Evaluation of Surgical Outcomes of Abdominal Radical Hysterectomy and Total Laparoscopic Radical Hysterectomy for Cervical Cancer: A Retrospective Analysis of Data Collected before the LACC Trial

Abstract

Although a surgical approach is one of the key treatments for stages IA1-IIA2, results of the Laparoscopic Approach to Cervical Cancer (LACC) published in 2018 radically changed the field, since minimally invasive surgery was associated with a four-fold higher rate of recurrence and a six-fold higher rate of all-cause death compared to an open approach. We aimed to evaluate surgical outcomes of abdominal radical hysterectomy (ARH) and total laparoscopic radical hysterectomy (TLRH) for cervical cancer, including data collected before the LACC trial. In our retrospective analysis, operative time was significantly longer in TLRH compared to ARH (p < 0.0001), although this disadvantage could be considered balanced by lower intra-operative estimated blood loss in TLRH compared with ARH (p < 0.0001). In addition, we did not find significant differences for intra-operative (p = 0.0874) and post-operative complication rates (p = 0.0727) between ARH and TLRH. This was not likely to be influenced by age and Body Mass Index, since they were comparable in the two groups (p = 0.0798 and p = 0.4825, respectively). Finally, mean number of pelvic lymph nodes retrieved (p = 0.153) and nodal metastases (p = 0.774), as well as death rate (p = 0.5514) and recurrence rate (p = 0.1582) were comparable between the two groups. Future studies should be aimed at assessing whether different histology/grades of cervical cancer, as well as particular subpopulations, may have significantly different outcomes using minimally invasive surgery or laparotomy, with or without neoadjuvant chemotherapy.

Prevalence and genotype screening of human papillomavirus among women attending a private hospital in Northern Cyprus: an 11-year retrospective study

“…Different approaches for hysterectomy include abdominal hysterectomy where the uterus and cervix are removed from a large abdominal incision, and laparoscopic hysterectomy where small instruments and a camera is inserted into the abdomen through small incisions. Although the latter choice is less invasive and may in turn cause less complications, recent research shows a higher recurrence rate for laparoscopic hysterectomy [ 32 ]. Radical trachelectomy is a primary method of treatment for patients with early-stage cervical cancer [ 33 ] and is considered an option where the patient’s fertility is protected by removing the cervix, small part of upper vagina and parametria but leaving the uterus intact.…”

Hysterectomy Using Vaginal Natural Orifice Transluminal Endoscopic Surgery Compared with Classic Laparoscopic Hysterectomy: A New Advantageous Approach? A Systematic Review on Surgical Outcomes

“…In addition, the use of vNOTES may open new possible scenarios also for the treatment of malignant gynecological diseases [24]. Indeed, the Laparoscopic Approach to Cervical Cancer (LACC) trial found worse oncological outcomes in women with cervical cancer undergoing laparoscopic surgery compared with open surgery, and this raised concerns about the use of MIS for this purpose and led to an ongoing debate [25,26]. From this perspective, further studies should be aimed to investigate the role of vNOTES for gynecological cancers, in order to clarify whether this technique has similar surgical and oncological outcomes compared with other approaches [27][28][29][30][31][32][33].…”

Effect of annualized surgeon volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004–2016: a retrospective cohort study

“…ARH therefore has re-emerged as a mainstream treatment for cervical cancer, bringing attention to the effect of abdominal surgeon volume on the complication rates. Despite the finding of poor survival with minimally invasive surgery (MIS) in LACC trail, some studies were still conducted to re-establish the role of MIS and select the appropriate patient for MIS, considering the tumour size and the histological type [32][33][34][35]. Thus, further exploration of the effect of surgeon volume on complications among patients who undergo LRH is also warranted.…”