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Journal of Laparoendoscopic & Advanced... Dec 2015Studies comparing the prognostic results between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in cervical cancer reported... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Studies comparing the prognostic results between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in cervical cancer reported contradictory results. We aimed to evaluate the prognostic and safety roles of LRH by pooling studies in a meta-analysis.
MATERIALS AND METHODS
Original articles were searched in PubMed, EMBASE, and the Cochrane Library. The survival results (5-year disease-free survival [DFS], 5-year overall survival [OS], and recurrence rate [RR]), safety parameters (intra-, peri-, and postoperative complication rates and postoperative bowel or bladder recovery days), efficiency parameters (pelvic/para-aortic lymph nodes removed), and other parameters (operative time, estimated blood loss, and hospital of stay) between the two approaches were reviewed.
RESULTS
For the 2922 cases identified, DFS, OS, and RR did not differ in balanced prognostic factors, including lymph node metastasis, Stage IIB or above, non-squamous cancer histology, grade G3, lymphovascular space invasion, tumor size ≥4 cm, and positive parametrial and vaginal margin rates. Meanwhile, LRH was associated with higher complication rates and a shorter time to the recovery of bowel or bladder function than for ARH. The number of removed pelvic or para-aortic lymph nodes did not significantly differ. Other parameters showed LRH was associated with a longer operative time, less blood loss, and a shorter length of hospital stay. The survival and prognostic results did not differ in balanced prognostic factors.
CONCLUSIONS
LRH is safe and has lower operative complication rates than ARH.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Neoplasm Recurrence, Local; Postoperative Complications; Prognosis; Survival Analysis; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 26584414
DOI: 10.1089/lap.2015.0390 -
Clinical & Translational Oncology :... Nov 2021Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this...
PURPOSE
Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this retrospective cohort study was to evaluate bladder, bowel and sexual function in women who underwent minimally invasive surgery for early-stage cervical cancer.
METHODS
From 2007-2013, 261 women underwent laparoscopically assisted radical vaginal hysterectomy (LARVH = 45), vaginally assisted laparoscopic or robotic radical hysterectomy (VALRRH = 61) or laparoscopic total mesometrial resection (TMMR = 25) and 131 of them completed the validated German version of the Australian Pelvic Floor Questionnaire (PFQ). Results were compared with controls recruited from gynecological clinics (n = 24) and with urogynecological patients (n = 63).
RESULTS
Groups were similar regarding age, BMI and parity. The TMMR group had significantly shorter median follow-up (16 months versus 70 and 36 months). Postoperatively, deterioration of bladder function was reported by 70%, 57% and 44% in the LARVH, VARRVH and TMMR groups, respectively (p = 0.734). Bowel function was significantly worse after TMMR with a higher deterioration rate in 72 versus 43% (LARVH) and 47% (VARRVH) with a correspondingly higher bowel dysfunction score of 2.9 versus 1.5 and 1.8, respectively and 1.8 in urogynaecological patients. Sexual dysfunction was common in all surgical groups. 38% considered their vagina too short which was significantly associated with deep dyspareunia. Compared with controls, surgical groups had significantly increased PFQ scores.
CONCLUSION
Pelvic floor dysfunction commonly deteriorates and negatively impacts on quality of life after minimally invasive radical hysterectomy, especially bowel function after TMMR. Pelvic floor symptoms should routinely be addressed pre- and postoperatively.
Topics: Adult; Aged; Case-Control Studies; Constipation; Dyspareunia; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Intestinal Diseases; Laparoscopy; Middle Aged; Neoplasm Staging; Organ Size; Patient Reported Outcome Measures; Postoperative Complications; Postoperative Period; Quality of Life; Retrospective Studies; Robotic Surgical Procedures; Sexual Dysfunction, Physiological; Surveys and Questionnaires; Urinary Bladder Diseases; Urinary Bladder, Overactive; Urinary Incontinence, Stress; Uterine Cervical Neoplasms; Vagina
PubMed: 34003456
DOI: 10.1007/s12094-021-02632-7 -
Journal of Gynecologic Oncology Nov 2021To evaluate the incidence of urologic complications requiring a urologic procedure during the perioperative period and compare the differences between abdominal radical...
The incidence of urologic complications requiring urologic procedure in radical hysterectomy and difference between abdominal radical hysterectomy and laparoscopic radical hysterectomy.
OBJECTIVE
To evaluate the incidence of urologic complications requiring a urologic procedure during the perioperative period and compare the differences between abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH).
METHODS
We identified all Korean women who underwent radical hysterectomy (RH) between January 2006 and December 2019 using the National Health Insurance Service database. Complications requiring surgical intervention-based urologic procedures between ARH and LRH were investigated.
RESULTS
A total of 12,068 patients were classified into the ARH group and 8,837 patients were classified into the LRH group. Urologic complications requiring urologic procedures occurred in 1,546 of 20,905 patients (7.40%) who underwent RH. The most common urologic procedure was double-J insertion (R326, 5.18%), followed by bladder repair (R3550, 0.90%). There was no significant difference in urologic complications requiring urologic procedures between the ARH and LRH groups (odds ratio [OR]=1.027; 95% confidence interval [CI]=0.925-1.141; p=0.612). The incidence of bladder repair (R3550) was significantly higher in patients who underwent LRH (OR=1.620; 95% CI=1.220-2.171; p<0.001). Urologic complications requiring urologic procedures were statistically higher in the LRH group during the first half (OR=1.446; 95% CI=1.240-1.685; p<0.001), but more in the ARH group during the second half (OR=0.696; 95% CI=0.602-0.804; p<0.001) of the study period.
CONCLUSION
There was no difference of urologic complications between ARH and LRH with regard to urologic procedures. The incidence of urologic procedures decreases with time in patients who underwent LRH.
Topics: Abdomen; Female; Humans; Hysterectomy; Incidence; Laparoscopy; Neoplasm Staging; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 34431255
DOI: 10.3802/jgo.2021.32.e84 -
JSLS : Journal of the Society of... 2012The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical...
INTRODUCTION
The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported.
CASE DESCRIPTION
We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence.
CONCLUSION
Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.
Topics: Adult; Biopsy; Carcinoma, Squamous Cell; Cervix Uteri; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Hysterectomy; Laparoscopy; Pregnancy; Pregnancy Complications, Neoplastic; Uterine Cervical Neoplasms
PubMed: 23318085
DOI: 10.4293/108680812X13462882736097 -
Gynecologic Oncology Aug 2021To compare long-term oncological outcomes in early-stage cervical cancer (CC) patients treated with minimally invasive radical hysterectomy (MIRH) versus abdominal...
Long-term oncological outcomes and recurrence patterns in early-stage cervical cancer treated with minimally invasive versus abdominal radical hysterectomy: The Norwegian Radium Hospital experience.
OBJECTIVE
To compare long-term oncological outcomes in early-stage cervical cancer (CC) patients treated with minimally invasive radical hysterectomy (MIRH) versus abdominal radical hysterectomy (ARH), with a focus on recurrence patterns, tumor sizes, and conization.
METHODS
This single-institution, retrospective study consisted of stage IA1-IB1 (FIGO 2009) squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix, who underwent radical hysterectomy between 2000 and 2017.
RESULTS
Of the 582 patients included, 353 (60.7%) underwent ARH, and 229 (39.3%) MIRH. The median follow-up was 14.4 years in the ARH group and 6.1 years in the MIRH group (p < 0.0001). Among the 96 stage IA patients, only 3 (3.1%) experienced recurrence. Among stage IB1 patients, the risk of recurrence, after adjusting for standard prognostic variables, was twofold higher in the MIRH group versus the ARH group (HR 2.73, 95% CI: 1.56-4.80), and the relative difference was similar in terms of risk of cancer-specific survival (CSS) (HR 3.04, 95% CI: 1.28-7.20) and overall survival (OS) (HR 2.35, 95% CI: 1.21-4.59). In stage IB1 ≤ 2 cm patients without conization MIRH was associated with reduced time to recurrence (TTR) (HR 4.00, 95% CI: 1.67-9.57), CSS (HR 3.71, 95% CI: 1.19-11.58) and OS (HR 3.02, 95% CI: 1.24-7.34). Intraperitoneal combined recurrences accounted for 12 of 30 (40.0%) recurrences in the MIRH group but were not identified after ARH (p = 0.0001).
CONCLUSIONS
MIRH was associated with reduced TTR, CSS and OS versus ARH in stage IB1 CC patients. The risk of peritoneal recurrence was high, even for tumors ≤2 cm without conization.
Topics: Adult; Aged; Cervix Uteri; Conization; Female; Follow-Up Studies; Humans; Hysterectomy; Kaplan-Meier Estimate; Laparoscopy; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Retrospective Studies; Time Factors; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 34083029
DOI: 10.1016/j.ygyno.2021.05.028 -
American Journal of Obstetrics and... Oct 2023International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage...
BACKGROUND
International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer.
OBJECTIVE
This study aimed to assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence.
STUDY DESIGN
This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy.
RESULTS
A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non-nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non-nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P<.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P=.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9-92.2) vs 93.8% (95% confidence interval, 91.1-96.5), respectively (P=.047). Non-nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31-0.81; P=.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1-97.2) vs non-nerve-sparing 96.5% (95% confidence interval, 94.3-98.7), respectively (P=.78). In patients with a tumor diameter ≤20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non-nerve-sparing radical hysterectomy (P=.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non-nerve-sparing radical hysterectomy vs 83.1% in nerve-sparing radical hysterectomy (P=.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P=.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P=.70).
CONCLUSION
For tumors ≤20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease-free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non-nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve-sparing radical hysterectomy after propensity score match analysis.
Topics: Female; Pregnancy; Humans; Uterine Cervical Neoplasms; Retrospective Studies; Neoplasm Staging; Hysterectomy; Disease-Free Survival; Carcinoma, Squamous Cell
PubMed: 37336255
DOI: 10.1016/j.ajog.2023.06.030 -
Acta Obstetricia Et Gynecologica... Nov 2019Surgery by open radical hysterectomy for cervical cancer is associated with sexual dysfunction as well as lymphedema and bladder problems. Our aim was to assess the...
INTRODUCTION
Surgery by open radical hysterectomy for cervical cancer is associated with sexual dysfunction as well as lymphedema and bladder problems. Our aim was to assess the impact of robot-assisted laparoscopic radical hysterectomy (RRH) with pelvic lymphadenectomy for early-stage cervical cancer on sexual, bowel, bladder, and lymphatic function and to measure ovarian function after RRH.
MATERIAL AND METHODS
Twenty-six women with early-stage cervical cancer during 2011-2013 were investigated before and 1 year after RRH using a validated questionnaire measuring psychological well-being and sexual, bowel, bladder, and lymphatic function. Blood samples for follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex-hormone-binding globulin (SHBG), estradiol, total testosterone, androstenedione, and anti-Müllerian hormone (AMH) were analyzed at baseline and 1 year after treatment.
RESULTS
Anxiety and depression increased in 17/26 (62%) and 16/26 (65%) of the women respectively. Sexual distress symptoms reported 1 year after RRH were numbness of the labia (P = 0.04) and deep pain during intercourse (P = 0.02). Twelve of 26 (46%) had lymphedema, and 10/26 (35%) had bladder problems 1 year after surgery. Levels of FSH and LH were significantly increased (P < 0.01) and AMH decreased (P = 0.02) 1 year after RRH in women <45 years with preserved ovaries. Androgen levels were unchanged.
CONCLUSIONS
In our study, RRH was associated with minor sexual dysfunction. RRH may facilitate the preservation of posterior branches from the hypogastric nerve that are important for arousal and orgasm. Bladder problems and lymphedema remain the most frequently reported sequelae. Women with preserved ovaries after RRH may have an early onset of menopause.
Topics: Adult; Carcinoma, Squamous Cell; Cohort Studies; Early Detection of Cancer; Female; Follow-Up Studies; Hospitals, University; Humans; Hysterectomy; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Ovary; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Sexual Behavior; Sweden; Time Factors; Treatment Outcome; Urinary Bladder; Uterine Cervical Neoplasms
PubMed: 31237957
DOI: 10.1111/aogs.13680 -
Vojnosanitetski Pregled Jun 2007[corrected] Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical...
BACKGROUND/AIM
[corrected] Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy.
METHODS
The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient's age; the International Federation of Ginecology and Obstetrics (FIGO) stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection.
RESULTS
The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentoned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal fistuls had abscess of vaginal cuff.
CONCLUSION
The stage of the disease seem to be the most significant factor in the development of intraoperative ureter and bladder injuries. The stage of the disease, intraoperative bladder injury, diabetes mellitus and postoperative infection of surgical site are the most significant factors in the development of postoperative fistuls.
Topics: Adult; Aged; Female; Humans; Hysterectomy; Intraoperative Complications; Middle Aged; Ureter; Urinary Bladder; Urinary Fistula; Uterine Cervical Neoplasms
PubMed: 17687941
DOI: 10.2298/vsp0706381l -
Medicine Jan 2020To compare the clinical outcomes of radical hysterectomy (RH) with chemoradiotherapy (CRT) in women with stage IB2-IIA cervical cancer. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
To compare the clinical outcomes of radical hysterectomy (RH) with chemoradiotherapy (CRT) in women with stage IB2-IIA cervical cancer.
METHODS
Based on articles published up to December 2017, a literature search of PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese National Knowledge Infrastructure (CNKI) databases was conducted to identify eligible studies. Overall survival (OS), progression-free survival (PFS) with hazard ratios (HRs), and toxicities with odds ratios (ORs) were analyzed.
RESULTS
In total, 7 studies comprising 687 patients were identified for this meta-analysis. RH showed a significant trend toward improved survival outcomes compared with those of CRT, regardless of OS (HR = 0.49, 95% confidence interval [CI] 0.36-0.67, P < .001); or PFS (1.61, 95% CI 1.15-2.26, P = .005) for IB2-IIA cervical cancer. Subgroup analysis revealed that stage IB2 cervical cancer patients obtained better OS (HR = 0.36, 95% CI 0.23-0.56, P < .001; heterogeneity: P = .32, I = 13%). However, a higher incidence of grade 3/4 genitourinary abnormalities was evident with RH (OR = 2.3, 95% CI 1.42-3.87, P = .021).
CONCLUSION
Our study suggested that RH had distinct advantages over CRT for carcinoma of the uterine cervix with FIGO stage IB2-IIA, especially for IB2 cervical cancer.
Topics: Carcinoma; Chemoradiotherapy; Female; Humans; Hysterectomy; Uterine Cervical Neoplasms
PubMed: 32000377
DOI: 10.1097/MD.0000000000018738 -
Medicine Sep 2017The aim of this study was to compare the safety and survival outcomes of early stage cervical cancer patients treated by laparoscopically assisted radical vaginal... (Comparative Study)
Comparative Study
BACKGROUND
The aim of this study was to compare the safety and survival outcomes of early stage cervical cancer patients treated by laparoscopically assisted radical vaginal hysterectomy (LARVH) versus abdominal radical hysterectomy (ARH).
METHODS
Since March 2008 to July 2012, the patients with early stage cervical cancer undergoing LARVH or ARH in Beijing hospital have been entered into this study. Statistical analysis used Statistical Product and Service Solutions (SPSS) and significance was defined as P < .05.
RESULT
Forty-two patients were included in LARVH group and 35 patients in ARH group. Both groups were similar with respect to age, body mass index (BMI), histological diagnosis, and stage. There were no differences in operative time, vaginal length, and postoperative complications, but blood loss, rate of transfusion, length of catheterized, and length of hospital stay were significantly less in LARVH. Number of lymph node retrieved was less than ARH. No differences were seen regarding recurrence rate, length of disease free survival, overall survival, and mortality rate after a median follow up of 58.5 and 48.5 months.
CONCLUSION
LARVH is a suitable alternative to ARH for early-stage cervical cancer, which shows less blood loss, shorter catheterized and hospital stay, and similar survival outcomes.
Topics: Adult; Aged; Blood Loss, Surgical; Blood Transfusion; Catheters; Female; Follow-Up Studies; Humans; Hysterectomy; Laparoscopy; Length of Stay; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Operative Time; Postoperative Complications; Retrospective Studies; Survival Analysis; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 28885364
DOI: 10.1097/MD.0000000000008005