Radical Hysterectomy: Efficacy and Safety in the Dawn of Minimally Invasive Techniques

Gil‐Moreno, Antonio; Carbonell-Socias, Melchor; Salicrú, Sabina; Centeno-Mediavilla, Cristina; Franco-Camps, Sílvia; Colás, Eva; Oaknin, Ana; Pérez-Benavente, Assumpció; Díaz-Feijoó, Berta

doi:10.1016/j.jmig.2018.06.007

Cited by 42 publications

(25 citation statements)

References 29 publications

(20 reference statements)

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“…Our findings of better intra-operative outcomes for LRH than ARH are consistent with previous studies (10, 13, 25), including a smaller volume of blood loss and a lower transfusion rate. These findings reflect the better ability to identify small vessels under the magnification provided by an optical system on the laparoscope, as well as the use of the argon-beam coagulator during surgery (26).…”

Section: Discussionsupporting

confidence: 92%

Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China

et al. 2019

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Study Objective: To compare the surgical and oncologic outcomes between open abdomen radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) for cervical cancer.Methods: Retrospective observational study with propensity score matching was used to ensure balanced groups for ARH and LRH. One-hundred-and-ninety-eight women with cervical cancer, 99 treated using ARH and 99 using LRH, between January 2012 and December 2014. Outcomes included disease-free survival (DFS), overall survival (OS), intra-operative factors, post-operator recovery, urinary retention, and adverse events. Moreover, the inverse probability of the treatment weighting (IPTW) method was also used.Main Results: Compared with ARH, LRH was associated with a lower volume of blood loss (P < 0.001) and transfusion rate (P < 0.001), with a broader resection of the parametrium (P < 0.001). Post-operatively, the time to first flatus was shorter for LRH than ARH (P < 0.001) but the rate of urinary retention was higher for LRH (22.2%) than ARH (8.1%; P = 0.009). DFS and OS were similar between groups. By IPTW, laparoscopy was also not associated with poorer survival in terms of DFS (HR 1.52, CI 0.799–2.891, P = 0.202) or OS (HR 0.942, HR 0.425–2.09, P = 0.883).Conclusion: Compared with ARH, LRH provided better intra-operative and post-operative outcomes, with no significant difference in oncologic outcomes and survival. Urinary retention remains a clinical issue to improve with LRH. The technology of LRH has been improved in China to address the inconsistent results of oncologic outcomes in previous studies. Whether these improvements could be effective needs to be investigated in the future.

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Section: Discussionsupporting

confidence: 92%

Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China

et al. 2019

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“…Our data showed that LRH was superior to RAH in blood loss, the length of hospital stay and the risk of blood transfusion ( Table 2). The results consisted with the published researches by other authors [6][7][8][9]. Jin Hee Kim et al showed that laparoscopic radical hysterectomy was associated with fewer intraoperative complications (9.9% vs. 12.0%, P < 0.001) and shorter median length of stay (P < 0.001), compared with abdominal radical hysterectomy [9].…”

Section: Discussionmentioning

confidence: 57%

“…Some clinical studies showed the similar therapeutic outcomes between LRH and abdominal radical hysterectomy (ARH). Moreover, LRH presented the advantages in the reduced morbidity and improved quality of postoperative life [5][6][7][8][9]. Laparoscopic surgery had seen to be the popular surgical approach for treatment of ECC at one time.…”

Section: Introductionmentioning

confidence: 99%

Standardized radical hysterectomy promises the clinical outcomes of laparoscopic surgery for early-stage cervical cancer

Yang¹,

Chen²,

Li³

et al. 2020

Preprint

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Background: The recent publication of LACC Clinical Trial (NCT00614211) stated that minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer (ECC). The purpose of this present study is to evaluate clinical outcomes of laparoscopic standardized radical hysterectomy for ECC. Methods: This is a retrospective controlled study. 328 women with ECC (IA1, IA2, IB1 or IIA1) underwent primary surgery treatments by laparoscopy or laparotomy in Tenth’s People Hospitals. The women diagnosed as stage IB1 or IIA1 performed radical hysterectomy (RH). The total parametrium excision in process of radical hysterectomy was clarified specially in the study. Results: 186 patients underwent open surgery and 142 ones were performed laparoscopic surgery. Laparoscopic surgery was associated with less blood loss (194.43±84.40ml vs. 362.68±253.36ml, P<0.01), shorter hospital staying (11day vs. 14day, P<0.01) and fewer risk of blood transfusion (2.8% vs. 18.8%, P<0.01). There was no statistical difference in postoperative complications between two groups (18/142,12.7% vs. 21/186,11.3% P>0.05). The rate of 5-years overall survival (OS) was 92.8% in laparoscopy group similar to that of 94.4% in open group (p=0.762). Disease-free survival (DFS) rate at 3 years in laparoscopy group significantly decreased when compared to open group (91.8% vs 95.0%, p=0.030). But there was no difference in 3-years DFS among the women with tumor size <2cm (100% vs 97.0%, p=0.818). Discussion: Laparoscopic surgery was associated with preferable surgical quality compared to open surgery in ECC. Laparoscopic radical hysterectomy may be fit to the women with tumor <2cm. Standardized radical hysterectomy helps to promise the clinical outcomes of LRH in ECC.

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“…Many other experiences still support the use of laparoscopy of robotics in the field: recently, Gil‐Moreno and colleagues did not observe differences in recurrence rates between minimally invasive and open radical hysterectomy (15.1% versus 14.4%, P = 0.64) after a long follow‐up of 112.4 months (range 52‐162 months) …”

Section: Discussionmentioning

confidence: 99%

Survival outcomes of robotic radical hysterectomy for early stage cervical cancer: A 9‐year study

Siesto

Finco

Portuesi

et al. 2019

Robotics Computer Surgery

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Background Recently, the results of a RCT have raised concerns on the management of cervical cancer through a minimally invasive approach. This study reports on the outcomes of patients with early stage cervical cancer submitted to robotics. Methods Retrospective review of a consecutive series of patients with an early cervical cancer treated with robotics at a single Institution over a 9‐year period. Results A total of 91 women were managed; 39 (41.1%) had cervical adenocarcinoma. One (1.1%) conversion to laparotomy and one (1.1%) intraoperative complication occurred. Five (5.5%) patients experienced postoperative (>G2) complications; 24 (26.4%) patients required further adjuvant therapies. After a median follow‐up of 40.7 (3.8‐96.6) months, the DFS and OS were 90.4 (95%CI 85.3‐95.6)% and 94.5 (95%CI 91.8‐97.2)%, respectively. Conclusions According to the available literature, the survival outcomes of this series of RRH for ECC are not inferior to what recorded in the past by an open approach.

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Radical Hysterectomy: Efficacy and Safety in the Dawn of Minimally Invasive Techniques

Abstract: With 1 of the largest follow-up periods in the literature, this study provides added evidence that MIS could become the preferable surgical approach for early-stage cervical cancer since it appears to reduce morbidity without affecting oncologic results.

Cited by 42 publications

References 29 publications

Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China

Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China

Standardized radical hysterectomy promises the clinical outcomes of laparoscopic surgery for early-stage cervical cancer

Survival outcomes of robotic radical hysterectomy for early stage cervical cancer: A 9‐year study

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