Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study

Kimmig, Rainer; Ind, Thomas

doi:10.3802/jgo.2018.29.e75

Cited by 54 publications

(24 citation statements)

References 17 publications

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“…Furthermore, several other factors that may have contributed to the poorer outcomes seen in the MIS arm have also been discussed, such as very good outcomes of open arm (not particularly poor outcomes of MIS arm), insufficient power of the trial, the MIRH learning curve, the facts that histological data were unknown for a high proportion of patients, subgroup analyses stratified by tumor size or stage, histology and so on . In our view, therefore, a number of different factors may be involved, as described above, and the reason is not due to any of these alone, but to a combination of several together.…”

Section: Discussionmentioning

confidence: 95%

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

Kawakami

Andou

Yanai

et al. 2019

J of Obstet and Gynaecol

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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.

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Section: Discussionmentioning

confidence: 95%

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

Kawakami

Andou

Yanai

et al. 2019

J of Obstet and Gynaecol

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“…Moreover, recently, in a large multi-institutional retrospective study in the United States, the results showed that MIS was associated with worse PFS but not OS compared with the open approach, especially in patients with a tumor size ≤2 cm on final pathology ( 20 ). Nevertheless, some researchers are doubtful since the LACC trial recruited an average of only two patients per center per year for the MIS group ( 27 , 28 ). Additionally, some surgeons who performed LRH for cervical cancer were simply gynecologists and might not have been experts in the field of gynecologic oncology.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

Qin

Huang

et al. 2020

Front. Oncol.

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Objective To investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer. Methods This retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000–2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups. Results The ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups ( P = 0.122, adjusted HR = 0.449, 95% CI: 0.162–1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively ( P = 0.578, adjusted HR = 0.650, 95% CI: 0.143–2.961). The presence of more than two comorbidities led to poor OS ( P = 0.011). For patients with a BMI greater than 24 kg/m 2 , LRH was associated with better PFS ( P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006–2012, 2013–2015, and 2016–2018 in the LRH group ( P = 0.126 and P = 0.583). Conclusion Compared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.

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“…The recent publication of two papers and an editorial in the New England Journal of Medicine has caused consternation in the gynaecological oncology community . Both papers demonstrate a worse outcome for women undergoing radical hysterectomy by the minimal access route compared with open surgery and so question the dominant paradigm of the last decade that minimal access surgery is the preferred method by which to carry out radical surgery for cervical cancer.…”

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confidence: 99%

Survival of women with early‐stage cervical cancer in the UK treated with minimal access and open surgery

Martin‐Hirsch

Wood

Whitham

et al. 2019

BJOG

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Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study

Cited by 54 publications

References 17 publications

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

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

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

Survival of women with early‐stage cervical cancer in the UK treated with minimal access and open surgery

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