Laparoscopic radical hysterectomy: a European Society of Gynaecological Oncology (ESGO) statement

Querleu, Denis; Cibula, David; Concin, Nicole; Fagotti, Anna; Ferrero, Annamaria; Fotopoulou, Christina; Knapp, Paweł; Kurdiani, Dina; Ledermann, Jonathan A.; Mirza, Mansoor Raza; Morice, Philppe; Ponce, Jordi; Steen-Banasik, Elzbieta van der; Taskiran, Cagatay; Wimberger, Pauline; Zalewski, Kamil; Sessa, Cristiana

doi:10.1136/ijgc-2019-000775

Cited by 48 publications

(40 citation statements)

References 5 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Subsequently, a number of retrospective studies corroborated these findings, [10][11][12][13][14][15] resulting in a recent modification of the NCCN, European Society of Gynecological Oncology (ESGO), and ESMO guidelines. [16][17][18] The unexpected results of the LACC trial and other retrospective studies led to an ongoing discussion regarding the ideal surgical approach in patients with early cervical cancer. Also, the potential of implementing new trials containing a minimally invasive approach arm has been difficult, given the challenges of offering an option of treatment that has been deemed oncologically inferior.…”

Section: Original Researchmentioning

confidence: 99%

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

Chiva

Zanagnolo

Querleu

et al. 2020

Int J Gynecol Cancer

Self Cite

205

177

View full text Add to dashboard Cite

BackgroundMinimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse.MethodsWe obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group.ResultsMean age was 48.3 years (range; 23–83) while the mean BMI was 25.7 kg/m2 (range; 15–49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52).ConclusionsMinimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.

show abstract

Section: Original Researchmentioning

confidence: 99%

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

Chiva

Zanagnolo

Querleu

et al. 2020

Int J Gynecol Cancer

Self Cite

205

177

View full text Add to dashboard Cite

show abstract

“…Surgical approach was performed by minimally invasive surgery (laparoscopic or robotic) at surgeon's discretion until October 2018 (Ramirez 2018) and for tumors < 2 cm in compliance with European Society of Gynaecological Oncology (ESGO) statement and National Comprehensive Cancer Network (NCCN) guidelines, using protecting maneuvers (no uterine manipulator and vaginal cuff formation in patients with tumor completely excised at preoperative conization), after that date (Koh 2019;Querleu 2020). Laparotomy approach was performed at surgeon's discretion until October 2018 (Ramirez 2018) and for tumors ≥ 2 cm after that date.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…Treatment of early-stage disease (clinical International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB1 and IIA1) is represented by radical hysterectomy and pelvic lymphadenectomy with sentinel lymph node (SLN) biopsy (Cibula 2018). After the publication of a randomized controlled trial, which demonstrated an inferior survival outcome if patients with early-stage cervical cancer were treated with minimally invasive, compared to open radical hysterectomy (Ramirez 2018), multiple retrospective studies showed a survival difference between the two approaches, with consequent recommendations amendment by international societies (Koh 2019;Nitecki 2020;Querleu 2020), particularly for tumors larger than 2 cm (Pedone Anchora 2020).…”

Section: Introductionmentioning

confidence: 99%

Sentinel lymph node mapping with indocyanine green in cervical cancer patients undergoing open radical hysterectomy: a single-institution series

Bizzarri

Anchora

Ferrandina

et al. 2020

J Cancer Res Clin Oncol

Self Cite

View full text Add to dashboard Cite

Purpose To assess the rate of bilateral sentinel lymph node (SLN) detection with indocyanine green (ICG), to evaluate the sensitivity and the negative predictive value of cervical cancer patients undergoing open radical hysterectomy; to compare open versus minimally invasive SLN biopsy performance and to assess factors related to no/unilateral SLN mapping. Methods We retrospectively reviewed consecutive patients with FIGO 2018 stage IA1 with lymph-vascular space involvement to IIB and IIIC1p cervical carcinoma who underwent SLN mapping with ICG followed by systematic pelvic lymphadenectomy between 05/2017 and 06/2020. Patients were divided according to surgical approach for statistical analysis. Results Eighty-five patients met inclusion criteria. Twenty-seven (31.8%) underwent open and 58 (68.2%) underwent minimally invasive SLN mapping. No difference in any SLN mapping (laparotomy 92.6% and minimally invasive 91.4%) or in SLN bilateral detection (laparotomy 72.0% and minimally invasive 84.9%) (p = 0.850 and p = 0.222, respectively), in median number of SLNs mapped and retrieved (2 in both groups, p = 0.165) and in site of SLN mapping per hemi-pelvis (right side, p = 0273 and left side, p = 0.618) was evident between open and minimally invasive approach. Per-patient sensitivity of SLN biopsy in laparotomy was 83.3% (95% CI 35.9–99.6%) and the negative predictive value was 95.0% (95% CI 76.0–99.1%). No difference in per-patient sensitivity was noted between two approaches (p = 0.300). None of the analyzed variables was associated with no/unilateral SLN mapping. Conclusion The use of ICG to detect SLN in cervical cancer treated with open surgery allows a bilateral detection, sensitivity and negative predictive value comparable to minimally invasive surgery with potential advantages of ICG compared to other tracers.

show abstract

“…While some commentators continue to favor the use of minimally invasive surgery in clinical practice while additional randomized trials are in progress, national and international guidelines have coalesced around the notion that laparotomy is the evidence-based approach to radical hysterectomy for early-stage cervical cancer. [2][3][4][5] In addition to LACC, these guidelines have cited a growing literature of adequately powered, well-designed observational studies that, overall, have had concordant results. [6][7][8][9][10][11][12][13][14][15] In this issue of the International Journal of Gynecological Cancer, Chiva and colleagues 16 present additional evidence of the deleterious effect of minimally invasive radical hysterectomy, and suggest possible mechanisms underlying this association.…”

mentioning

confidence: 99%

Time to accept a new old standard of care in cervical cancer

Nitecki

Melamed

2020

Int J Gynecol Cancer

View full text Add to dashboard Cite

Laparoscopic radical hysterectomy: a European Society of Gynaecological Oncology (ESGO) statement

Cited by 48 publications

References 5 publications

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

Sentinel lymph node mapping with indocyanine green in cervical cancer patients undergoing open radical hysterectomy: a single-institution series

Time to accept a new old standard of care in cervical cancer

Contact Info

Product

Resources

About