Long‐term oncological outcomes of minimally invasive radical hysterectomy for early‐stage cervical cancer: A retrospective, single‐institutional study in the wake of the LACC trial

Abstract

Aim: The objective of this study was to investigate the long-term oncological outcomes of minimally invasive radical hysterectomy (MIRH) for the treatment of early-stage cervical cancer retrospectively in the wake of the laparoscopic approach to cervical cancer (LACC) trial. Methods: A total of 109 patients with stage IA1 with lymphovascular space involvement, IA2, and IB1 cervical cancers were included in this study. The surgical and oncological outcomes were retrospectively evaluated. All patients underwent type C MIRH with a no-touch isolation technique for cervical tumor. Results: The median number of resected pelvic lymph nodes was 36 (range, 14-94), and 10 patients (9.2%) had positive nodes. One patient (0.9%) had positive surgical margins. Forty-six patients (42%) underwent adjuvant therapy. The median follow-up time was 73 months (range, 30-146 months). Five patients (4.6%) developed recurrent disease, and 3 patients (2.8%) died of cervical cancer. The 5-year disease-free survival and overall survival rates were 96.3% and 97.2%, respectively. A comparison between patients with tumor diameter ≤ 2 cm (n = 59) and those with tumor diameter > 2 cm (n = 50) did not identify any significant differences, with 5-year disease-free survival 96.6% versus 94.0% and 5-year overall survival 98.3% versus 96.0%, respectively. Conclusion: In this retrospective study, MIRH with a no-touch isolation technique for stage IA to IB1 cervical cancer was a safe approach in terms of oncological outcomes. However, every surgeon who treats early-stage cervical cancer should inform each patient of the results of the LACC trial because it has an exceedingly high impact.

Survival after Laparoscopic Radical Surgery for Early-stage Cervical Cancer in 1316 Consecutive Cases from a National Laparoscopic Training Center in China

“…Generally, the survival after LRH in patients with stage IA-IB1 cervical cancer is satisfying but varies across studies, with a 5-year PFS rate ranging from 80.2-96.3% (5,8,15). In the present study, we also report a high 4-year PFS of 92.0% in patients, which is not inferior to that in the open surgery group of the LACC trial.…”

“…Several studies have provided retrospective evidence supporting some improvements in LRH to prevent possible tumor cell spillage. The survival after LRH with the "no-look no-touch technique" for stage IB1 tumors was found to be equal to that after open surgery (15). A multicenter analysis of 389 patients showed that LRH with transvaginal closure of the vaginal cuff avoided the use of a manipulator and offered oncologic outcomes similar to those of the laparotomy arm in the LACC trail (25).…”

Feasibility and Outcomes of “No-Look No-Touch” Laparoscopic Radical Trachelectomy for Early-Stage Cervical Cancer

“…Several authors noted the routine use of a uterine manipulator and intracorporeal colpotomy under CO 2 circulation as two of several possible reasons for the inferior oncologic outcomes associated with minimally invasive approaches. Protective maneuvers of cancer cell spillage are regarded as mandatory to ensure oncologic outcomes [ 13 , 20 , 21 , 22 ].…”

A simple technique of vaginal cuff closure to prevent tumor cell spillage in laparoscopic radical hysterectomy for uterine cervical cancer

“…It is not suitable for nulliparous patients with a narrow vagina. In the transvaginal approach usually used by Japanese surgeons, the vaginal cuff is closed by continuous suture after cutting the vaginal mucosa pulled with silk stitches 3,9 . The traditional method closing the vaginal cuff is as follows.…”