Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer

Plante, Marie; Kwon, Janice S.; Ferguson, Sarah; Samouëlian, Vanessa; Ferron, Gwenael; Maulard, Amandine; de Kroon, Cor; Van Driel, Willemien; Tidy, John; Williamson, Karin; Mahner, Sven; Kommoss, Stefan; Goffin, Frederic; Tamussino, Karl; Eyjólfsdóttir, Brynhildur; Kim, Jae-Weon; Gleeson, Noreen; Brotto, Lori; Tu, Dongsheng; Shepherd, Lois E.

doi:10.1056/nejmoa2308900

Cited by 69 publications

(13 citation statements)

References 26 publications

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“…Marie found that simple hysterectomy(SH) was non inferior to radical hysterectomy(RH) with respect to 3-year pelvic recurrence among women with low-risk cervical cancer [ 22 ]. Another meta-analysis showed that there was no significant difference in recurrence rate and overall survival in patients with stage IA2-IB1 cervical cancer who received SH or RH, while the SH group had better surgery-related outcomes [ 23 ]. The results indicate that simple hysterectomy also can achieve a good survival benefits for early-stage cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Lei,

Zhang,

Zheng

et al. 2024

BMC Cancer

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Objective To identify the risk factors of cervical high-grade squamous intraepithelial lesion(HSIL) complicated with occult cervical cancer and standardize the management of initial treatment for HSIL. Method The clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading. Result 1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2–59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244–12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78–23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947–14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892–11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good. Conclusion There is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.

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Section: Discussionmentioning

confidence: 99%

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Lei,

Zhang,

Zheng

et al. 2024

BMC Cancer

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“…In the context of early-stage cervical cancer diagnosed on conization, this vNOTES approach represents a valuable option in a two-step strategy with initial SLN mapping with definitive pathological analyses, followed by a radical hysterectomy [ 1 , 19 , 26 ] or a simple or radical trachelectomy if LNs appear negative [ 25 ]. Recent randomized data support that parametrial infiltration is very low in early-stage and low-risk cervical cancer [ 34 ]. Another recent prospective trial showed that conservative surgery with conization or simple hysterectomy is feasible in early stages and low-risk cervical cancer [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Mapping by Retroperitoneal vNOTES for Uterus-Confined Malignancies: A Standardized 10-Step Approach

Huber,

Hurni

2024

Cancers

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(1) Background: Sentinel lymph node (SLN) mapping represents an accurate and feasible technique for the surgical staging of endometrial and cervical cancer. This is commonly performed by conventional laparoscopy or robotic-assisted laparoscopy, but in recent years, a new retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach has been described and developed by Jan Baekelandt. This technique provides easy visualization of lymphatic afferent vessels and pelvic lymph nodes, early SLN assessment, and a coherent mapping methodology following the lymphatic flow from caudal to cranial. However, only a few publications have reported it. Following the IDEAL (Idea Development Exploration Assessment Long-term follow-up) framework, research concerning this technique is in Stage 2a, with only small case series as evidence of its feasibility. Its standardized description appears necessary to provide the surgical homogeneity required to move further. (2) Methods: Description of a standardized approach for retroperitoneal pelvic SLN mapping by vNOTES. (3) Results: We describe a 10-step approach to successfully perform retroperitoneal vNOTES SLN mapping, including pre-, intra-, and postoperative management. (4) Conclusions: This IDEAL Stage 2a study could help other surgeons approach this new technique, and it proposes a common methodology necessary for evolving through future IDEAL Stage 2b (multi-center studies) and Stage 3 (randomized controlled trials) studies.

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“…However, similar to our study, when evaluating patients who did not undergo a preoperative conization, those who underwent minimally invasive surgery (n = 191) had a higher risk of tumor recurrence (19.4% vs. 4.5%) and worse disease-free survival (HR: 5.85; 95% CI: 2.47, 13.9; p < 0.001) compared to those who had laparotomy (n = 176) [ 28 ]. In the recent phase III randomized trial (SHAPE) that compared the oncologic safety of simple hysterectomy to standard-of-care radical hysterectomy and included 700 patients with low-risk early-stage cervical cancer (size ≤2 cm and limited stromal invasion), the majority (77%) of patients underwent minimally invasive surgery [ 29 ]. Although not a primary outcome of the trial, exploratory analyses revealed that there was no difference in risk of recurrence between the open (3.8%) and minimally invasive (3.6%) surgery groups [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Radical Hysterectomy for Early-Stage Cervical Carcinoma, with or without Prior Cervical Excision Procedure

Nasioudis,

Labban,

Gysler

et al. 2024

Cancers

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Objective: To investigate the impact of a prior cervical excisional procedure on the oncologic outcomes of patients with apparent early-stage cervical carcinoma undergoing radical hysterectomy. Methods: The National Cancer Database (2004–2015) was accessed, and patients with FIGO 2009 stage IB1 cervical cancer who had a radical hysterectomy with at least 10 lymph nodes (LNs) removed and a known surgical approach were identified. Patients who did and did not undergo a prior cervical excisional procedure (within 3 months of hysterectomy) were selected for further analysis. Overall survival (OS) was evaluated following the generation of Kaplan–Meier curves and compared with the log-rank test. A Cox model was constructed to control a priori-selected confounders. Results: A total of 3159 patients were identified; 37.1% (n = 1171) had a prior excisional procedure. These patients had lower rates of lymphovascular invasion (29.2% vs. 34.9%, p = 0.014), positive LNs (6.7% vs. 12.7%, p < 0.001), and a tumor size >2 cm (25.7% vs. 56%, p < 0.001). Following stratification by tumor size, the performance of an excisional procedure prior to radical hysterectomy was associated with better OS even after controlling for confounders (aHR: 0.45, 95% CI: 0.30, 0.66). The rate of minimally invasive surgery was higher among patients who had a prior excisional procedure (61.5% vs. 53.2%, p < 0.001). For these patients, performance of minimally invasive radical hysterectomy was not associated with worse OS (aHR: 1.37, 95% CI: 0.66, 2.82). Conclusions: For patients undergoing radical hysterectomy, preoperative cervical excision may be associated with a survival benefit. For patients who had a prior excisional procedure, minimally invasive radical hysterectomy was not associated with worse overall survival.

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Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer

Cited by 69 publications

References 26 publications

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Clinical analysis of 314 patients with high-grade squamous intraepithelial lesion who underwent total hysterectomy directly: a multi-center, retrospective cohort study

Sentinel Lymph Node Mapping by Retroperitoneal vNOTES for Uterus-Confined Malignancies: A Standardized 10-Step Approach

Outcomes of Radical Hysterectomy for Early-Stage Cervical Carcinoma, with or without Prior Cervical Excision Procedure

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