Laparoendoscopic Single-site Radical Hysterectomy with Vaginal Closure and without Uterine Manipulator for FIGO IB1 Cervical Cancer

Chen, Sijing; Zheng, Ying; Tong, Longxia; Zhao, Xinghong; Chen, Lin; Wang, Yawen

doi:10.1016/j.jmig.2020.01.003

Cited by 16 publications

(14 citation statements)

References 4 publications

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“…However, the Laparoscopic Approach to Cervical Cancer (LACC) trial observed that disease-free survival (DFS) at 4.5 years and overall survival (OS) at three years of MIS were significantly lower than those of open surgery among women with stage IA1-IB1 cervical cancer, which remains controversial (3). Potential explanations include increasing tumor spillage due to the application of a uterine manipulator, the effect of CO 2 insufflation, the volume of surgery, and the surgeon's proficiency (4)(5)(6)(7). Several studies have focused on the correlation between surgeon proficiency and clinical outcomes in recent years.…”

Section: Introductionmentioning

confidence: 99%

The Surgeon’s Proficiency Affected Survival Outcomes of Minimally Invasive Surgery for Early-Stage Cervical Cancer: A Retrospective Study of 851 Patients

Ying

Huang²,

Li³

2021

Front. Oncol.

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PurposeTo compare the clinical outcomes of patients with early-stage cervical cancer who underwent minimally invasive surgery (MIS) by surgeons in different phases and evaluate whether the proficiency of surgeons affects the survival outcomes.Materials and MethodsA total of 851 patients with early-stage cervical cancer who underwent radical hysterectomy between January 2008 and June 2018 (every year from January to June) at a tertiary hospital were retrospectively analyzed. We categorized patients into four phases according to their sequence (phase one, 1-10 cases; phase two: 11-20 cases; phase three: 21-30 cases; phase four: > 30 cases). Demographics and clinical and pathological data were collected and analyzed.ResultsThere were no statistical differences between the open surgery and MIS groups regarding three- and five-year overall survival (OS) and disease-free survival (DFS). The OS and DFS of patients in the MIS group in phase one were significantly lower than those in later phases and those in the open surgery group after adjustment (OS, P = 0.009; HR, 2.896; 95%CI, 1.303-6.435; DFS, P = 0.009; HR, 2.712; 95%CI, 1.289-5.706). Survival outcomes were not statistically significant when comparing different surgeons.ConclusionThe phase one cases of MIS had lower OS and DFS than those in later phases and those in the open surgery group. Thus, we suggest that the proficiency of surgeons is associated with survival outcomes of MIS. Favorable outcomes can be obtained after a certain number of MIS cases.

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Section: Introductionmentioning

confidence: 99%

The Surgeon’s Proficiency Affected Survival Outcomes of Minimally Invasive Surgery for Early-Stage Cervical Cancer: A Retrospective Study of 851 Patients

Ying

Huang²,

Li³

2021

Front. Oncol.

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“…Radical hysterectomy is the operative standard procedure for early cervical cancer. There is a broad spectrum of open, total laparoscopic, laparoscopic-assisted vaginal, robotic, and LESS techniques for cervical cancer [ 18 – 21 ]. However, a retrospective study and a multicenter prospective randomized controlled trial published in 2018 showed that the disease-free survival (DFS) and overall survival (OS) of patients with early cervical cancer who underwent MIS were significantly lower [ 6 , 7 ], and MIS radical hysterectomy is debated.…”

Section: Discussionmentioning

confidence: 99%

Vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy for early cervical cancer: a retrospective pilot study

Wang

Hua

et al. 2021

World J Surg Onc

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Background Minimally invasive surgery for early cervical cancer is debated. We developed this new vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy for early cervical cancer, and we aimed to evaluate the feasibility and safety of this surgical procedure and observe the early oncologic outcomes. Methods From January 2019 to August 2020, patients with early cervical cancer who underwent vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy were studied retrospectively. The clinical characteristics, pathologic outcomes, perioperative outcomes, and follow-up details of the patients were recorded. Results Forty-eight patients underwent vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy were included, 14 (29.2%) with stage IB1, 13 (27.1%) with stage IB2, 7 (14.6%) with stage IB3, 10 (20.8%) with stage IIA1, and 4 (8.3%) stage with IA2. The mean age at diagnosis was 50.4 (range 28–72) years old. The mean operative time was 237.3 min (range 162–393), and the mean estimated blood loss was 246.5 ml (range 80–800). No intraoperative complications occurred, and there were no patients who were readmitted. Histological types were distributed as follows: squamous cell carcinoma 72.9%, adenocarcinoma 10.4%, and adenosquamous cell carcinoma 16.7%. There were 2 patients (4.2%) with positive nodes, 20 patients (41.7%) with positive lymphovascular space invasion, and 2 patients (4.2%) with positive parametria. Twenty-eight patients (58.3%) received adjuvant therapy after the operation. With a mean follow-up of 17.7 months (range 6–26), there were no recurrent cases, and 11 patients (22.9%) suffered lower limb lymphoedema. Conclusions The vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy might be a feasible technique for early cervical cancer, with promising short-term oncological outcomes and safety. A prospective study with more patients and longer follow-up periods should be performed to further evaluate the safety and oncological outcomes.

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“…Another case report performed abdominal manipulation of the uterus by suturing the round ligament, the ovary ligament, and the fallopian tube together [14]. Our colleagues from West China Second University Hospital recently published a video article to introduce the laparoscopic single-site (LESS) approach with enclosed colpotomy and without uterine manipulator [15]. Similarly, Intracorporeal open colpotomy, the last step of minimally invasive radical hysterectomy, may increase the risk for tumor spillage in the abdominal cavity.…”

Section: Discussionmentioning

confidence: 99%

Application of Novel Tumor-free Techniques in Laparoscopic Radical Hysterectomy for Early Cervical Cancer.

Jing

Zhou

Ran

et al. 2021

Preprint

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Objective: Minimally invasive radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, it was recently reported to be significantly inferior in long-term outcomes of the minimally invasive approach to open approach. The underlying causes of this finding arouse great concern and remain controversial. Here we would like to share some initial experience of tumor-free techniques in laparoscopic procedures for early cervical cancer, including uterine manipulator-free manipulation and enclosed colpotomy. Methods: Between December 2019 and May 2020, we performed manipulator-free laparoscopic radical hysterectomy in 26 cases with early cervical cancer. The modified tumor-free techniques, including uterine manipulator-free manipulation and enclosed colpotomy, was described in detail with illustrations.Results: The procedures went well in all patients. In our initial experience, these modifications do not increase the difficulty of surgical techniques, and can be well performed by the experienced surgeons.Conclusions: These techniques are safe and feasible, and the effects on oncological outcomes deserve follow-up and further clinical studies.

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Laparoendoscopic Single-site Radical Hysterectomy with Vaginal Closure and without Uterine Manipulator for FIGO IB1 Cervical Cancer

Cited by 16 publications

References 4 publications

The Surgeon’s Proficiency Affected Survival Outcomes of Minimally Invasive Surgery for Early-Stage Cervical Cancer: A Retrospective Study of 851 Patients

The Surgeon’s Proficiency Affected Survival Outcomes of Minimally Invasive Surgery for Early-Stage Cervical Cancer: A Retrospective Study of 851 Patients

Vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy for early cervical cancer: a retrospective pilot study

Application of Novel Tumor-free Techniques in Laparoscopic Radical Hysterectomy for Early Cervical Cancer.

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