235 Succor cone: is it cervical conization a protective maneuver

Chacón, Enrique; Manzour, Nabil; Mínguez, J.; Vázquez, D; Castellano, T; Lorenzo, Luisa Sánchez; Salas‐Benito, Diego; Alcázar, Juan Luis; González-Martín, Antonio; Chiva, Luis

doi:10.1136/ijgc-2020-esgo.16

Cited by 4 publications

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“…8 In an analysis of the SUCCOR multi-institutional study, which included 1156 patients with stage IB1 cervical cancer undergoing radical hysterectomy, 733 underwent cold knife cone. 15 Following propensity score matching, cold knife cone was associated with a 65% reduction in the risk of relapse. 15 Another multi-institutional study demonstrated a significant correlation between the presence of gross cervical tumor at the time of surgery and risk of relapse.…”

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

“…15 Following propensity score matching, cold knife cone was associated with a 65% reduction in the risk of relapse. 15 Another multi-institutional study demonstrated a significant correlation between the presence of gross cervical tumor at the time of surgery and risk of relapse. 16 Casarin et al identified 186 patients with stage IA1-IB1 disease who underwent minimally invasive radical hysterectomy and reported that performance of pre-operative conization was associated with a lower risk of relapse (1.1% vs 16.1%, p<0.001) even for patients with stage IB1 disease (1.8% vs 17.2%, p=0.004).…”

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

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Minimally invasive hysterectomy for stage IA cervical carcinoma: a survival analysis of the National Cancer Database

Nasioudis

Byrne

et al. 2021

Int J Gynecol Cancer

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ObjectiveTo evaluate the outcomes of minimally invasive surgery for patients with stage IA cervical carcinoma undergoing hysterectomy.MethodsPatients with pathological stage IA (IA1, IA2, IA not otherwise specified) squamous, adenocarcinoma, adenosquamous carcinoma of the cervix, no history of another tumor, who underwent radical or simple hysterectomy with known mode of surgery, diagnosed between 2010 and 2015 with at least 1 month of follow-up, were drawn from the National Cancer Database. Comparisons of demographic and clinicopathologic characteristics were made with the χ2 test. The impact of minimally invasive surgery (robotic-assisted or traditional laparoscopic) on overall survival was assessed with the log-rank test following generation of Kaplan–Meier curves. A Cox model was constructed to control for confounders.ResultsA total of 1930 patients were identified; the majority (73.3%, 1414 patients) had stage IA1 disease, while 458 (23.7%) patients had stage IA2, and 58 (3%) patients had stage IA not otherwise specified. In the present cohort, 685 patients (35.5%) had open, 438 patients (22.7%) had laparoscopic, and 807 patients (41.8%) had robotic-assisted laparoscopic hysterectomy. Patients who had an open approach were more likely to undergo lymphadenectomy (58.1% vs 52.7%, p=0.021) and have radical hysterectomy (42% vs 32.4%, p<0.001). Patients who had minimally invasive surgery had a shorter hospital stay (median 1 vs 3 days, p<0.001). There was no difference in overall survival between patients who had open and minimally invasive hysterectomy (p=0.87); 4-year overall survival rates were 97.7% and 98.6%, respectively. There was no difference in overall survival between the open and minimally invasive surgery groups for patients who had simple (p=0.61; 4-year overall survival rates 97.6% and 98.7%, respectively) or radical hysterectomy (p=0.70; 4-year overall survival rates 97.8% and 98.4%, respectively). After controlling for patient age, tumor histology, and presence of lymphovascular invasion, minimally invasive hysterectomy was not associated with worse survival (HR 0.94, 95% CI 0.49 to 1.81). In a sensitivity analysis, based on 3048 patients with clinical stage IA after controlling for confounders, minimally invasive surgery was not associated with worse survival than laparotomy (HR 1.06, 95% CI 0.65 to 1.72).ConclusionsIn a large cohort of patients with stage IA cervical carcinoma, performance of minimally invasive hysterectomy was not associated with a detrimental effect on overall survival.

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Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Minimally invasive hysterectomy for stage IA cervical carcinoma: a survival analysis of the National Cancer Database

Nasioudis

Byrne

et al. 2021

Int J Gynecol Cancer

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“…The application of protective maneuvers may partly explain some of the recurrences in patients who undergo MIS. Several protective factors against recurrences have been postulated, such as cervical conization prior to a radical hysterectomy [26,27]. Consequently, many aspects of the current clinical practice might explain the results of the LACC trial.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry

Fernández-González

Ponce

Martínez-Maestre

et al. 2022

Cancers

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This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of <10% and >10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13–1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02–1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04–1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer.

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“…After these publications, we observed a growing interest in understanding why patients who underwent radical hysterectomy via MIS for early cervical cancer presented a higher risk of relapse and mortality than others. There is also a great interest and effort to find out what other variables besides the approach, such as the preoperative cone [6] and protective maneuvers during surgery [2], might affect the likelihood of relapse, using some of these variables to create a score to predict which patients have a higher risk [7].…”

Section: Introductionmentioning

confidence: 99%

Pattern of relapse in patients with stage IB1 cervical cancer after radical hysterectomy as primary treatment. Minimally invasive surgery vs. open approach. Systematic review and meta-analysis.

Manzour

Núñez‐Córdoba

Chiva

et al. 2022

Gynecologic Oncology

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235 Succor cone: is it cervical conization a protective maneuver

Cited by 4 publications

References 0 publications

Minimally invasive hysterectomy for stage IA cervical carcinoma: a survival analysis of the National Cancer Database

Minimally invasive hysterectomy for stage IA cervical carcinoma: a survival analysis of the National Cancer Database

The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry

Pattern of relapse in patients with stage IB1 cervical cancer after radical hysterectomy as primary treatment. Minimally invasive surgery vs. open approach. Systematic review and meta-analysis.

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