Retrospective Analysis of Cervical Cancer Treatment Outcomes: Ten Years of Experience with the Vaginal Assisted Radical Laparoscopic Hysterectomy VARLH

Abstract

Background. LACC trial demonstrated inferiority of laparoscopic approach for the treatment of early-stage cervical cancer. There are still limited data from retrospective trials regarding whether survival outcomes after laparoscopic radical hysterectomy are equivalent to those after open abdominal radical hysterectomy. In this study, we present results of combined vaginal radical laparoscopic hysterectomy in the treatment of early-stage cervical cancer. Methods. This retrospective study was carried out at the Department of Gynecology in Mathilden Hospital (Herford, Germany). Between January 2008 and April 2018, all the patients with invasive cervical cancer who underwent combined vaginal assisted radical laparoscopic hysterectomy (VARLH) without the use of any uterine manipulator were enrolled to the study. Results. A total number of 124 patients with diagnosis of invasive cervical cancer were enrolled in the study. All of the patients underwent minimally invasive surgery and were divided according to FIGO 2019: stage IA (25.9%), IB1 (25.0%), IB2-IIB (28.4%), and III/IV (20.7%). Overall, the mean age of the patients was 51.84 years. After a study collection, a median follow-up was 45.6 (range 23.7-76.5) months. The 3- and 5-year disease-free survival rates for early-stage cervical cancer were both 98%, and the 3- and 5-year overall survival rates were 100% and 97%, respectively. We have not observed any recurrence in our study group of patients with early-stage cervical cancer. Conclusions. Combined VARLH can be considered a safe and effective procedure for the treatment of early-stage cervical cancer. Surgical strategy with oncological principles determines the quality and long-term success of the operation in early cervical cancer regardless of laparoscopic approach.

Complications of radical hysterectomy with pelvic lymph node dissection for cervical cancer: a 10-year single-centre clinical observational study

“…Previous studies have reported that laparoscopic surgery can reduce the incidence of complications [ 32 , 39 ]. Thus, surgeons who are highly proficient with open surgery can perform laparoscopic surgery to capitalize on the advantages of the latter, such as a smaller surgical wound, less bleeding, clear visual field, flexible operation, and quick postoperative recovery, thereby reducing the incidence of complications [ 40 , 41 ]. Robot-assisted laparoscopy offers the advantages of a high-definition three-dimensional field of view, multi-dimensional flexible Endowrist movements, and stable tremor-filtered operations over simple laparoscopic surgery, which can better reduce the incidence of complications, shorten postoperative recovery time, and improve patient quality of life [ 42 , 43 ].…”

Comparison of oncology outcome between laparotomy and laparoscopy in early cervical squamous cell carcinoma without any high risk pathological factors

“…In 2020, national comprehensive cancer network (NCCN) cervical cancer guideline [3] changed open surgery to the standard surgical approach. Later, many studies thought that there was no difference in oncology outcome between laparotomy and laparoscopic surgery for some cervical cancer staging [4][5] . In the limitations of LACC research, it was mentioned that this research failed to further analyze the differences of oncology outcomes between the two surgical approaches possibly caused by pathological factors, and the conclusion could not be extended to the oncology outcomes of low-risk cervical cancer patients.…”

The Role of Hysterectomy in Modern Gynaecological Surgery

“…L. A. Torres-de la Roche et al described a possible complication of uterine artery embolization and discussed the role of hysterectomy as a secondary intervention after treatment failure in uterus-sparing techniques [8]. While Q. Zhang et al described the impact of B7-H4 expression in precancerous lesions of the uterine cervix and the decision-making process regarding follow-up and conization in patients with CIN2 [9], R. Wojdat et al presented a retrospective analysis of their experience with vaginal assisted radical laparoscopic hysterectomy in patients with cervical cancer in the post-LACC trial era [10]. The role of hysterectomy in the management of obstetrical complications, especially in peripartum hemorrhage, has been reviewed by D. Tsolakidis et al [11].…”