Revisiting Minimally Invasive Surgery in the Management of Early-Stage Cervical Cancer

Pennington, Kathryn P.; Urban, Renata R.; Gray, Heidi J.

doi:10.6004/jnccn.2018.7263

Cited by 17 publications

(8 citation statements)

References 10 publications

(15 reference statements)

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“…In our hospital, the TLH technique is essentially based on an extra-fascial procedure, given the possibility of neoplastic lesions. We note that minimally invasive surgery for cervical malignant tumors has been suggested to be inferior to open Open Journal of Obstetrics and Gynecology surgery in terms of oncologic outcome [14] [15]. Thus, given this point, careful consideration should be given to the indication of TLH for cervical cystic lesions.…”

Section: Discussionmentioning

confidence: 93%

Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series

Morisada¹,

Tanaka²,

Iijima³

et al. 2020

OJOG

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Objective: Cervical cystic lesions are often observed in gynecological clinical practice. Many are caused by benign diseases such as lobular endocervical glandular hyperplasia (LEGH), and it is important to differentiate these lesions from those due to malignant diseases such as minimal deviation adenocarcinoma (MDA). In cases in which fertility preservation is not a concern, the final pathology is often confirmed by hysterectomy. To investigate the feasibility and safety of laparoscopic surgery for cervical cystic lesions, we retrospectively examined cases in which total laparoscopic hysterectomy (TLH) was performed for diagnosis and treatment. Methods: The subjects were 28 women who underwent TLH from April 2012 to March 2017 at Keio University Hospital. The pre-and post-operative courses of these patients were examined. Results: The average age was 49.4 (range 39-65) years and the mean body mass index was 21.7 (16.8-30.5) kg/m 2. The average operation time was 159 (101-314) min and the average bleeding volume was 106.8 (0-600) g. There were no severe perioperative complications. The average hospital stay was 8.4 (7-14) days. In postoperative pathological diagnosis, 13 cases had benign diseases such as Nabot cysts, there were 14 cases of LEGH, and one patient was diagnosed with MDA. In the MDA case, additional bilateral salpingo-oophorectomy and pelvic lymph node dissection were performed at a later date. No metastasis was observed in these excised specimens. Conclusions: Our results suggest that TLH for cervical cystic lesions can be performed safely. However, it is important to consider the TLH indication before surgery based on the possibility of malignant disease.

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Section: Discussionmentioning

confidence: 93%

Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series

Morisada¹,

Tanaka²,

Iijima³

et al. 2020

OJOG

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“…The significantly higher recurrence at the vaginal vault in the ARH group was comparable to the previously reported results (8). It is supposed that total laparoscopic/robotic intracorporeal colpotomy under CO 2 pneumoperitoneum might pose a risk for implantation in vaginal cuff margin and intraperitoneal spread (32). ARH may limit the chance of intra-abdominal seeding during cancer cell removal by placing two sets of clamps across the vagina below the cervix (33).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. Abdominal Radical Hysterectomy for Locally Advanced Cervical Cancer

Wang

et al. 2019

Front. Oncol.

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This study is to compare the survival outcomes of laparoscopic radical hysterectomy (LRH) to those of abdominal radical hysterectomy (ARH) for patients with locally advanced cervical cancer (LACC). Patients with the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2 to IIB LACC who underwent radical hysterectomy between 2001 and 2015 were identified. The disease-free survival (DFS) and overall survival (OS) were compared according to the surgical approach and were adjusted based on clinicopathologic characteristics. A total of 396 patients were included in the study, with 179 (45.2%) and 217 (54.8%) patients in the ARH and LRH groups, respectively. The LRH group showed a significantly lower amount of estimated blood loss, lower blood transfusion rate and shorter length of hospital stay. Overall, there were no significant differences in the 5-year DFS and 5-year OS between the LRH and ARH groups with the Kaplan-Meier method. However, multivariate analyses identified LRH as an independent prognostic factor for a poor DFS (hazard ratio [HR] 2.5; 95% confidence interval [95% CI] 0.19 to 0.87; p = 0.02). The analysis of stage IB2 disease and the squamous subtype (61.9% and 87.9% of all participants, respectively) reached the same conclusion. When stratifying by FIGO stage, the patients with IB2 (n = 348) in the ARH group had a significantly better DFS (HR 0.14, 95% CI 0.05–0.42, p < 0.01) and OS (HR 0.17, 95% CI 0.04–0.67, p = 0.11) than those in the LRH group in the Cox regression model. However, no differences were found in patient with stage IIA1, IIA2, or IIB in Cox regression model. When stratifying by histological types, for the patients with squamous carcinomas (n = 375), in Cox model, ARH had a significantly superior DFS compared with those who underwent LRH (HR 0.45, 95% CI 0.25–0.82, p = 0.01), but the OS was not statistically significant (HR 0.57, 95% CI 0.27–1.20, p = 0.14). However, no differences were found in patient with adenocarcinoma and adenosquamous carcinomas in the Cox model. Therefore, ARH was associated with a higher DFS than LRH in patients with LACC, especially in patients with stage IB2 disease or the squamous subtype.

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“…Some experts report that the exceptionally impressive TARH DFS from the LACC trial (96.5%) differs from that of previous GOG studies (80% to 95%) of early-stage cervical cancer, but these latter studies targeted patients at higher risk for recurrence as opposed to the population-based recruitment for the LACC trial. [81][82][83][84][85] At the present time, surgeons should proceed with caution with the robotic-assisted radical hysterectomy approach and counsel their patients with cervical cancer on the results of the LACC trial. This will allow women to make the most informed decision about surgical approach to treat their cervical cancer.…”

Section: Specific Disease-based Gynecologic Outcomes With Robotic Surmentioning

confidence: 99%

Updates and Controversies of Robotic-Assisted Surgery in Gynecologic Surgery

Varghese

Doglioli

Fader³

2019

Clinical Obstetrics &Amp; Gynecology

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minimally invasive surgery (MIS) is the standard approach to performance of several gynecologic procedures, including hysterectomy, gynecologic cancer staging procedures, myomectomy, pelvic organ prolapse repair, and select adnexal procedures. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with other MIS approaches. This review critically appraises the evolving role, benefits, limitations, and controversies of robotic-assisted surgery utilization in benign and oncologic gynecology settings.

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Revisiting Minimally Invasive Surgery in the Management of Early-Stage Cervical Cancer

Cited by 17 publications

References 10 publications

Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series

Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series

Laparoscopic vs. Abdominal Radical Hysterectomy for Locally Advanced Cervical Cancer

Updates and Controversies of Robotic-Assisted Surgery in Gynecologic Surgery

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