Incidence of adverse events in minimally invasive vs open radical hysterectomy in early cervical cancer: results of a randomized controlled trial

Abstract

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Total laparoscopic vs. conventional open abdominal nerve-sparing radical hysterectomy: clinical, surgical, oncological and functional outcomes in 301 patients with cervical cancer

“…The main findings of our study are: first, the risk of surgical complications of this technically-challenging procedure is acceptable; we observed 25 (8.3%) cases of intra-/post-operative urinary tract lesions in the overall population, although our cohort included patients with locally-advanced disease, submitted to NACT [ 4 26 ]. Second, we provide a large amount of data showing that the rate of pelvic dysfunction after this type of radical surgery is low, thus demonstrating that preservation of the neural autonomic fibers has actually a positive effect on patients' post-operative wellbeing and QoL.…”

“…In our experience, the first step for a safe NSRH is the knowledge of the anatomy of the female pelvis and pelvic ligaments. To better identify neural fibers and surgical landmarks, avascular spaces are routinely developed: typically, the medial and lateral (Latzko's space) pararectal spaces are dissected, in order to achieve different dissection planes, leading to the Deep Uterine Vein and to the origin of the parasympathetic PSN at the sacral roots [ 26 ]. According to the series by Ercoli et al [ 30 ], it is anatomically possible to identify 3 main groups of visceral efferent fibers, leaving the PP, directed to the target viscera:…”

The Silva Pattern-based Classification for HPV-associated Invasive Endocervical Adenocarcinoma and the Distinction Between In Situ and Invasive Adenocarcinoma: Relevant Issues and Recommendations From the International Society of Gynecological Pathologists

“…Patients with FIGO stage IA2 tumors and those with IA1 tumors associated with LVI or with positive margins undergo radical surgery (radical hysterectomy, or alternatively large conization or radical trachelectomy as fertility preservation approaches); sentinel lymph node (SLN) mapping and/or pelvic lymph node (LN) dissection are also considered in this group of patients 15 . Patients that undergo simple/radical hysterectomy or radical trachelectomy may experience surgical complications such as bladder dysfunction, vascular or ureteral injuries, and blood loss among others 16 . In addition, 10% to 41% of patients treated with LN dissection can experience lower extremity lymphedema as postoperative morbidity 17 , 18 .…”

Financial viewpoint of minimally invasive radical hysterectomy for early cervical cancer: another disadvantage?

“…A battery of analyses of the LACC trial has now added additional information that minimally invasive radical hysterectomy for early cervical cancer is not associated with improved quality of life after surgery compared with open radical hysterectomy. [1][2][3] Taken together with the prior principal findings of the LACC trial including (1) increased risk of disease recurrence/death and (2) similar peri-operative morbidity in minimally invasive versus open radical hysterectomy, 2 3 the study team recommended that gynecologic oncologists perform open radical hysterectomy for women with early cervical cancer. 1 Because comparable survival, reduced surgical adverse events, and improved quality of life were the expected premise for performance of minimally invasive over open surgery, failure to demonstrate these three outcome measures argues against the utilization of a minimally invasive approach for cervical cancer treatment.…”