuvant surgery.ConclusionAdjuvant hysterectomy after CCRT improves survival outcome for patients with LACAC compared with current standard care. Extrafascial hysterectomy is sufficient in tumor reduction and laparoscopic procedure may be more promising with lower blood loss and expedite recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Extrafascial hysterectomy after concurrent chemoradiotherapy in locally advanced cervical adenocarcinoma

et al. 2016

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“…The guidelines mention the procedure for situations where the radiation cannot be completed (degree of recommendation 3). 13 However, response to radiotherapy is worse for adenocarcinomas, 9,15,16 and a Brazilian study showed high rates of residual tumor in the surgical specimens of patients who underwent surgery 3-4 weeks after completion of treatment with radiotherapy and chemotherapy. 16 When surgery is indicated, salpingo-oophorectomy should be indicated along with hysterectomy 9,15,16 considering ovarian failure caused by radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Cervical cancer: what's new?

Sadalla

Andrade

Genta³

et al. 2015

Rev. Assoc. Med. Bras.

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Financial support: none Cervical cancer is the most common gynecological cancer in Brazil. Among women, it is the second most frequent, second only to breast cancer. It is the fourth leading cause of cancer death in the country, with estimated 15,590 new cases (2014) and 5,430 deaths (2013). In order to update information to improve outcomes, reduce morbidity and optimize the treatment of this cancer, this article will address the advancement of knowledge on cervical cancer. The topics covered include the role of surgery in different stages, treatment of locally advanced carcinomas, fertility preservation, the role of the sentinel lymph node technique, indications and techniques of radiotherapy and chemotherapy, and some special situations.

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“…To reduce the recurrences and improve survival in patients with high-risk factors, concurrent chemoradiation (CTRT) has long been held as the optimum postoperative adjuvant therapy (Favero et al, 2014;Sun et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Vaginal delivery of carboplatin-loaded thermosensitive hydrogel to prevent local cervical cancer recurrence in mice

Wang

et al. 2016

Drug Delivery

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Local tumor recurrence after cervical cancer surgery remains a clinical problem. Vaginal delivery of thermosensitive hydrogel may be suited to reduce tumor relapse rate with more efficacy and safety. A pilot study was carried out to evaluate the efficacy of carboplatin-loaded poloxamer hydrogel to prevent local recurrence of cervical cancer after surgery. In vivo vaginal retention evaluation of 27% poloxamer hydrogel in mice was proven to be a suitable vaginal drug delivery formulation due to its low gelation temperature. A mimic orthotopic cervical/vaginal cancer recurrence model after surgery was established by injecting murine cervical cancer cell line U14 into the vaginal submucosa to simulate the residual tumor cells infiltrated in the surgical site, followed by drug administration 24 h later to interfere with the formation/ recurrence of the tumor. By infusing fluorescein sodium-loaded hydrogel into the vagina of mice, a maximized accumulation of fluorescein sodium (Flu) in the vagina was achieved and few signals were observed in other organs. When used in the prevention of the cervical cancer formation/recurrence in mice, the carboplatin-loaded poloxamer hydrogel exhibited great efficacy and systemic safety. In conclusion, thermosensitive hydrogel presents a simple, practical approach for the local drug delivery via vagina against cervical cancer recurrence.

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Laparoscopic Extrafascial Hysterectomy (Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer: Technical Aspects and Operative Outcomes

Abstract: Laparoscopic extrafascial hysterectomy (completion surgery) after primary CRT in patients with apparent node-negative LACC is a feasible and safe strategy to improve tumor local control mainly in cases of adenocarcinoma.

Cited by 25 publications

References 31 publications

Extrafascial hysterectomy after concurrent chemoradiotherapy in locally advanced cervical adenocarcinoma

Extrafascial hysterectomy after concurrent chemoradiotherapy in locally advanced cervical adenocarcinoma

Cervical cancer: what's new?

Vaginal delivery of carboplatin-loaded thermosensitive hydrogel to prevent local cervical cancer recurrence in mice

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