Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer

Kong, Tae-Wook; Chang, Suk-Joon; Piao, Xianling; Paek, Jiheum; Lee, Yonghee; Lee, Eun Ju; Chun, Mison; Ryu, Hee Sug

doi:10.1111/jog.12840

Cited by 140 publications

(105 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, exposing the tumor to circulating carbon dioxide can lead to loco-regional tumor implants 28. Despite some reservations regarding manipulator application,29 it has been widely used and considered safe among most gynecologic oncologists 6 30. In contrast, our group has established a surgical technique combining a laparoscopic and vaginal approach,14 in which we never used any uterine manipulator and always created a tumor-covering vaginal cuff transvaginally.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Köhler

Hertel

Herrmann

et al. 2019

Int J Gynecol Cancer

150

View full text Add to dashboard Cite

ObjectiveLaparoscopic/robotic radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC) has demonstrated significant inferiority of the minimally invasive approach. The aim of this study is to evaluate the oncologic outcomes of combined laparoscopic-vaginal radical hysterectomy.MethodsBetween August 1994 and December 2018, patients with invasive cervical cancer were treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to the LACC trial were identified. In contrast to the laparoscopic/robotic technique used in the LACC trial, all patients in our cohort underwent a combined transvaginal-laparoscopic approach without the use of any uterine manipulator.ResultsA total of 1952 consecutive patients with cervical cancer were included in the analysis. Initial International Federation of Gynecology and Obstetrics (FIGO) stage was IA1 lymphovascular space invasion (LVSI+), IA2 and IB1/IIA1 in 32 (8%), 43 (11%), and 314 (81%) patients, respectively, and histology was squamous cell in 263 (68%), adenocarcinoma in 117 (30%), and adenosquamous in 9 (2%) patients. Lymphovascular invasion was confirmed in 106 (27%) patients. The median number of lymph nodes was 24 (range 2–86). Lymph nodes were tumor-free in 379 (97%) patients. Following radical hysterectomy, 71 (18%) patients underwent adjuvant chemoradiation or radiation. After a median follow-up of 99 (range 1–288) months, the 3-, 4.5-, and 10-year disease-free survival rates were 96.8%, 95.8%, and 93.1 %, and the 3-, 4.5-, and 10-year overall survival rates were 98.5%, 97.8%, and 95.8%, respectively. Recurrence location was loco-regional in 50% of cases with recurrence (n=10). Interestingly, 9/20 recurrences occurred more than 39 months after surgery.ConclusionThe combined laparoscopic-vaginal technique for radical hysterectomy with avoidance of spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery may be oncologically safe and should be validated in further randomized trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Köhler

Hertel

Herrmann

et al. 2019

Int J Gynecol Cancer

150

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…As mentioned in the introduction, peritoneal dissemination of cervical cancer cells by intracorporal colpotomy may be the main factor for increased recurrence rates in patients treated by laparoscopic radical hysterectomy. 1,8,9,[14][15][16][17][18] Some findings indicate a prognostic role of tumor cell spillage potomy is essential to prevent peritoneal tumor dissemination. [6][7][8] Therefore, a vaginal cuff is formed to cover the cervix completely Other experts criticize the frequent use of uterine manipulators during laparoscopic radical hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

“…for cervical cancer. The study by Kong et al16 on 128 patients described a significantly increased recurrence rate in patients treated with intracorporal colpotomy compared with vaginal colpotomy for laparoscopic radical hyterectomy (16.3% vs 5.1%, P = 0.057). 16 Additionally, analyzing the recurrence patterns of the patients treated in the LACC study, patients in the laparoscopy group more frequently suffered from non-vaginal peritoneal recurrences.…”

mentioning

confidence: 98%

See 1 more Smart Citation

Peritoneal contamination with ICG‐stained cervical secretion as surrogate for potential cervical cancer tumor cell dissemination: A proof‐of‐principle study for laparoscopic hysterectomy

Klapdor

Hertel

Hillemanns

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction Intracorporal colpotomy during radical hysterectomy for cervical cancer is discussed to be a risk factor for peritoneal dissemination of tumor cells. It might lead to increased recurrence rates after laparoscopic radical hysterectomy compared with abdominal hysterectomy, as shown by the recent LACC study. Data on the frequency or mechanisms of peritoneal contamination are missing. We aimed to analyze peritoneal contamination of cervical secretion during intracorporal colpotomy with a novel indocyaningreen (ICG)‐based technique. Material and methods In this prospective proof‐of‐principle study, patients undergoing routine laparoscopic or robot‐assisted hysterectomy were selected. ICG was specifically applied to the cervical surface and routine surgery was performed. During colpotomy, pictures under white and fluorescence light were taken to evaluate frequency of contamination. Results By using cervically applied ICG we were able to visualize directly peritoneal contamination with cervical secretion during intracorporal colpotomy. We detected peritoneal contamination in 9/12 (75%) patients undergoing routine laparoscopic hysterectomy. Contamination of laparoscopic instruments occurred in 60% of the patients. When contamination occurred, it was routinely detectable during all steps of colpotomy. There were no adverse effects during surgery. Conclusions Peritoneal contamination with cervical secretion frequently occurs during intracorporal colpotomy. This novel technique represents a promising tool for feasible and direct visualization of peritoneal contamination during colpotomy. The technique may be easily implemented in further studies on laparoscopic and abdominal hysterectomy and serve as a quality assessment tool for surgeons and surgical techniques.

show abstract

“…This supports the possible role of peritoneal diffusion of neoplastic cells from the embolization of the tumor and the pneumoperitoneum in minimally invasive surgery. This topic was evaluated by Kong et al13 in a retrospective analysis of 128 patients with FIGO stage IB and IIA cervical cancer, who underwent laparoscopic or robotic radical hysterectomy. Multivariate analysis demonstrated that laparoscopic intra-corporeal colpotomy represented a strong prognostic factor related to disease recurrence (OR=7.04, 95% CI 1.06 to 15.18; p<0.041), with five patients who presented peritoneal recurrence in this group.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive radical hysterectomy: an analysis of oncologic outcomes from Hospital Italiano (Argentina)

Odetto

Puga

Saadi

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

BackgroundThe Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated a higher rate of disease recurrence and worse disease-free survival in patients who underwent minimally invasive radical hysterectomy.ObjectivesTo evaluate surgical and oncological outcome of laparoscopic radical hysterectomy performed at Hospital Italiano in Buenos Aires, Argentina.MethodsThis retrospective study included all patients with cervical cancer, 2009 FIGO stage IA1, with lymphovascular invasion to IB1 (<4 cm) who underwent a laparoscopic radical hysterectomy between June 2010 and June 2015. Patients were eligible if they had squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, and no lymph node involvement by imaging. Patients must have undergone a type C1 radical hysterectomy. Only patients who were treated by a laparoscopic approach were included. Patients were excluded if histopathology showed a component of neuroendocrine carcinoma before or after surgery; if they had synchronous primary tumors, history of abdominal or pelvic radiotherapy, or were operated on at an outside institution; and if they had only surgery and no follow-up in our institution. Relapse rate and disease-free survival were evaluated using the Kaplan-Meier method.ResultsA total of 108 patients were evaluated. The median age was 41 years (range 27–70). Distribution of histologic sub-types was squamous carcinoma in 77 patients (71%), adenocarcinoma in 27 patients (25%), and adenosquamous carcinoma in four patients (4%). Ninety-nine patients (92%) had stage IB1 tumors and 58 (54%) patients had tumors ≤2 cm. The median surgical time was 240 min (range 190–290), the median estimated blood loss was 140 mL (range 50–500) and the transfusion rate was 3.7%. The median length of hospital stay was 2 days (range 1–11). The median follow-up time was 39 months (range 11–83). The global recurrence rate after laparoscopic radical hysterectomy was 15% (16/108). According to tumor size, the recurrence rate was 12% in patients with tumors ≤2 cm (7/58) and 18% in patients with tumors >2 cm (9/50) (OR=0.76; 95% CI 0.26 to 2.22; p=0.62) The 3- and 5-year relapse rate was 17% (95% CI 11% to 27%). The 3- and 5-year disease-free survival was 81% (95% CI 71% to 88%) and 70% (95% CI 43% to 86%), respectively. Overall survival at 3 years was 87% (95% CI 76% to 93%).ConclusionThe recurrence rate after laparoscopic radical hysterectomy was 15%, and in tumors ≤2 cm it was 12%. The 3-year disease-free survival was 81%. Given these results our hospital has changed the approach to open radical hysterectomy.

show abstract

Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer

Abstract: Total laparoscopic/robotic intracorporeal colpotomy under CO2 pneumoperitoneum may carry a risk of positive vaginal cuff margin, as well as intraperitoneal tumor spreads in patients with early-stage cervical cancer treated with LRH/RRH.

Cited by 140 publications

References 30 publications

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Peritoneal contamination with ICG‐stained cervical secretion as surrogate for potential cervical cancer tumor cell dissemination: A proof‐of‐principle study for laparoscopic hysterectomy

Minimally invasive radical hysterectomy: an analysis of oncologic outcomes from Hospital Italiano (Argentina)

Contact Info

Product

Resources

About