Primary conization overcomes the risk of developing local recurrence following laparoscopic radical hysterectomy in early stage cervical cancer

Abstract

Objective To investigate whether primary conization might overcome the risk of local dissemination in patients undergoing laparoscopic radical hysterectomy. Methods Consecutive data of 262 patients with early stage cervical cancer were retrieved: 88 women had conization followed by radical hysterectomy. A propensity‐matched comparison (1:1) was carried out in order to compare laparoscopy and open surgery. Accumulating data highlighted that minimally invasive surgery has been associated with higher recurrence rates and worse overall survival than open surgery in women with early stage cervical cancer. Results Data of 35 paired patients (total 70 patients) were analyzed. No between‐group differences in baseline, disease, and pathological variables were observed. Patients undergoing laparoscopy correlated with lower blood loss (50 [range 30–100] vs 150 [range 50–500] mL; P<0.001) and shorter length of stay (3 ± 0.8 vs 5.4 ± 1.4 days; P<0.001) compared to open surgery. One local recurrence was observed per group (P=1.00). Type of surgical approach did not influence site of recurrence (P=1.00) or survival outcomes, in terms of 10‐year disease‐free (P=0.549, log‐rank test) and overall survivals (P=0.615, log‐rank test). Conclusions The data show that primary conization might overcome the risk of local recurrence after laparoscopic radical hysterectomy in early stage cervical cancer. Further prospective evidence is needed.

Minimally invasive surgery in gynecological cancers: update and systematic review

“…[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]), and 16 studies regarding MIS in cervical cancer (Table 3, Ref. [61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76]). The study selection flow-chart was reported in Fig.…”

“…Women with >20 mm disease should undergo open surgery, while in case of tumor <20 mm, both approaches appear safe. Bogani, 2020 [76] Retrospective case-control study Cervical cancer 70 Primary conisation might overcome the risk of local recurrence after laparoscopic radical hysterectomy in early stage cervical cancer. Brandt, 2020 [69] Retrospective study Cervical cancer 196 MIS approach did not seem to compromise oncologic outcomes in patients who underwent radical hysterectomy for early stage cervical carcinoma.…”

“…Furthermore, a minimally invasive approach may be considered after conisation without residual disease (stage IA1, IA2 cervical cancer), in patients requiring hysterectomy [76].…”

Preoperative Conization May Have a Positive Impact on Survival in Early-Stage Cervical Cancer: A Propensity-Matched Study

“…The uses of a uterine manipulator and laparoscopic intracorporeal colpotomy reportedly could lead to tumor proliferation, thereby enhancing the risk of recurrence [12, 18]. Furthermore, it has been suggested that tumor resection by preoperative conization might limit potential parauterine microscopic residual disease caused by the uterine manipulator and decrease the exposure of tumor to the abdominal cavity as a result of laparoscopic intracorporeal colpotomy [19, 20]. Conceivably, therefore, preoperative conization might provide oncologic protection for the use of MIS in appropriately selected cervical cancer patients.…”

Outcomes and complications of total laparoscopic hysterectomy after conization

“…However, some replication studies have indicated that tumor size or surgical procedure might be the source of the undesirable outcomes in the LACC trial [21][22][23]. Moreover, Bogani et al [24] re-ported that conization might overcome the local recurrence risk after laparoscopic hysterectomy for early-stage cervical cancer. Thus, as none of our cases had visible lesions, we believe it was appropriate to perform laparoscopic surgery.…”