Radical Hysterectomy After the LACC Trial: Back to Radical Vaginal Surgery

Querleu, Denis; Hudry, Délphine; Narducci, Fabrice; Rychlik, Agnieszka

doi:10.1007/s11864-022-00937-5

Cited by 6 publications

(6 citation statements)

References 56 publications

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“…Interestingly, since the publication of the LACC trial, radical hysterectomy by vaginal approach, which had been sidelined for years, has regained timely application in CC surgery [ 49 , 50 , 51 , 52 , 53 ]. The development of a vaginal manchette before performing laparoscopic radical hysterectomy may be an appropriate protective maneuver to avoid tumor spillage and potentially justify the minimally invasive approach by avoiding the negative outcomes of minimally invasive surgery in early-stage CC [ 54 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer

Chiofalo¹,

Laganà

Ghezzi

et al. 2023

IJERPH

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Background: The aim of our study was to compare the number of lymph nodes removed during indocyanine green (ICG)-guided laparoscopic/robotic pelvic lymphadenectomy with standard systematic lymphadenectomy in endometrial cancer (EC) and cervical cancer (CC). Methods: This is a multicenter retrospective comparative study (Clinical Trial ID: NCT04246580; updated on 31 January 2023). Women affected by EC and CC who underwent laparoscopic/robotic systematic pelvic lymphadenectomy, with (cases) or without (controls) the use of ICG tracer injection within the uterine cervix, were included in the study. Results: The two groups were homogeneous for age (p = 0.08), Body Mass Index, International Federation of Gynaecology and Obstetrics (FIGO) stages (p = 0.41 for EC; p = 0.17 for CC), median estimated blood loss (p = 0.76), median operative time (p = 0.59), and perioperative complications (p = 0.66). Nevertheless, the number of lymph nodes retrieved during surgery was significantly higher (p = 0.005) in the ICG group (n = 18) compared with controls (n = 16). Conclusions: The accurate and precise dissection achieved with the use of the ICG-guided procedure was associated with a higher number of lymph nodes removed in the case of systematic pelvic lymphadenectomy for EC and CC.

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Section: Discussionmentioning

confidence: 99%

Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer

Chiofalo¹,

Laganà

Ghezzi

et al. 2023

IJERPH

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“…Since the 1990s, little has been reported on preventative/protective measures to close the vaginal cuff to avoid tumor spillage into the peritoneal cavity during an open abdominal radical hysterectomy for early-stage cervical cancer. Daniel Dargent and Denis Querleu, both French gynecological cancer surgeons, pioneered in the 1990s the vaginal approach of protective vaginal cuff closure during radical vaginal hysterectomy (or trachelectomy) or during laparoscopic-assisted radical vaginal hysterectomy [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, most authors developed methods to make a protective vaginal cuff closure vaginally by using Chrobak forceps or several sutures after a circular incision of the vaginal mucosa [ 10 , 12 ]. These techniques are a possible addendum to all different approaches for radical hysterectomy (open, laparoscopic, or robotic-assisted).…”

Section: Discussionmentioning

confidence: 99%

“…Given the potential of peritoneal spread of tumor cells during the colpotomy phase of an MIH, large retrospective cohort studies have been published on the survival of MIH with vaginal cuff closure as a way to limit tumor cell spillage [ 6 , 8 , 10 - 12 ]. With this approach, the disease-free and overall survival seems to be similar to those of the OH group in the LACC trial [ 6 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…With this approach, the disease-free and overall survival seems to be similar to those of the OH group in the LACC trial [ 6 , 10 ]. The first modalities described for vaginal cuff closure were a vaginal approach during a radical vaginal hysterectomy (Shauta operation) and a radical vaginal trachelectomy (Dargent’s operation) [ 12 ]. In 2019, Kanao et al introduced the “no-look, no-touch technique” for laparoscopic radical hysterectomy [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Robotic Vaginal Cuff Closure During Radical Hysterectomy for Early-Stage Cervical Cancer: The Bruges Method

Lesseliers,

Van Trappen

2023

Cureus

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The only randomized trial (LACC trial, Laparoscopic Approach to Cervical Cancer), published in 2018, comparing the oncologic outcomes of minimally invasive and open surgery in early-stage cervical cancer, has shown inferior disease-free and overall survival for minimally invasive surgery. Subsequent large retrospective cohort studies of centers with long-standing experience in minimally invasive surgery and large nationwide cohort studies have shown that both the laparoscopic and robotic approaches have similar survival outcomes as the open surgery group in the LACC trial. Important protective measures to avoid tumor spillage in the peritoneal cavity during colpotomy were the closure of the vaginal cuff and avoiding the use of a uterine manipulator. Several methods have been described to close the vaginal cuff, mainly by a vaginal approach. Here we describe with a video a new technique of vaginal cuff closure during a robotic-assisted radical hysterectomy. During the robotic procedure, a purse string barbed suture is placed through the vaginal walls in order to close the vagina prior to colpotomy. The technique is a feasible, relatively fast, and easy-to-learn addition to the robotic radical hysterectomy procedure in early-stage cervical cancer.

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Vaginal Natural Orifice Transluminal Endoscopic Surgery for Treating Gynecologic Malignancies

Burnett

2024

Journal of Gynecologic Surgery

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Radical Hysterectomy After the LACC Trial: Back to Radical Vaginal Surgery

Cited by 6 publications

References 56 publications

Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer

Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer

Robotic Vaginal Cuff Closure During Radical Hysterectomy for Early-Stage Cervical Cancer: The Bruges Method

Vaginal Natural Orifice Transluminal Endoscopic Surgery for Treating Gynecologic Malignancies

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