Short- and long term outcomes after abdominal radical trachelectomy versus radical hysterectomy for early stage cervical cancer: a systematic review of the literature and meta-analysis

Prodromidou, Anastasia; Iavazzo, Christos; Fotiou, Alexandros; Psomiadou, Victoria; Douligeris, Athanasios; Vorgias, George; Kalinoglou, N

doi:10.1007/s00404-019-05176-y

Cited by 21 publications

(9 citation statements)

References 27 publications

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“…RT patients had a lower duration of post-operative hospital stay. These results are similar to the previous reviews on this aspect and add to the body of the already available evidence ( 9 , 10 ). Our findings underscore that in women of reproductive age with early-stage cervical cancer, RT can be used in place of RH as a way to preserve fertility.…”

Section: Discussionsupporting

confidence: 92%

“…They noted a significantly prolonged operative time for RT compared to RH, but the 5-year overall survival and disease-free survival were similar between the two groups. Based on these findings, the authors concluded that RT has a similar efficacy and safety profile compared to RH and recommended the use of this technique for women of reproductive age who wish to have future pregnancies (9). Another recent review, using five studies, concluded that RT, particularly the vaginal mode, is safe and effective for the management of early-stage cervical cancer with lesion size of <2 cm and negative tumor margins (10).…”

Section: Introductionmentioning

confidence: 99%

“…While there are studies comparing the clinical outcomes between RH and RT, very few attempts have been done to systematically synthesize the findings of these studies to derive a meaningful interpretation of the comparative efficacy of these two modalities. Prodromidou et al compared outcomes of abdominal RT and RH by pooling data from five studies consisting of 840 women with early-stage cervical cancer ( 9 ). The authors excluded data of all vaginal trachelectomies.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

Guo

Deng

et al. 2021

Front. Surg.

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Objective: To provide updated evidence on comparative efficacy for clinical outcomes of radical trachelectomy and radical hysterectomy in patients with early-stage cervical cancer.Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews, and Google scholar databases. Studies were done in patients with early-stage cervical cancer that compared the outcomes between radical trachelectomy (RT) and hysterectomy (RH) were considered for inclusion in the review. The outcomes of interest were operative time, the volume of blood loss, need for blood transfusion, any complications, length of hospital stay, risk of recurrence, and survival. The strength of association was presented in the form of pooled relative risk (RR), hazards risk (HR), and weighted mean difference (WMD). Statistical analysis was done using STATA version 16.0.Results: A total of 12 articles were included in the meta-analysis. The majority were retrospective cohort-based studies. Compared to RH, the operative time (in min) was comparatively higher in RT (WMD 23.43, 95% CI: 5.63, 41.24). Patients undergoing RT had blood loss (in ml) similar to those undergoing RT (WMD −81.34, 95% CI: −170.36, 7.68). There were no significant differences in the risk of intra-operative (RR 1.61, 95% CI: 0.49, 5.28) and post-operative complications (RR 1.13, 95% CI: 0.54, 2.40) between the two groups. Patients in the RT group had lesser duration of post-operative hospital stay (in days) (WMD −1.65, 95% CI: −3.22, −0.09). There was no statistically significant difference in the risk of recurrence (HR 1.21, 95% CI: 0.68, 2.18), 5-year overall survival (HR 1.00, 95% CI: 0.99, 1.02), and recurrence-free survival (HR 0.99, 95% CI: 0.96, 1.01) between the two groups.Conclusion: Among the patients with early-stage cervical cancer, RT is similar to RH in safety and clinical outcomes. Future studies with a randomized design and larger sample sizes are needed to further substantiate these findings.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

Guo

Deng

et al. 2021

Front. Surg.

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“…The change is associated with the development of medical standards in some countries, increased cervical cancer screening and human papillomavirus vaccination coverage and enhancement of women's health awareness. These interventions seem oncologically safe in the current selection of patients with low-stage and low-grade disease ( 32 ). Internationally, the chance for recurrence in early stage cervical cancer is 6–9% ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Matrine exerts antitumor activity in cervical cancer by protective autophagy via the Akt/mTOR pathway in vitro and in vivo

Zhang

et al. 2022

Oncol Lett

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Matrine is a quinazoline alkaloid extracted from Sophora flavescens. The aim of the present study was to determine whether matrine can induce autophagy in the human HeLa and SiHa cervical cancer cell lines in vitro and in vivo. Cell viability assay was used to assess the suppressive effect of matrine and cisplatin on the proliferation of HeLa and SiHa cells. A total of 28 4-week-old female BALB/c nude mice were used for the in vivo study. Autophagy and protein expression were observed via transmission electron microscopy, monodansylcadaverine and immunohistochemical staining and western blotting. The inhibitory effect of matrine on the proliferation of cervical cancer cells was time-and dose-dependent. The combination of matrine and cisplatin synergistically inhibited the proliferation of cervical cancer cells in vitro and in vivo. Transmission electron microscopy showed that after the addition of matrine, numerous autophagosomes and autophagolysosomes were observable in HeLa and SiHa cells, as demonstrated by monodansylcadaverine staining. Western blotting and immunohistochemical staining showed that as the concentration of matrine increased, the expression of the autophagy marker LC3A/B-II also increased significantly in vitro and in vivo. These findings suggested that matrine inhibited the proliferation of cervical cancer cells and induced autophagy by inhibiting the Akt/mTOR signaling pathway. Thus, matrine may represented a potential candidate in combination therapy for cervical cancer as an inducer of autophagy.

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“…Small and limited lesions can be treated by less invasive, fertility-preserving procedures like conization; LLETZ (Large Loop Excision of Transformation Zone); simple or radical trachelectomy (removing the cervix and upper vagina but not the body of the uterus) (Shuurman et al 2021). The oncological prognosis after these surgical procedures is acceptable with low recurrence rate in stages lower that IB1 (Prodromidou et al 2019). However, about 4% of the fertility-preserving procedures carry a higher risk of cancer development like positive resection margins, positive lymph nodes, or other features that necessitate a more invasive operation or the use of adjuvant chemo-and/or radiotherapy (Berman & Schiller, 2017;Bhatla et al 2019).…”

Section: Therapeutic Approaches To Cervical Cancermentioning

confidence: 99%

Human papillomavirus-mediated carcinogenesis and tumor progression

Abboodi

Delva

Emmel

et al. 2021

GENOME INSTAB. DIS.

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High-risk human papillomaviruses (HPV) cause 5% of all human cancers and are primary etiologic agents of cervical, anal, and oropharyngeal cancer. HPV infection is necessary, but not sufficient per se to produce cancer: additional changes must occur that transform HPV-infected cells to malignancy. The HPV oncoproteins E6 and E7 immortalize human keratinocytes, cervical cells, and fibroblasts in culture. Each oncoprotein interacts with a variety of cellular binding partners; most important for transformation are E6 and E7's interactions with p53 and RB (respectively) which lead to degradation of p53 and RB through the ubiquitin pathway. Inactivation of p53 and RB leads to inactivation of pivotal cell cycle checkpoints, thereby stimulating cell proliferation and allowing cell division to occur independently of the presence of DNA damage, replicative stress, and other such insults, leading to genome instability. Continuous expression of E6/E7 drives the proliferation and progression of most HPV-mediated cancers of the cervix and a substantial fraction of those of the oropharynx. However, at both cancer sites, "HPV-inactive" tumors that contain HPV DNA, but do not express E6/E7 arise. We propose that these HPV-inactive cancers begin as HPV-driven lesions, but lose E6/E7 expression at some point during progression. We have recently shown that p53 deletion in HPV-immortalized, premalignant cells allows for the emergence of cell populations that no longer express E6/E7. These findings corroborate the notion of a pivotal role of p53 in the context of HPV-mediated transformation, both at the initiation and progression stages of cancer development.

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Short- and long term outcomes after abdominal radical trachelectomy versus radical hysterectomy for early stage cervical cancer: a systematic review of the literature and meta-analysis

Cited by 21 publications

References 27 publications

Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

Matrine exerts antitumor activity in cervical cancer by protective autophagy via the Akt/mTOR pathway in vitro and in vivo

Human papillomavirus-mediated carcinogenesis and tumor progression

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