Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach

Anchora, Luigi Pedone; Bizzarri, Nicolò; Kucukmetin, Ali; Turco, Luigi Carlo; Gallotta, Valerio; Carbone, Maria Rita; Rundle, Stuart; Ratnavelu, Nithya; Cosentino, Francesco; Chiàntera, Vito; Fagotti, Anna; Fedele, Camilla; Gomes, Nathália Silva; Ferrandina, Gabriella; Scambia, Giovanni

doi:10.1016/j.ejso.2020.09.038

Cited by 18 publications

(12 citation statements)

References 47 publications

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“…The other potential confounding factor is peritoneal dissemination by intraoperative tumor spillage or excessive manipulation of tumor tissues 30 , 31 . We theorized that the use of a uterine manipulator during RRH might result in tumor spillage into the peritoneal cavity and combination of steep Trendelenburg position and aerosolization might have facilitated the intraabdominal seeding which leads to worse oncological outcome.…”

Section: Discussionmentioning

confidence: 99%

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

Paek¹,

Lim²

2021

Int. J. Med. Sci.

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Objective: To identify the pattern of recurrence and assess the clinicopathologic prognostic factors for survival after robotic radical hysterectomy (RRH) in the treatment of stage IB cervical cancer. Methods: From December 2008 to March 2018, 64 cervical cancer patients who underwent RRH with pelvic lymph node dissection by a single surgeon were enrolled in this retrospective historical cohort timeline study. The patient's status was estimated in terms of operative outcomes, pathologic results, and survival outcomes. Results: The median follow-up was 63 months. The recurrence rate was 9.4% (6/64). There were two recurrences at the vaginal vault, two in the pelvic cavity, and two at the peritoneum in the intraabdominal cavity. The overall survival rate was 95.3% (61/64). When patients were divided into three groups in order based on surgery date, the first surgical period showed significantly higher recurrence rate (21%) compared to both the second (10%) and the third period (0%) (p=0.037). Multivariate analysis showed that the early period of RRH (p=0.025) and clinical tumor size more than 3 cm (p=0.003) were prognostic factors related to the recurrence. Although there was no statistical significance, there has been no recurrence since a uterine manipulator was not used. Conclusion:The early surgical period and large tumor were related to the disease recurrence after RRH. We suggest that the achievement of proficiency and appropriate patient selection are critical for prognosis after RRH in stage IB cervical cancer.

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Section: Discussionmentioning

confidence: 99%

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

Paek¹,

Lim²

2021

Int. J. Med. Sci.

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“…Numerous studies have compared the effect of the Minimally Invasive and Abdominal Radical Hysterectomy for cervical cancer (20)(21)(22). The conclusion shows that for early cervical cancer the minimally invasive surgery (laparoscopic or robotassisted radical hysterectomy) has a higher recurrence rate than open surgery.…”

Section: Surgical Protocolmentioning

confidence: 99%

Markers of Prognosis for Early Stage Cervical Cancer Patients (Stage IB1, IB2) Undergoing Surgical Treatment

Sun

et al. 2021

Front. Oncol.

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BackgroundFor individuals with cervical cancer, large tumor volume, lymph node metastasis, distant metastasis, and parauterine infiltration are usually associated with a poor prognosis. Individuals with stage 1B1 and 1B2 cervical cancer usually do not have these unfavorable prognostic factors. Once the disease progresses, the prognosis becomes extremely poor. Therefore, investigating the prognostic markers of these cervical cancer patients is necessary for treatment.MethodsThis retrospective study included 95 cervical cancer patients treated with surgery. The patients were divided into progressor and non-progressor groups according to postoperative follow-up results. T-test (or Mann−Whitney U test), chi-squared test (or Fisher’s exact test) and receiver operating characteristic (ROC) curves were used to evaluate imaging, hematology, and clinicopathological index differences between the two groups. Cox analysis was performed to select the independent markers of progression-free survival (PFS) when developing the nomogram. Validation of the nomogram was performed with 1000 bootstrapped samples. The performance of the nomogram was validated with ROC curves, generated calibration curves, and Kaplan-Meier and decision curve analysis (DCA).ResultsCervical stromal invasion depth, lymphovascular space invasion (LVSI), human papilloma virus (HPV-16), Glut1, D-dimer, SUVmax and SUVpeak showed significant differences between the two groups. Multivariate Cox proportional hazard model showed SUVpeak (p = 0.012), and HPV-16 (p = 0.007) were independent risk factors and were used to develop the nomogram for predicting PFS. The ROC curves, Kaplan-Meier method, calibration curves and DCA indicated satisfactory accuracy, agreement, and clinical usefulness, respectively.ConclusionsSUVpeak level (≥7.63 g/cm3) and HPV-16 negative status before surgery were associated with worse PFS for patients with cervical cancer. Based on this result, we constructed the nomogram and showed satisfactory performance. Clinically, individualized clinical decision-making can be performed on patients based on this result.

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“…Intraperitoneal exposure during minimally invasive surgery had a significantly worse prognosis than no intraperitoneal exposure. Intraperitoneal tumor exposure was an independent prognostic factor for worse survival ( 31 ). A novel fluorescence imaging‐based tool for feasible and direct visualization of peritoneal contamination during colpotomy might serve as a quality assessment tool for surgeons and surgical techniques ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Radical Hysterectomy Results in Higher Recurrence Rate Versus Open Abdominal Surgery for Stage IB1 Cervical Cancer Patients With Tumor Size Less Than 2 Centimeter: A Retrospective Propensity Score-Matched Study

Chen

Zhao

et al. 2021

Front. Oncol.

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ObjectiveTo compare the oncologic outcomes between laparoscopic and open radical hysterectomy in patients with stage IB1 cervical cancer lesion less than 2 cm.MethodsPatients diagnosed FIGO (2009) stage IB1 (tumor diameter <2 cm) and underwent radical hysterectomy in our hospital between March 2008 and November 2018 were studied. A propensity-matched comparison (1:2) was conducted to minimize selection biases. Demographic and baseline oncologic characteristics were balanced between groups. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan–Meier model, along with univariable and multivariable regression analysis.ResultsA total of 261 patients were enrolled in this study after propensity-matching, with 174 in the open group and 87 in the laparoscopic group. Disease relapsed in seven patients in laparoscopy group, and the recurrence rate was 8.0% (7/87). There were eight patients underwent abdominal radical hysterectomy experienced recurrence, and the recurrence rate was 4.6% (8/174). The multivariate analysis model revealed that laparoscopic operation was associated with higher risk of recurrence than abdominal radical hysterectomy (HR, 3.789; 95% CI, 1.143–12.559; p = 0.029). There were five patients or 2.9% (5/174) died in open surgery group and the corresponding percentage in laparoscopy group was 2.3% (2/87). No difference was found in OS between the two groups (HR, 1.823; 95% CI, 0.2673–12.44; log-rank p = 0.5398). All the recurrence occurred within two years after operation in the laparoscopy group, among which pelvic recurrence (85.7%) was dominant.ConclusionTraditional laparotomy radical hysterectomy has a lower recurrence rate when compared with laparoscopic operation in those cervical cancer patients with a foci diameter less than 2 cm. However, no detrimental effect on survival was found in minimal invasive operation group. Further multi-center prospective trials are needed to confirm our results on a large scale.

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Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach

Cited by 18 publications

References 47 publications

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

Markers of Prognosis for Early Stage Cervical Cancer Patients (Stage IB1, IB2) Undergoing Surgical Treatment

Laparoscopic Radical Hysterectomy Results in Higher Recurrence Rate Versus Open Abdominal Surgery for Stage IB1 Cervical Cancer Patients With Tumor Size Less Than 2 Centimeter: A Retrospective Propensity Score-Matched Study

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