Surgical Approach and Use of Uterine Manipulator Are Not Associated with LVSI in Surgery for Early-stage Cervical Cancer

Liu, Yinxia; Huang, Shuying; Ming, Xiu; Jing, Huining; Li, Zhengyu

doi:10.1016/j.jmig.2021.01.013

Cited by 15 publications

(16 citation statements)

References 28 publications

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“…A possible explanation is the use of an intrauterine manipulator in minimally invasive surgery, which might increase the intrauterine pressure and spread the cancer cells into the lymphovascular space 16 – 19 . However, other reports showed that the use of manipulators is not associated with worse prognosis, and its clinical significance remains controversial 20 , 21 . Thus, the basic principles in oncologic surgery are important; although they are not the absolute factors, there could be other factors that have a great influence.…”

Section: Discussionmentioning

confidence: 99%

Clinical effects of cervical conization with positive margins in cervical cancer

Nagao

Yokoi²,

Yoshida³

et al. 2021

Sci Rep

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Radical surgery after cervical conization is a common approach for the treatment of cervical cancer. In some cases, disease progression is observed after positive margins at conization, but the effect of conization on disease progression remains unclear. Thus, the aim of this study was to investigate the clinical outcomes of positive margins at conization in cervical cancer. A total of 101 patients who underwent cervical conization before radical hysterectomy and pelvic lymph node dissection were considered eligible by reviewing medical records. The association between the positive margins and patient outcomes, including subsequent lymph node metastasis, was evaluated. The rate of lymphovascular space invasion (LVSI) positivity at radical surgery was significantly higher in patients with positive margins (p = 0.017) than in those with negative margins, although there was no significant difference in the rate of pelvic lymph node metastasis (p = 0.155). Moreover, there was no significant difference in the overall survival or progression-free survival between the two groups (p = 0.332 and 0.200, respectively). A positive margin at conization presented no significant prognostic disadvantage; thus, diagnostic conization is one of the most suitable treatment options for early-stage cervical cancer that is difficult to accurately assess.

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Section: Discussionmentioning

confidence: 99%

Clinical effects of cervical conization with positive margins in cervical cancer

Nagao

Yokoi²,

Yoshida³

et al. 2021

Sci Rep

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show abstract

“…Even RCTs, the most rigorous study design, were difficult to conduct rigorously in the evaluation of some complex surgical interventions [76]. Therefore, the reported increased risk of recurrence of cervical cancer associated with MIS might reflect the uneven proficiency in the MIS technique around the world rather than the inferiority of the surgical approach itself [77,78]. Center-associated factors such as center sample volume and experience of surgeons needed to be taken consideration in future evaluation of MIS hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of survival after minimally invasive radical hysterectomy versus abdominal radical hysterectomy in cervical cancer: center-associated factors matter

Sun

Cai

et al. 2022

Arch Gynecol Obstet

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Purpose To explore the possible factors that contributed to the poor performance of minimally invasive surgery (MIS) versus abdominal surgery regarding progression-free survival (PFS) and overall survival (OS) in cervical cancer. Methods MEDLINE, EMBASE, Cochrane Library and Web of Science were searched (January 2000 to April 2021). Study selection was performed by two researchers to include studies reported oncological safety. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were combined using random-effect model. Subgroup analyses were stratified by characteristics of disease, publication, study design and treatment center. Results Sixty-one studies with 63,369 patients (MIS 26956 and ARH 36,049) were included. The overall-analysis revealed a higher risk of recurrence (HR 1.209; 95% CI 1.102–1.327) and death (HR 1.124; 95% CI 1.013–1.248) after MIS versus ARH expect in FIGO IB1 (FIGO 2009 staging) patients with tumor size less than 2 cm. However, subgroup analyses showed comparable PFS/DFS and OS in studies published before the Laparoscopic Approach to Cervical Cancer (LACC) trial, published in European journals, conducted in a single center, performed in centers in Europe and in centers with high sample volume or high MIS sample volume. Conclusion Our findings highlight possible factors that associated with inferior survival after MIS in cervical cancer including publication characteristics, center-geography and sample volume. Center associated factors were needed to be taken into consideration when evaluating complex surgical procedures like radical hysterectomy.

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“…Nevertheless, in the current study, different surgical approach didn’t influence the incidence of LVSI significantly. A recent prospective study also found that surgical approach and the utilization of manipulator are not associated with LVSI in cervical cancer [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy versus chemoradiotherapy for FIGO stages IB1 and IIA1 cervical squamous cancer patients with lymphovascular space invasion: a retrospective study

Zhang

et al. 2022

BMC Cancer

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Purpose To evaluate the impact of different adjuvant therapy on IB1 and IIA1 stage cervical squamous cell cancer patients with lymphovascular space invasion. It also aimed to analyze the relationship between lymphovascular space invasion and other clinical pathological characteristics on IB1 and IIA1 stage cervical squamous cell cancer patients. Methods This retrospective observational study collected data of FIGO stages IB1 and IIA1 squamous cervical cancer patients at the First Affiliated Hospital of Chongqing Medical University between 2014 and 2018. A correlation analysis between lymphovascular space invasion and other clinical or pathological factors was conducted. Prognosis analysis of patients with lymphovascular space invasion were performed to assess associations between clinical-pathological characteristics and survival. Results A total of 357 women were identified including 110 (30.8%) with lymphovascular space invasion, 247 (69.2%) without lymphovascular space invasion. Both middle 1/3 cervical stromal invasion (p = 0.000) and deep 1/3 cervical stromal invasion (p = 0.000) were independently associated with lymphovascular space invasion. Among lymphovascular space involved women, tumor differentiation (P = 0.001) and postoperative therapy (P = 0.036) had a significant influence on disease recurrence. Multivariate analysis showed that lymph node metastasis (P = 0.017), poorer tumor differentiation (P = 0.036) and postoperative chemotherapy alone (P = 0.021) can increase the risk of tumor relapse. Conclusion Our study suggested that the presence of deep stromal invasion independently increases the risk of lymphovascular space invasion. Compared with chemotherapy, chemoradiotherapy seems to improve progression-free survival in squamous cervical cancer patients with lymphovascular space invasion.

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Surgical Approach and Use of Uterine Manipulator Are Not Associated with LVSI in Surgery for Early-stage Cervical Cancer

Cited by 15 publications

References 28 publications

Clinical effects of cervical conization with positive margins in cervical cancer

Clinical effects of cervical conization with positive margins in cervical cancer

A meta-analysis of survival after minimally invasive radical hysterectomy versus abdominal radical hysterectomy in cervical cancer: center-associated factors matter

Chemotherapy versus chemoradiotherapy for FIGO stages IB1 and IIA1 cervical squamous cancer patients with lymphovascular space invasion: a retrospective study

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