Hysterectomy: Let’s Step Up the Ladder of Evidence to Look Over the Horizon

Giannini, Andrea; D’Oria, Ottavia; Bogani, Giorgio; Donato, Violante Di; Vizza, Enrico; Chiàntera, Vito; Laganà, Antonio Simone; Muzii, Ludovico; Salerno, Maria Giovanna; Caserta, Donatella; Gerli, Sandro; Favilli, Alessandro

doi:10.3390/jcm11236940

Cited by 24 publications

(17 citation statements)

References 30 publications

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“…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].…”

Section: Overall Results Summarymentioning

confidence: 99%

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

Chaccour¹,

Giannini²,

D’Augè³

et al. 2023

Gynecol Obstet Invest

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Introduction: Minimally invasive surgery aims to reduce surgical trauma and post-operative morbidity. Natural orifice transluminal endoscopic surgery is a safe and valid surgical option for hysterectomy. The present systematic review aims to compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) with laparoscopic hysterectomy in terms of efficacy, surgical outcomes, complications, and cost. Materials and Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It includes randomized controlled trials, controlled clinical trials, prospective or retrospective cohorts, case-control studies, and previous systematic reviews. Inclusion criteria are as follows: female patients undergoing hysterectomy for benign pathologies by vNOTES or laparoscopic hysterectomy. The assessed outcomes were the following: conversion rate, mean uterus weight (g), operative time (mins), hospital stay (days), peri-operative complications, post-operative complications, peri-operative blood loss (mL), blood transfusion needs, post-operative day 1 hemoglobin (Hb) change (g/dL), post-operative pain level (VAS), and cost (USD) in both techniques. Results: Seven studies were included. vNOTES hysterectomy was not inferior to laparoscopic hysterectomy regarding surgical outcomes, with a shorter operative time, shorter recovery time, less post-operative pain, and fewer post-operative complications. There was no significant difference in the rate of peri-operative complications and no differences in peri-operative blood loss, post-operative day 1 Hb change, and transfusions. Nevertheless, vNOTES hysterectomy was shown to be more expensive than its laparoscopic counterpart. Conclusions: While the feasibility and safety of the vNOTES hysterectomy were already established, this review also underlines the noninferiority of this technique when compared to laparoscopic hysterectomy in terms of surgical outcomes. In addition, vNOTES hysterectomy was associated with faster operating time, shorter hospital stay, and better post-operative pain scores compared with laparoscopic hysterectomy.

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Section: Overall Results Summarymentioning

confidence: 99%

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

Chaccour¹,

Giannini²,

D’Augè³

et al. 2023

Gynecol Obstet Invest

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“…In addition, most patients with EC have personal risk factors, such as obesity, diabetes or metabolic syndrome that contribute to increased surgery-related complications. Tailored surgery and no overtreatment could reduce the incidence of these adverse events [29][30][31][32][33][34][35].…”

Section: Resultsmentioning

confidence: 99%

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Cuccu¹,

Sgamba²,

Cannicchio³

et al. 2023

Ital J Gynaecol Obstet

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Endometrial cancer (EC) is the most common female genital tract malignant cancer. Lymphatic staging is a major prognostic factor and the main predictor of recurrence. The aim of this review is to explore lymph nodal management in EC up to this day and understand how the new molecular EC classification may affect lymph nodal management. A search was conducted in December 2022 to find all relevant trials and shows how,over the years, staging techniques have evolved, becoming more accurate and less invasive. In 1996, a less invasive staging method was found: the Sentinel Lymph Node (SLN), more safer and reliable in detecting metastatic disease. To date, the available pieces of evidence suggests that lymphadenectomy should not be performed in all patients with EC because it does not increase Overall Survival (OS) or Disease Free Survival (DFS) compared to standard surgery without lymphadenectomy, while it actually increases the risk of postoperative complications,in all EC risk classes. In addition, SLN and lymphadenectomy do not have any difference in terms of Recurrence Free Survival (RFS) in patients with low volume disease. Moreover, data available in literature highlight that the molecular classification may play a more accurate prognostic role than histological analysis. Even though some studies showed that the molecular mutations were not significant predictors of recurrence, several large ongoing trials may set new treatment standards. In conclusion, we can state that SLN mapping is an optimal method of EC staging with good sensibility,specificity and decreased surgical complications. Instead, more studies are needed to understand how molecular mutations can affect lymph nodal management.

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“…There are many options surgical approach for performing hysterectomy, including abdominal, robot-assisted laparoscopic and vaginal natural orifice transluminal endoscopic surgery (vNOTES). 25 It is still controversial whether RH affects endometrial cancer outcomes. RH with bilateral salpingo-oophorectomy (BSO) is recommended for patients with stage II EC based on guidelines before 2014.…”

Section: Discussionmentioning

confidence: 99%

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single‐center retrospective study

Sun

Zhang

et al. 2023

Cancer Medicine

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PurposeWe aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease‐free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients.MethodsFour hundred sixty‐five women with EC were included in this retrospective study. Log‐rank tests and Kaplan–Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis.ResultsAmong the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log‐rank p = 0.914 and 0.810 for OS; log‐rank p = 0.707 and 0.771 for DFS, respectively).ConclusionBased on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II‐III EC patients.

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Hysterectomy: Let’s Step Up the Ladder of Evidence to Look Over the Horizon

Abstract: Hysterectomy is one of the most common non-obstetric gynecological surgical procedures carried out in Western countries [...]

Cited by 24 publications

References 30 publications

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

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

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single‐center retrospective study

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