Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis

Hoegl, Jorge; Viveros‐Carreño, David; Palacios, Tatiana; Ardila, Andres Gallego -; Rauh-Hain, Jose Alejandro; Estrada, Erick; Noll, Florencia; Krause, Kate; Baiocchi, Glauco; Minig, Lucas; Ardila, Carlos Fernando Grillo -; Pareja, René

doi:10.1136/ijgc-2022-003937

Cited by 8 publications

(5 citation statements)

References 49 publications

(71 reference statements)

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“…Squamous neoplastic cells shed from cervical tumors may grow slowly, as these patients developed late recurrences, 13 and 5 years after hysterectomy, respectively [17,19]. In women with cervical carcinoma treated with minimally invasive surgery, implantation metastasis is known to develop more often than open surgery [20]. This case indicates that the peritoneal recurrence of squamous cell carcinoma that developed in a nonirradiated area appears to be radiosensitive and cured with radiation.…”

Section: Discussionmentioning

confidence: 99%

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Peritoneal Recurrence of Squamous Cell Carcinoma in a Young Woman After Conization for Microinvasive Cervical Cancer

Otsuka

2024

Cureus

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Microinvasive squamous cell carcinoma of the cervix develops mainly in young women. As metastases rarely occur, cervical conization to preserve fertility is often performed. We report a case of peritoneal recurrence developed after conization. A 31-year-old nulligravid woman with microinvasive squamous cell carcinoma of the cervix was treated with laser conization. Pathology showed a stromal invasion of <1 mm and a longitudinal spread of 3 mm without lymphovascular space involvement. Forty-seven months after conization, a pelvic examination revealed a firm, immobile mass on the right side of the pelvis. Transvaginal ultrasonography and magnetic resonance imaging showed a 3.8-cm solid mass located right of the rectum and anterior to the sacrum. A fine-needle biopsy showed squamous cell carcinoma. The tumor was diagnosed as a metastasis of cervical carcinoma. After salvage concurrent chemoradiation, the patient was well and had no evidence of disease at 90 months after the treatment. In this case, tumor cells appear to spread through the endometrial cavity and the lumen of the fallopian tube.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Peritoneal Recurrence of Squamous Cell Carcinoma in a Young Woman After Conization for Microinvasive Cervical Cancer

Otsuka

2024

Cureus

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“…Tumor seeding, either from uterine manipulator placement or tumor exposure to the intraperitoneal cavity during the performance of colpotomy, is hypothesized to be one of the causes of increased risk of relapse with minimally invasive radical hysterectomy. A recent systematic review and meta-analysis that examined patterns of recurrence included data on 7626 patients derived from 22 studies and found that, compared to the open approach, minimally invasive radical hysterectomy was associated with a higher risk of peritoneal carcinomatosis (OR: 1.90, 95% CI: 1.32, 2.74) [ 22 ]. Protective maneuvers such as avoidance of uterine manipulator, closure of the vaginal cuff before colpotomy, and preoperative conization can eliminate or mitigate the risk of peritoneal tumor seeding.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Radical Hysterectomy for Early-Stage Cervical Carcinoma, with or without Prior Cervical Excision Procedure

Nasioudis,

Labban,

Gysler

et al. 2024

Cancers

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Objective: To investigate the impact of a prior cervical excisional procedure on the oncologic outcomes of patients with apparent early-stage cervical carcinoma undergoing radical hysterectomy. Methods: The National Cancer Database (2004–2015) was accessed, and patients with FIGO 2009 stage IB1 cervical cancer who had a radical hysterectomy with at least 10 lymph nodes (LNs) removed and a known surgical approach were identified. Patients who did and did not undergo a prior cervical excisional procedure (within 3 months of hysterectomy) were selected for further analysis. Overall survival (OS) was evaluated following the generation of Kaplan–Meier curves and compared with the log-rank test. A Cox model was constructed to control a priori-selected confounders. Results: A total of 3159 patients were identified; 37.1% (n = 1171) had a prior excisional procedure. These patients had lower rates of lymphovascular invasion (29.2% vs. 34.9%, p = 0.014), positive LNs (6.7% vs. 12.7%, p < 0.001), and a tumor size >2 cm (25.7% vs. 56%, p < 0.001). Following stratification by tumor size, the performance of an excisional procedure prior to radical hysterectomy was associated with better OS even after controlling for confounders (aHR: 0.45, 95% CI: 0.30, 0.66). The rate of minimally invasive surgery was higher among patients who had a prior excisional procedure (61.5% vs. 53.2%, p < 0.001). For these patients, performance of minimally invasive radical hysterectomy was not associated with worse OS (aHR: 1.37, 95% CI: 0.66, 2.82). Conclusions: For patients undergoing radical hysterectomy, preoperative cervical excision may be associated with a survival benefit. For patients who had a prior excisional procedure, minimally invasive radical hysterectomy was not associated with worse overall survival.

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“…Beyond the increased risk of recurrence, the recurrence pattern diverges notably following minimally invasive radical hysterectomy for cervical cancer compared to open surgery. Specifically, minimally invasive radical hysterectomy exhibits a statistically significant association with a higher risk of peritoneal carcinomatosis [16]. Microscopic peritoneal spread at the time of surgery can lead to subsequent growth since most cervical cancer patients do not receive adjuvant therapy after a radical hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Minimally Invasive Surgery with Open Surgery for Type II Endometrial Cancer: An Analysis of the National Cancer Database

Zhang,

Silver,

Chen

et al. 2023

Healthcare

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Objective: Prior studies comparing minimally invasive surgery with open surgery among patients with endometrial cancer have reported similar survival outcomes and improved perioperative outcomes with minimally invasive surgery (MIS). However, patients with Type II endometrial cancer were underrepresented in these studies. We sought to compare the overall survival and surgical outcomes between open surgery and MIS in a large cohort of women with Type II endometrial cancer. Methods: Using data from the National Cancer Database, we identified a cohort of women who underwent hysterectomy for type II endometrial cancer (serous, clear cell, and carcinosarcoma) between January 2010 and December 2014. The primary outcome was a comparison of the overall survival for MIS with that for the open approach. The secondary outcomes included a comparison of the length of hospital stay, readmission within 30 days of discharge, and 30- and 90-day mortality. Outcomes were compared between the cohorts using the Mann–Whitney U test, Pearson’s chi-square test, or Fisher’s exact test. Multivariable logistic regression with inverse propensity weighting was used to determine clinical characteristics that were statistically significant predictors of outcomes. p values < 0.05 were considered significant. Results: We identified 12,905 patients with Type II, Stage I–III endometrial cancer that underwent a hysterectomy. In total, 7123 of these women (55.2%) underwent MIS. The rate of MIS increased from 39% to 64% over four years. Women who underwent MIS were more often White, privately insured, older, and had a higher income. The laparotomy group had a higher rate of carcinosarcoma histology (30.9% vs. 23.6%, p < 0.001), stage III disease (38.4% vs. 27.4%, p < 0.001), and larger primary tumors (59 vs. 45 mm, p < 0.001). Lymph node dissection was more commonly performed in the MIS group (89.6% vs. 85.4%, p < 0.001). With regard to adjuvant therapy, subjection to postoperative radiation was more common in the MIS group (37% vs. 40.1%, p < 0.001), while chemotherapy was more common in the laparotomy group (37.6% vs. 33.9%, p < 0.001). The time interval between surgery and the initiation of chemotherapy was shorter in the MIS group (39 vs. 42 days, p < 0.001). According to the results of propensity-score-weighted analysis, MIS was associated with superior overall survival (101.7 vs. 86.7 months, p = 0.0003 determined using the long-rank test), which corresponded to a 10% decreased risk of all-cause mortality (HR 0.9; CI 0.857–0.954, p = 0.0002). The survival benefit was uniform across all three histology types and stages. MIS was associated with superior perioperative outcomes, including shorter length of stay (1 vs. 4 days, p < 0.001), lower 30-day readmission rates (2.5% vs. 5%), and lower 30- and 90-day postoperative mortality (0.5% vs. 1.3% and 1.5% vs. 3.6%, respectively; p < 0.001 for both). The increased adoption of MIS from 2010 to 2014 corresponds to a decrease in 90-day postoperative mortality (2.8% to 2.2%, r = −0.89; p = 0.04) and overall mortality (51% to 38%, r = −0.95; p = 0.006). Conclusions: In a large cohort of patients from the National Cancer Database, MIS was associated with improved overall survival and superior perioperative outcomes compared to open surgery among women with Type II endometrial cancer. A decrease in postoperative mortality and a shorter interval between surgery and the initiation of chemotherapy may contribute to the survival benefit of MIS. A racial and economic disparity in the surgical management of Type II endometrial cancer was identified, and further investigation is warranted to narrow this gap and improve patient outcomes.

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Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis

Cited by 8 publications

References 49 publications

Peritoneal Recurrence of Squamous Cell Carcinoma in a Young Woman After Conization for Microinvasive Cervical Cancer

Peritoneal Recurrence of Squamous Cell Carcinoma in a Young Woman After Conization for Microinvasive Cervical Cancer

Outcomes of Radical Hysterectomy for Early-Stage Cervical Carcinoma, with or without Prior Cervical Excision Procedure

Comparison of Minimally Invasive Surgery with Open Surgery for Type II Endometrial Cancer: An Analysis of the National Cancer Database

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