Completion Of Radical Hysterectomy Research Articles

Completion of radical hysterectomy does not improve survival of patients with cervical cancer and intraoperatively detected lymph node involvement: ABRAX international retrospective cohort study.

The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N=361) or abandoned (ABAND group, N=154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P=0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P=0.56), or death (HR 1.064, 95% CI 0.690-1.641, P=0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. NCT04037124.

Oncologic outcome after completing or abandoning (radical) hysterectomy in patients with cervical cancer and intraoperative detection of lymph node positivity; ABRAX (ABandoning RAd hyst in cerviX cancer)

BackgroundThe management of patients with intraoperative detection of lymph node involvement remains controversial. The most significant aspect is the decision regarding the completion of the cervical procedure, such as hysterectomy,...

Use of Abdominal Radical Trachelectomy to Treat Cervical Cancer Greater Than 2 cm in Diameter

Invasive cervical cancer is one of the most common cancers, with 500,000 new cases diagnosed annually. Fertility preservation has become an important component of the overall quality of life of many cancer survivors. Expert opinion has suggested that fertility-sparing surgery should be limited to those patients diagnosed with cervical cancer less than 2 cm in diameter. Our objective was to report our abdominal radical trachelectomy (ART) experience in the opposite group of patients-those with a cervical cancer more than 2 cm in diameter. Between 1999 and 2006, a total of 45 patients with cervical carcinoma at International Federation of Gynecology and Obstetrics stage IB1-IB2 measuring more than 2 cm in diameter underwent fertility-sparing ART and pelvic lymphadenectomy at the 3 institutions where the authors are based (Budapest, Hungary; London, United Kingdom; New York, United States). They were followed up for more than 5 years. For 69% of patients (n = 31), completed ART was considered to have been curative, and no adjuvant treatment was advised. Of those patients, 93.5% (n = 29) were alive at the time of follow-up. Thirty-one percent of patients (n = 14) underwent immediate completion of radical hysterectomy. Three of 8 patients who wished to fall pregnant delivered healthy neonates. The 5-year survival rate (93.5%) for this case series is equal (or better) to rates reported in the literature for patient treated with radical hysterectomy. Our survival data seem to support the hypothesis that ART is a safe treatment option for patients with invasive cervical cancer lesions of more than 2 cm.

Completed versus aborted radical hysterectomy for node-positive stage IB cervical cancer in the modern era of chemoradiation therapy

ObjectiveDebate continues about optimal management of patients with node-positive stage I cervical cancer. Our objective was to determine if patient outcomes are affected by radical hysterectomy in the modern era of adjuvant chemoradiation. MethodsCervical cancer patients diagnosed from 2000 to 2008 were identified. Demographics, therapy, clinicopathologic data, progression free survival (PFS), overall survival (OS), total radiation exposure, and grade 3–4 complications were analyzed by student t, Mann–Whitney, Fisher's exact, Kaplan–Meier, and log rank tests. ResultsThis single-institution review evaluated forty-one of 334 (13.4%) patients scheduled to undergo radical hysterectomy that had gross nodal disease diagnosed intraoperatively. 15 underwent aborted radical hysterectomy following lymphadenectomy; the remaining 26 underwent radical hysterectomy and lymphadenectomy. Eleven patients undergoing radical hysterectomy underwent whole pelvic radiation therapy (WPRT) while 8 (30.7%) patients underwent WPRT and postoperative vaginal brachytherapy (BT) for local treatment secondary to close margins. All patients undergoing aborted radical hysterectomy underwent WPRT and BT. With mean follow-up of 42.3months, there were no significant differences in urinary, gastrointestinal, or hematologic complications between groups. When comparing those undergoing radical hysterectomy to aborted radical hysterectomy, there were no significant differences in local recurrence (11.5% vs 26.7%, p=0.39) or distant recurrence (19.2% vs. 33.3%, p=0.45), PFS (74.9months vs 46.8months, p=0.106), or OS (91.8months vs 69.4months, p=0.886). ConclusionsTreatment of patients with early stage cervical cancer and nodal metastasis may be tailored intraoperatively. Completion of radical hysterectomy and lymphadenectomy decreases radiation exposure without apparently compromising safety or outcome in the era of adjuvant chemoradiation.

Should Radical Hysterectomy Be Aborted on Intraoperative Detection of Nodal Tumor Metastasis in Early Stage Cervical Cancer?

In the United States, type 1 to 3 radical hysterectomy (RH) is used for the treatment of early stage (I-IIA) cervical cancer (ESCC). In the event that nodal metastasis is detected intraoperatively, completion of the procedure is controversial. Here, we present a review of the literature regarding clinical management of patients with ESCC with intraoperative diagnosis of nodal metastasis. An electronic search of PubMed and OVID for the English-language literature published between 1980 and 2008 was performed. Studies regarding completion or abandonment of RH on intraoperative detection of nodal metastasis in ESCC were reviewed to evaluate the impact of either approach on overall survival, recurrence rate, and complication rate. This review was unable to document a difference in overall survival greater than 10% between the aborted and completed RH groups, and the difference was not statistically significant. No clear relationship was found between completion of RH and pelvic control or morbidity. Although urinary complications including bladder dysfunction and fistulae were unique to the completed RH group, radiation-related complications such as radiation cystitis, radiation proctitis, and bone necrosis were seen primarily in the aborted RH group. Given the lack of significant difference in survival, further studies are needed to evaluate the impact of completing versus aborting RH on pelvic control and morbidity to reach a definitive conclusion.

Abdominal Radical Trachelectomy in Fertility-Sparing Treatment of Early-Stage Cervical Cancer

Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. In comparison with vaginal radical trachelectomy, the published results of ART are so far limited. Enrolled were women referred for ART either by laparoscopy or laparotomy. The main inclusion criterion was stage IA2 or IB1 with a cranial extent that allows for preservation of at least 1 cm of the endocervical canal. A total of 24 women were referred for the procedure, but fertility could not be preserved in 7 (29%) of them. Four women underwent immediate completion of radical hysterectomy because of a positive cranial surgical margin (n = 2) or sentinel node macrometastasis (n = 2) on frozen section. We found no correlation between tumor volume and inability to preserve fertility. A positive sentinel node was identified in 4 patients (17%); there were no false-negative results. Of the 9 women (53%) who have tried to conceive so far, 6 (67%) have conceived and 5 given birth, 2 of which were premature deliveries. Fertility cannot be preserved because of positive cranial margins or involved lymph nodes in almost one third of patients originally referred for radical trachelectomy. The main criterion for the selection of suitable patients should be the cranial extent of the tumor. Abdominal radical trachelectomy allows for achievement of satisfactory obstetrical outcomes.

OC129: Role of ultrasound in guiding of surgery radicality in cervical cancer management

Objectives: Standard treatment for early-stage cervical cancer (stage IA2-IB2) is radical hysterectomy (RH). This is accompanied by side effects that affect the quality of life. Moreover there are young patients who want to preserve fertility. If the disease is accurately graded (tumor volume, depth of invasion [DOI]), radicality of surgery could be adjusted and patients offered alternatives to the standard technique that include fertility-sparing surgery (FSS) using radical trachelectomy (RT), or nerve-sparing (NS) surgery that offers lower morbidity. This study aims to evaluate the role of US in guiding of surgery radicality and the importance of a novel marker distance measurement between tumor and pericervical fascia (DTF). Methods: 106 early stage cervical cancer patients treated between January 2005 and December 2007 were enrolled. All underwent US examination including the staging and topography of tumor, distance evaluation between tumor and pericervical fascia in all directions, and volumometry of tumor/cervix. US data were confirmed by histopathology. Results: Based on US topography and volumometry, 4 RT, 2 NS RT, 26 type II RH, 38 type II NS RH (8 site-differentiated surgeries) and 36 type III RH were performed. The correlation coefficient (R) for US volumometry (compared to histopathology) was 0.996, the accuracy of US tumor topography reached 93%. Based on US measurement of craniocaudal distance and tumor topography, 6 RT were performed (2 of them NS), one of them requiring completion of RH due to peroperationally determined endometrial extent of disease. Conclusion: Ultrasound is an invaluable tool in cervical cancer management. While radical hysterectomy type III is still needed in bulky tumors and insufficient DTF, many patients with tumors ≤40 mm and tumor-pericervical fascia distance ≥ 5 mm (determined by US) could undergo less radical nerve-sparing parametrial resection, or, based on the measurement of craniocaudal extent ≥10 mm, be offered FSS.

Early invasive cervical cancer with pelvic lymph node involvement: To complete or not to complete radical hysterectomy?

The completion of radical hysterectomy in the face of pelvic lymph node involvement presents a dilemma for the surgeon. Some believe it is appropriate to abort the hysterectomy to avoid the excessive morbidity of combined treatment; others believe that completion of the hysterectomy enhances survival. This study was undertaken to define the impact of completing radical hysterectomy followed by adjuvant radiation therapy upon patient survival or pelvic control. Fifteen patients with stage IB and IIA invasive cervical cancer whose radical hysterectomies were aborted solely for reasons of pelvic lymph node involvement were compared to a control group of 15 patients matched for tumor size and number of lymph nodes involved whose radical hysterectomies were completed. Both groups were treated with radiation therapy postoperatively. Survival was not different between groups (P = 0.81). Unexpectedly, local control was slightly improved in the group treated by radiation only (P = 0.127). If radiation therapy is anticipated, completion of radical hysterectomy followed by radiation therapy appears to offer no advantage over radiation therapy with the uterus in place in patients with early-stage invasive cervical cancer and pelvic lymph node involvement.

Early invasive cervical cancer with pelvic lymph node involvement: To complete or not to complete radical hysterectomy?

The completion of radical hysterectomy in the face of pelvic lymph node involvement presents a dilemma for the surgeon. Some believe it is appropriate to abort the hysterectomy to avoid the excessive morbidity of combined treatment; others believe that completion of the hysterectomy enhances survival. This study was undertaken to define the impact of completing radical hysterectomy followed by adjuvant radiation therapy upon patient survival or pelvic control. Fifteen patients with stage IB and IIA invasive cervical cancer whose radical hysterectomies were aborted solely for reasons of pelvic lymph node involvement were compared to a control group of 15 patients matched for tumor size and number of lymph nodes involved whose radical hysterectomies were completed. Both groups were treated with radiation therapy postoperatively. Survival was not different between groups ( P = 0.81). Unexpectedly, local control was slightly improved in the group treated by radiation only ( P = 0.127). If radiation therapy is anticipated, completion of radical hysterectomy followed by radiation therapy appears to offer no advantage over radiation therapy with the uterus in place in patients with early-stage invasive cervical cancer and pelvic lymph node involvement.