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BMC Cancer Mar 2020This study aimed to compare the survival outcomes of radio-chemotherapy (R-CT) and radical hysterectomy with postoperative standard therapy (RH) in stage IB1-IIA2... (Clinical Trial)
Clinical Trial
Comparison of survival outcomes between radio-chemotherapy and radical hysterectomy with postoperative standard therapy in patients with stage IB1 to IIA2 cervical cancer: long-term oncological outcome analysis in 37 Chinese hospitals.
BACKGROUND
This study aimed to compare the survival outcomes of radio-chemotherapy (R-CT) and radical hysterectomy with postoperative standard therapy (RH) in stage IB1-IIA2 cervical cancer patients.
METHODS
Based on the large amount of diagnostic and treatment cervical cancer data in China, a real-world study and 1:1 case-control matching were used to compare overall survival (OS) and disease-free survival (DFS) in cervical cancer patients.
RESULTS
In this real-world study, the 5-year OS and DFS in the R-CT group (n = 8949) were lower than those in the RH group (n = 18,152). After applying the inclusion criteria, the OS and DFS in the R-CT group (n = 582) were lower than those in the RH group (n = 4308). After 1:1 case-control matching, the 5-year OS and DFS in the R-CT group (n = 535) were lower than those in the RH group (n = 535) (OS: 76.1% vs. 84.6%, p < 0.001, HR = 1.819; DFS: 75.1% vs. 81.5%, p < 0.001, HR = 1.462, respectively). Further stratification showed that for stage IB1 and IIA1 patients, the 5-year OS and DFS in the R-CT group (n = 300) were lower than those in the RH group (n = 300) (OS: 78.9% vs. 87.0%, p < 0.001, HR = 2.160; DFS: 77.0% vs. 84.9%, p < 0.001, HR = 2.053, respectively). In stage IB2 and IIA2 patients, the 5-year OS in the R-CT group (n = 235) was lower than that in the RH group (n = 235) (72.5% vs. 81.5%, p = 0.039; HR = 1.550), but no difference in the 5-year DFS was found between the two groups (72.6% vs. 76.9%, p = 0.151).
CONCLUSIONS
Our study found that for stage IB1-IIA2 cervical cancer patients, RH offers better overall survival and disease-free survival outcomes than R-CT, however, due to the inherent biases of retrospective study, it needs to be confirmed by randomized trials. In addition, we need to further understand the quality of life of the two treatments.
TRIAL REGISTRATION
registration number: CHiCTR1800017778; International Clinical Trials Registry Platform Search Port, http://apps.who.int/trialsearch/. registration date: August 14, 2018.
Topics: Adult; Aged; Chemoradiotherapy; Chemotherapy, Adjuvant; China; Disease-Free Survival; Female; Follow-Up Studies; Humans; Hysterectomy; Kaplan-Meier Estimate; Middle Aged; Neoplasm Staging; Postoperative Care; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 32138718
DOI: 10.1186/s12885-020-6651-8 -
Medicine Jul 2015This article aims to review our 13-year experience in the treatment of patients with cervical cancer by comparing total laparoscopic radical hysterectomy and...
This article aims to review our 13-year experience in the treatment of patients with cervical cancer by comparing total laparoscopic radical hysterectomy and lymphadenectomy with laparotomy.We reviewed all patients undergoing total laparoscopic or laparotomic radical hysterectomy and lymphadenectomy because of cervical cancer between 2001 and 2014 in our hospital.In total, 154 eligible patients with International Federation of Gynecology and Obstetrics Ia-IIb were enrolled, including 106 patients undergoing total laparoscopic procedure and 48 patients undergoing laparotomic procedure. In the present study, patients in total laparoscopy group were associated with superior surgical outcomes, such as significantly lower blood transfusion compared to those in laparotomy group. Furthermore, patients had significantly lower postoperative complication rate in total laparoscopy group compared with that in laparotomy group (24.5% vs 52.1%) (P = 0.001). Three patients (2.8%) in total laparoscopy group had unplanned conversion to laparotomy. Disease-free survival rates were 89.7% and 88.9% in total laparoscopy and laparotomy groups (P = 0.39), respectively, and overall survival rates were 90.2% in total laparoscopy group and 91.3% in laparotomy group (P = 0.40).Total laparoscopic procedure is a surgically and oncologically safe and reliable alternative to laparotomic procedure in the treatment for cervical cancer.
Topics: China; Female; Forecasting; Humans; Hysterectomy; Laparoscopy; Laparotomy; Lymph Node Excision; Lymphatic Metastasis; Neoplasm Staging; Pelvis; Retrospective Studies; Survival Rate; Uterine Cervical Neoplasms
PubMed: 26222868
DOI: 10.1097/MD.0000000000001264 -
Medicine Jan 2019To perform a meta-analysis of high-quality studies comparing robotic radical hysterectomy (RRH) vs laparoscopic radical hysterectomy (LRH), and open radical hysterectomy... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
To perform a meta-analysis of high-quality studies comparing robotic radical hysterectomy (RRH) vs laparoscopic radical hysterectomy (LRH), and open radical hysterectomy (ORH) for the treatment of cervical cancer.
METHODS
A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared RRH with LRH or ORH. The selection of high-quality, nonrandomized comparative studies was based on a validated tool (methodologic index for nonrandomized studies) since no randomized controlled trials have been published. Outcomes of interest included conversion rate, operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, number of retrieved lymph nodes (RLNs), and long-term oncologic outcomes.
RESULTS
Twelve studies assessing RRH vs LRH or ORH were included for this meta-analysis. In comparison with LRH, there was no difference in operation time, EBL, conversion rate, intraoperative or postoperative complications, LOS, and tumor recurrence (P > .05). Compared with ORH, patients underwent RRH had less EBL (weighted mean difference [WMD] = -322.59 mL; 95% confidence interval [CI]: -502.75 to -142.43, P < .01), a lower transfusion rate (odds ratio [OR] = 0.14, 95% CI: 0.06-0.34, P < .01), and shorter LOS (WMD = -2.71 days; 95% CI: -3.74 to -1.68, P < .01). There was no significant difference between RRH and LRH with respect to the operation time, intraoperative or postoperative complications, RLN, and tumor recurrence (P > .05).
CONCLUSION
Our results indicate that RRH is safe and effective compared to its laparoscopic and open counterpart and provides favorable outcomes in postoperative recovery.
Topics: Adult; Blood Loss, Surgical; Conversion to Open Surgery; Female; Humans; Hysterectomy; Laparoscopy; Length of Stay; Middle Aged; Operative Time; Postoperative Complications; Robotic Surgical Procedures; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 30681582
DOI: 10.1097/MD.0000000000014171 -
Scientific Reports Sep 2019Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who... (Randomized Controlled Trial)
Randomized Controlled Trial
Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who received laparoscopic nerve-sparing radical hysterectomy (NSRH) in a randomized controlled study. However, the definite reasons for these results were unknown. This subgroup analysis compared the neural areas and impairment in the IHP uterine branches harvested during NSRH as an alternative to the IHP vesical branches between the waterjet and control groups. This study included samples from 30 eligible patients in each group of the trial NCT03020238. At least one specimen from each side of the IHP uterine branches was resected. The tissues were scanned, images were captured, and the neural component areas were calculated using the image segmentation method. Immunohistochemical staining was used to evaluate neural impairment. The control and waterjet groups had similar areas of whole tissues sent for evaluation. However, the control group had significantly fewer areas (median 272158 versus 200439 μm, p = 0.044) and a lower percentage (median 4.9% versus 3.0%, p = 0.011) of neural tissues. No significant changes in immunohistochemical staining were found between the two groups. For patients with residual urine ≤100 and >100 ml at 14 days after NSRH (42 and 18 patients, respectively), there were significantly different percentages of neural tissues in the resected samples (p < 0.001). Hence, Due to the accurate identification of IHP during NSRH, the waterjet dissection technique achieved better urodynamic results.
Topics: Case-Control Studies; Female; Humans; Hypogastric Plexus; Hysterectomy; Organ Sparing Treatments; Peripheral Nerves; Urinary Bladder; Urodynamics; Uterine Cervical Neoplasms
PubMed: 31519975
DOI: 10.1038/s41598-019-49856-w -
Journal of Gynecologic Oncology May 2019Intraoperative tumor manipulation and dissemination may possibly compromise survival of women with early-stage cervical cancer who undergo minimally-invasive radical...
OBJECTIVES
Intraoperative tumor manipulation and dissemination may possibly compromise survival of women with early-stage cervical cancer who undergo minimally-invasive radical hysterectomy (RH). The objective of the study was to examine survival related to minimally-invasive RH with a "no-look no-touch" technique for clinical stage IB1 cervical cancer.
METHODS
This retrospective study compared patients who underwent total laparoscopic radical hysterectomy (TLRH) with no-look no-touch technique (n=80) to those who underwent an abdominal radical hysterectomy (ARH; n=83) for stage IB1 (≤4 cm) cervical cancer. TLRH with no-look no-touch technique incorporates 4 specific measures to prevent tumor spillage: 1) creation of a vaginal cuff, 2) avoidance of a uterine manipulator, 3) minimal handling of the uterine cervix, and 4) bagging of the specimen.
RESULTS
Surgical outcomes of TLRH were significantly superior to ARH for operative time (294 vs. 376 minutes), estimated blood loss (185 vs. 500 mL), and length of hospital stay (14 vs. 18 days) (all, p<0.001). Oncologic outcomes were similar between the 2 groups, including disease-free survival (DFS) (p=0.591) and overall survival (p=0.188). When stratified by tumor size (<2 vs. ≥2 cm), DFS was similar between the 2 groups (p=0.897 and p=0.602, respectively). The loco-regional recurrence rate following TLRH was similar to the rate after ARH (6.3% vs. 9.6%, p=0.566). Multiple-pelvic recurrence was observed in only 1 patient in the TLRH group.
CONCLUSION
Our study suggests that the no-look no-touch technique may be a useful surgical procedure to reduce recurrence risk via preventing intraoperative tumor spillage during TLRH for early-stage cervical cancer.
Topics: Adult; Carcinoma, Squamous Cell; Feasibility Studies; Female; Humans; Hysterectomy; Laparoscopy; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Staging; Operative Time; Postoperative Complications; Retrospective Studies; Survival Analysis; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 30887768
DOI: 10.3802/jgo.2019.30.e71 -
Current Oncology (Toronto, Ont.) Feb 2022Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery... (Review)
Review
Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) emerged as the mainstay in the surgical management of cervical cancer, bringing advantages such as lower operative morbidity and shorter hospital stay compared to open surgery while maintaining comparable oncologic outcomes in numerous retrospective studies. However, in 2018, a prospective phase III randomized controlled trial, "Laparoscopic Approach to Carcinoma of the Cervix (LACC)", unexpectedly reported that MIS was associated with a statistically significant poorer overall survival and disease-free survival compared to open surgery in patients with early-stage cervical cancer. Various hypotheses have been raised by the authors to try to explain these results, but the LACC trial was not powered to answer those questions. In this study, through an exhaustive literature review, we wish to explore some of the potential causes that may explain the poorer oncologic outcomes associated with MIS, including the type of MIS surgery, the size of the lesion, the impact of CO pneumoperitoneum, prior conization, the use of uterine manipulator, the use of protective measures, and the effect of surgical expertise/learning curve.
Topics: Clinical Trials, Phase III as Topic; Female; Humans; Hysterectomy; Laparoscopy; Minimally Invasive Surgical Procedures; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 35200592
DOI: 10.3390/curroncol29020093 -
The Journal of International Medical... Sep 2019We aimed to compare the survival and perioperative outcomes of patients with stage II endometrial cancer (EC) undergoing simple hysterectomy (SH) or radical hysterectomy... (Comparative Study)
Comparative Study
Comparison of survival and perioperative outcomes following simple and radical hysterectomy for stage II endometrial cancer: a single-institution, retrospective, matched-pair analysis.
OBJECTIVE
We aimed to compare the survival and perioperative outcomes of patients with stage II endometrial cancer (EC) undergoing simple hysterectomy (SH) or radical hysterectomy (RH), to validate the various guidelines.
METHODS
A total of 155 consecutive patients diagnosed with stage II EC from 2000 to 2014 were reviewed. We identified 40 pairs of patients (40 SH and 40 RH) who were matched in terms of age, pathological type, and lymphovascular space invasion status using matched-pair analysis. Patient data were collected from medical records and outcomes were determined by telephone follow-up.
RESULTS
Among the 80 patients in the two groups, seven died from tumor recurrence. However, cancer-related survival rates were not significantly different between the SH and RH groups. The 3-year cancer-related survival rates in the SH and RH groups were 94.97% and 92.53%, and the 5-year survival rates were 92.40% and 90.03%, respectively. Regarding perioperative outcomes, the SH group had significantly less intraoperative bleeding and a significantly shorter catheter-indwelling time than the RH group.
CONCLUSIONS
SH provides similar survival outcomes and a superior perioperative quality of life compared with RH in patients with stage II EC.
Topics: Adult; Aged; Endometrial Neoplasms; Female; Humans; Hysterectomy; Matched-Pair Analysis; Middle Aged; Multivariate Analysis; Neoplasm Staging; Perioperative Care; Prognosis; Retrospective Studies; Survival Analysis; Young Adult
PubMed: 31357882
DOI: 10.1177/0300060519863190 -
BMC Women's Health Dec 2021Historically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no...
BACKGROUND
Historically, hysterectomy has been the radical treatment for adenomyosis. Although, some patients may not want to have their uterus removed, patients often have to no choice but to request hysterectomy during conservative treatment. The factors necessitating these hysterectomies remain unknown. The purpose of this study was to determine which patients can continue conservative treatment for adenomyosis.
METHODS
We selected women diagnosed with adenomyosis and provided with conservative treatment at the Kindai University Hospital and Osaka Red Cross Hospital in Osaka Japan from 2008 to 2017. Age at diagnosis, parity, uterine size, subtype of adenomyosis, type of conservative treatment, and timing of hysterectomy for cases with difficulty continuing conservative treatment were examined retrospectively.
RESULTS
A total of 885 patients were diagnosed with adenomyosis, and 124 started conservative treatment. Conservative treatment was continued in 96 patients (77.4%) and hysterectomy was required in 28 patients (22.6%). The cumulative hysterectomy rate was 32.4%, and all women had hysterectomy within 63 months. In the classification tree, 82% (23/28) of women aged 46 years or younger were able to continue conservative treatment when parity was zero or one. In those with parity two and over, 95% (20/21) of those aged 39 years and older had hysterectomy.
CONCLUSIONS
Patients who continue conservative treatment for approximately 5 years are more likely to have successful preservation of the uterus. Multiparity and higher age at diagnosis are factors that contribute to hysterectomy after conservative treatment. Parity and age at diagnosis may be stratifying factors in future clinical trials of hormone therapy.
Topics: Adenomyosis; Adult; Conservative Treatment; Endometriosis; Female; Humans; Hysterectomy; Middle Aged; Pregnancy; Retrospective Studies; Uterus
PubMed: 34961515
DOI: 10.1186/s12905-021-01577-x -
BMC Women's Health Mar 2024Half of countries in Africa lack access to radiation (RT), which is essential for standard treatment of locally advanced cervical cancers. We evaluated outcomes for...
Outcomes of neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer at Kigali University Teaching Hospital, Rwanda: a retrospective descriptive study.
BACKGROUND
Half of countries in Africa lack access to radiation (RT), which is essential for standard treatment of locally advanced cervical cancers. We evaluated outcomes for patients treated with neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in settings where no RT is available.
METHODS
We performed a retrospective descriptive study of all patients with FIGO stage IB2-IIA2 and some exceptional stage IIB cases who received NACT and surgery at Kigali University Teaching Hospital in Rwanda. Patients were treated with NACT consisting of carboplatin and paclitaxel once every 3 weeks for 3-4 cycles before radical hysterectomy. We calculated recurrence rates and overall survival (OS) rate was determined by Kaplan-Meier estimates.
RESULTS
Between May 2016 and October 2018, 57 patients underwent NACT and 43 (75.4%) were candidates for radical hysterectomy after clinical response assessment. Among the 43 patients who received NACT and surgery, the median age was 56 years, 14% were HIV positive, and FIGO stage distribution was: IB2 (32.6%), IIA1 (7.0%), IIA2 (51.2%) and IIB (9.3%). Thirty-nine (96%) patients received 3 cycles and 4 (4%) received 4 cycles of NACT. Thirty-eight (88.4%) patients underwent radical hysterectomy as planned and 5 (11.6%) had surgery aborted due to grossly metastatic disease. Two patients were lost to follow up after surgery and excluded from survival analysis. For the remaining 41 patients with median follow-up time of 34.4 months, 32 (78%) were alive with no evidence of recurrence, and 8 (20%) were alive with recurrence. One patient died of an unrelated cancer. The 3-year OS rate for the 41 patients who underwent NACT and surgery was 80.8% with a recurrence rate of 20%.
CONCLUSIONS
Neoadjuvant chemotherapy with radical hysterectomy is a feasible treatment option for locally advanced cervical cancer in settings with limited access to RT. With an increase in gynecologic oncologists skilled at radical surgery, this approach may be a more widely available alternative treatment option in countries without radiation facilities.
Topics: Humans; Female; Middle Aged; Uterine Cervical Neoplasms; Neoadjuvant Therapy; Retrospective Studies; Carcinoma, Squamous Cell; Rwanda; Universities; Hospitals, Teaching; Neoplasm Staging; Hysterectomy; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant
PubMed: 38555423
DOI: 10.1186/s12905-024-03024-z -
Asian Journal of Surgery Aug 2021
Topics: Female; Humans; Hysterectomy; Laparoscopy; Neoplasm Staging; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 34078579
DOI: 10.1016/j.asjsur.2021.05.001