Radical Hysterectomy For Cervical Cancer Research Articles

Chinese expert consensus on nerve-sparing radical hysterectomy for cervical cancer

Cervical cancer is the most common gynecologic malignancy. Radical hysterectomy for early-stage cervical cancer could cause damage to pelvic autonomic nerves, leading to postoperative urination, defecation and sexual dysfunction. In order to improve the postoperative quality of life, the international Querleu-Morrow (Q-M) surgical classification system recommends the nerve-sparing radical hysterectomy (type-C1) as the mainstay operation. The Gynecologic Oncology Group affiliated to Chinese Obstetricians and Gynecologists Association has invited a number of domestic specialists and conducted in-depth discussions on key issues such as anatomical basis, surgical indications, techniques, postoperative evaluation for nerve-sparing radical hysterectomy. Finally, the specialists reach a consensus to guide the standardized application of this procedure in China.

Laparoscopic radical hysterectomy for cervical cancer by pulling the round ligament without a uterine manipulator

ObjectiveTo demonstrate the experience of laparoscopic radical hysterectomy for cervical cancer without the use of a uterine manipulator and investigate the feasibility and treatment effectiveness of this surgical approach. Materials and methodsThe laparoscopic radical hysterectomy for cervical cancer by pulling the round ligament without a uterine manipulator prevented the oppression of the uterine manipulator on the tumour. Vaginal ligation was performed below the lesion of cervical cancer, and the vagina was cut off below the ligation line. Consequently, the exposure of cancer tissues in the abdominal cavity was prevented, enabling a tumour-free operation. We reviewed the medical records of the 22 patients with stage IB1-IIA2 cervical squamous cell carcinoma who were treated at our hospital between May 2019 and February 2020. All the patients underwent the laparoscopic radical hysterectomy for cervical cancer by pulling the round ligament. All the patients were informed about the different therapeutic schemes and surgical approaches as well as their advantages and disadvantages. Information about operative time, intraoperative blood loss, hospitalisation duration, postoperative complications, postoperative adjuvant therapy, prognosis and other data were recorded. ResultsAll the surgical procedures were successfully completed without perioperative complications, such as vascular injury, pelvic injury and abdominal organ injury. The mean operative duration was 204 min, and the mean operative blood loss was 102 mL. The mean duration of postoperative hospital stay was 13 days. Nineteen patients received postoperative chemotherapy once before hospital discharge. Urinary retention was the major postoperative complication. All the patients were followed up for 14–23 months. The median follow-up time was 18 months. 21 of the 22 patients survived. No recurrence was detected in the patients during follow-up. One patient who had a pelvic lymph node metastasis but refused complete chemoradiotherapy died before the last follow-up. ConclusionsThis surgical approach appears to be safe and feasible for patients with cervical cancer. A larger sample size and longer follow-up period are required to confirm whether this surgical approach can actually and effectively improve the prognosis.

Analysis of related risk factors of lung metastasis after laparoscopic radical hysterectomy of cervical cancer.

To explore the risk factors of lung metastasis in patients after laparoscopic radical hysterectomy (LRH) of cervical cancer (CC).The clinical data of CC patients with clinical stage of IA1–IIA2 diagnosed in our hospital from April 2007 to October 2015 were collected. According to the situation of metastasis, the patients were divided into lung metastasis (n = 73) and non-lung metastasis group (n = 2076). The clinical data were compared between 2 groups, and logistic stepwise regression model was used to analyze the risk factors of lung metastasis in patients with CC after LRH.The incidence of lung metastasis after LRH of CC was 3.39%, and 67.13% of patients with lung metastases had no obvious clinical symptoms. 15.06% patients had lung metastasis in the first year, 38.35% in the second year, 43.83% in the third year and later. The postoperative lung metastasis of CC was related to tumor diameter (P < .001), pathological type (P < .001), interstitial invasion depth (P < .001), pelvic lymph node metastasis (PLNM, P < .001), vascular tumor thrombus (P = .011), tumor uterine invasion (P = .002), and abnormal preoperative tumor markers (P = .015). However, it was not related to age, clinical stage, tumor growth pattern, tumor differentiation, and para-aortic lymph node metastasis (P > .05). Logistic regression analysis revealed non-squamous cell carcinoma (P = .022), tumor diameter ≥4 cm (P = .008), interstitial invasion depth >2/3 (P = .003), PLNM (P = .007), and tumor uterine invasion (P = .037) is an independent risk factor for lung metastasis after LRH of CC.Non-squamous cell carcinoma, tumor diameter ≥4 cm, tumor interstitial invasion depth >2/3, PLNM, and tumor uterine invasion are independent risk factors for lung metastasis after LRH of CC.

Laparoscopic appendectomy for metastatic cervical cancer presenting as appendicitis

BackgroundMetastatic lesions to the appendix are rare. They usually present with acute appendicitis or remain asymptomatic and are diagnosed incidentally. Metastases to the appendix have been reported from a number of primary tumor sites including ovary, colon, gastric and lung. We report a laparoscopic appendectomy for a metachronous metastatic lesion to the appendix from the uterine cervix.Case presentationA 68-year-old woman, who underwent radical hysterectomy for cervical cancer 16 years previously, presented with nausea and gradually worsening right lower quadrant abdominal pain. Abdominal computed tomography scan showed an enlarged appendix and periappendiceal fat stranding. She was diagnosed with appendicitis and underwent laparoscopic appendectomy. Pathological findings showed adenocarcinoma in the submucosa and muscularis propria. Gastrointestinal endoscopy and positron emission tomography with computed tomography (PET–CT) did not show other lesions. Immunohistochemical analysis showed cytokeratin 7 (CK7) positive, cytokeratin 20 (CK20) negative, estrogen receptor (ER) 70–80% and progesterone receptor (PgR) 40–50%. The ER and PgR expression was similar to the cervical lesion 16 years previously, and the diagnosis was a metastatic lesion to the appendix from the uterine cervix.ConclusionsMetastasis to the appendix from cancer of the uterine cervix is a rare lesion.

Standardization and experience may influence the survival of laparoscopic radical hysterectomy for cervical cancer

ObjectiveMinimally invasive radical hysterectomy has been shown to be associated with poorer outcome in an influential prospective, randomized trial. However, many centers worldwide performing minimally invasive radical hysterectomy have data and experience that prove otherwise. We aim to review surgical and oncologic outcomes of patients operated by Laparoscopic Radical Hysterectomy in a tertiary hospital, by experienced surgeons and standardization in radicality, for cervical carcinoma Stage 1A1-1B1 from January 2009 to May 2014. Materials & methodsStandardised surgical technique with Parametrium & Paracolpium resection approach was adopted by qualified and experienced Gynecologic/Gyne-Oncologic Endoscopic & Minimally Invasive Surgeons in performing Laparoscopic Radical Hysterectomy for Cervical Cancer stage 1A1-1B1 from January 2009–May 2014, involving 53 patients. Electronic Medical Record system (EMR) Of Chang Gung Memorial Hospital(Tertiary Referral Centre), Department of Obstetrics & Gynecology was accessed for surgical and oncologic outcomes. ResultsFifty-Three patients operated from January 2009 to May 2014 were followed up for an average of 96.7 months with longest follow-up at 127 months. There were no cases of recurrence or death reported. 5 Year – Survival Rate and 5 Year Disease-Free Survival Rate were 100%. Two patients received post-operative pelvic radiation concurrent with chemotherapy using Cisplatin due to greater than 1/3 cervical stromal invasion. ConclusionIt is vital to standardize minimally invasive surgical techniques for early stage cervical cancer, with focus on adequate radicality and resection which may contribute to excellent survival outcomes. Further international multi-center randomized trial (Minimally Invasive Therapy Versus Open Radical Hysterectomy In Cervical Cancer) will provide justification for continued practice of MIS in early stage cervical cancer.

Clostridium difficile infection occurred after radical hysterectomy for cervical cancer—a case report

: Clostridium difficile infection (CDI) is a global health challenge. In recent years, the incidence of CDI is increasing rapidly. Clostridium difficile (C. difficile) is now a common cause of nosocomial infection. Surgery is a known risk factor for the development of CDI. However, the rate of CDI that occurred after Gynecological surgeries has been reported significantly less. We presented a case of a 44-year-old woman with FIGO stage IB1 invasive cervical cancer who suffered from high fever, chills and severe diarrhea after receiving laparoscopic radical hysterectomy with bilateral salpingectomy and pelvic lymph node dissection. The symptoms of surgical complications and bowl diseases overlap with those of patients in the case. CDI in gynecological surgery patients is often misdiagnosed and ignored due to the absence of prominent symptoms and signs, as well as the low rate of positive examination results. Therefore, it is necessary for early confirmation and treatment of CDI. PCR and two-step algorithm (GDH detection followed by nucleic acid amplification test) have been reported to be the rapid and accurate laboratory examination for the diagnosis of CDI. Owing to the rare property of this disease, we present this case to underscore the importance of early diagnosis and intervention for CDI after gynecological surgeries.

Surgery for cervical cancer: consensus & controversies.

Surgery plays an important role in the management of early-stage cervical cancer. Type III radical hysterectomy with bilateral pelvic lymph node dissection using open route is the standard surgical procedure. There is level I evidence against the use of laparoscopic/robotic approach for radical hysterectomy for cervical cancer. Emerging data support the use of sentinel lymph node biopsy and nerve sparing radical hysterectomy in carefully selected patients with early-stage disease. In locally advanced cervical cancer patients, the use of neoadjuvant chemotherapy (NACT) followed by radical surgery yields inferior disease-free survival compared to definitive concurrent chemoradiation therapy. Therefore, definitive concurrent chemoradiation is the standard treatment for locally advanced disease. Fertility preserving surgery is feasible in highly selected young patients. Role of less-radical surgical procedures in patients’ with low-stage disease with good prognostic factors is under evaluation.

A Novel Direct Approach to the Deep Uterine Vein in Laparoscopic Radical Hysterectomy

To describe a direct approach to the deep uterine vein in laparoscopic radical hysterectomy. Demonstration of the laparoscopic technique with narrated video footage. Securing sufficient radicality is extremely important when performing a radical hysterectomy for cervical cancer, either by laparotomy or by minimally invasive surgery. The nerve-sparing Okabayashi radical hysterectomy (NS-RH) was originally aimed at achieving both radical resection and function preservation [1-3]. A key procedure when performing NS-RH is intraoperative identification of the relationship between the deep uterine vein and pelvic splanchnic nerve fibers [4]. With this in mind, a safe and easy method for identifying the crossing point of the deep uterine vein and pelvic splanchnic nerve in the initial phase of the surgery may greatly improve the safety and efficacy of functional preservation in NS-RH. Herein, we describe a minimally invasive "direct approach" to the deep uterine vein. Before undergoing the pelvic lymphadenectomy, all steps of laparoscopic radical hysterectomy were performed. First, we identified the ureter on the posterior peritoneum, and the peritoneum was dissected just above the ureter. By continuously exploring the pelvic cavity along the ureter, especially through the opening of the space below the ureter in a cranial to caudal direction, we could easily identify the deep uterine vein. This procedure also exposed the fibers of the hypogastric nerve, clarifying the relationship of these structures. Because the relationship between the deep uterine vein and nerve fibers is the most important guidepost of this surgery, their identification in the early phase of the surgery enables us to perform the subsequent procedure precisely and securely. This direct approach to the deep uterine vein can be easily and safely performed.

Salvage Concurrent Chemoradiotherapy Should be Considered for Local Recurrence after Radical Hysterectomy in Cervical Cancer

Little is known about the impact of salvage chemoradiotherapy on the long-term outcomes of cervical cancer patients with recurrence after radical hysterectomy. This study aims to evaluate the efficacy and safety of salvage chemoradiotherapy and share our own experience. 95 cervical cancer patients with local recurrence received salvage chemoradiotherapy between January 2011 and November 2018. All patients had not received adjuvant pelvic radiotherapy before. The dose of residual tumor and metastatic lymph nodes were all boosted to 64-82Gy (EQD2, a/β = 10) after pelvic irradiation in 50Gy/25F. The boost techniques were three-dimensional conformal radiotherapy, intensity-modulated radiotherapy or brachytherapy. Cisplatin-based chemotherapy was given concurrent with radiotherapy. Kaplan-Meier survival curve was used to analyze the outcomes of the patients. The median age of all patients was 51 years (range: 26-75 y). Median time from surgery to recurrence was 19.2 months (range：0.6-131.8 months). 91 patients had squamous cell carcinoma (95.8%), and 4 patients had adenocarcinoma (4.2%). The maximum diameter of residual mass with≥3cm occurred in 51 cases (53.7%). There were 26 cases (27.4%) with lymph node metastasis and 10 cases (10.5%) with adjacent organ invasion. 80 patients (84.2%) had received total radiation dose of 64-70Gy (EQD2, a/β = 10) for recurrent lesions, while 15 patients (15.8%) got 71-82Gy. 75 patients (78.9%) received concurrent chemotherapy. The median follow-up time was 32.7 months (range: 3.4-100.6 months). 13 patients died during follow-up. Kaplan-Meier survival curve analysis showed that the 3-year overall survival （OS）, disease-free survival (DFS), distant metastasis-free survival (DMFS), and local control （LC） were 87.5%, 84.6%, 84.8%, and 92.3%, respectively. 3-year OS for patients with vs without adjacent organ invasion was 58.7% and 94.8%, respectively (P < 0.001). 3-year OS for patients with or without lymph node metastasis was 50.5% and 91.8%, respectively (P = 0.007). 3-year OS for patients with mass ≥3cm or < 3cm was 80.5% and 95.4%, respectively (P = 0.018). The higher radiotherapy dose did not improve the local control rate. And the 3-year local control rate (LC) with total irradiation dose of 64-70Gy and 71-82Gy was similar 92.3% (p = 0.913). The number of patients with grade 3 or 4 myelosuppression during treatment was 40 cases (42.1%), and grade 3 or 4 gastrointestinal toxicity was 1 case (1.1%). There was no grade 3 or 4 late complication, according to RTOG toxicity grading. Salvage concurrent chemoradiotherapy for patients with local recurrence after radical hysterectomy showed favorable clinical outcomes without severe complications.

Patterns of Recurrence after Laparoscopic and Open Abdominal Radical Hysterectomy for Cervical Cancer: A Propensity-Matched Analysis

Study Objective To identify different patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer. Design This a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery. In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Setting Two oncologic referral centers. Patients or Participants Consecutive cervical cancer patients who developed recurrence after surgical treatments. Interventions Laparoscopic and open abdominal radical hysterectomy. Measurements and Main Results Chart of 1,058 cervical cancer patients were retrieved. The study population included 117 (14.2%) and 35 (14.9%) patients with recurrent cervical cancer who had had open abdominal and laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2) we reduced the study population to 105 patients (35 vs. 70 patients having recurrence after laparoscopic and open abdominal radical hysterectomy). The groups had similar baseline characteristics. Patients having laparoscopic radical hysterectomy experienced shorter progression-free survival than patients having open abdominal procedures (median progression-free survival: 8.0 vs. 15.8 months; HR: 1.98 (95%CI: 1.32 to 2.97); p=0.005). Site specific progression-free survival for vaginal, lymphatic and distant recurrences was similar between groups. However, patients having laparoscopy are at high risk of developing intra-pelvic recurrences and peritoneal carcinomatosis (HR: 17.9 (95%CI: 3.42 to 93.7); p=0.0006 log-rank test). Conclusion Patients having laparoscopy are at high risk of developing intra-pelvic recurrences and peritoneal carcinomatosis, due to unknown reasons (possibly due to a contamination of the pelvic area during colpotomy). Further evidence is needed in order to identify the best surgical treatment modality for cervical cancer patients.

Laparoscopic Radical Hysterectomy with Enclosed Colpotomy Using Surgical Stapler for Early-Stage Cervical Cancer

Study Objective To report the application of Ethicon Endo-Surgery re-usable linear cutter (Ethicon endocutter) in vaginal closure without usage of uterine manipulator to prevent tumor spillage in laparoscopic radical hysterectomy for early-stage cervical cancer. Design A step-by-step explanation of the procedures using a video. Setting Hospital for women's health teaching and research. Patients or Participants This is a 41-year-old woman with clinical stage IBI cervical squamous cell cancer. Interventions After the contraindication was removed, laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition were performed, the surgery was finished without usage of uterine manipulator. The patient signed an informed consent that allows us to use her clinical data. Measurements and Main Results In this method, after completion of the radical hysterectomy procedures, an Ethicon endocutter was placed into abdominal cavity through a 12-mm trocar. The uterus was elevated with fixed sutures on the uterus. Then, the stapler was placed. Before the surgical stapler was fired to close the vagina, we should checked that no other unintended structure was included in the jaws of the stapler. After being fired, the stapler places 2 triple-staggered rows of titanium staples and simultaneously knife blade cuts between them. Once the vagina has been divided, the stapler was released. The upper part of the vaginal cuff was excised and checked by pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with absorbable barbed sutures. Conclusion Vaginal closure with Ethicon endocutter before colpotomy is a useful and effective procedure to block vaginal cuff and prevent tumor spillage during laparoscopic radical hysterectomy of cervical cancer.

Understanding Anterior Parametrectomy for Preventing Local and Pelvic Recurrences in Cervical Cancer - an Answer to Failure of LACC Trial

Study Objective This video is a demonstration of the anatomy of parametrium and its significance in radical hysterectomy in cervical cancer. Design Video Demonstration. Setting It includes a case of ca cervix stage IB undergoing nerve sparing radical hysterectomy with complete parametrectomy. The dissection of posterior and lateral parametrium is technically easier as compared to that of anterior parametrium. Anteriorly and posteriorly, protection to the spread of cervical cancer is provided by the cervico-vesical fascia and Denonvilliers fascia respectively. Deficiency or the weakest area facilitating tumor spread lies on the lateral aspects as the cervico- vesical ligaments and their incomplete removal leads to local and pelvic recurrences. Patients or Participants 60-year-old with post-menopausal bleeding & cervical biopsy squamous cell carcinoma. FIGO stage IB2. Interventions Understanding the anatomy of parametrium is an important step to achieve optimum tumor clearance. “Lymphatics follow the veins”, was the dictum that led to the origin for the need of parametrectomy in this radical procedure. Schematic diagrams depict the various extents of the parametrium in the three-dimensional scenario. The inferior vesical vein is ligated around two centimeters lateral to the lateral border of vagina making it the lateral extent on either side enforcing complete parametrial clearance. Meticulous and careful dissection of the ureter, achieving hemostasis and preserving the innervation were the various challenges encountered during the procedure. Laparoscopy with its magnified vision and a thorough knowledge of anatomy can achieve a complete parametrectomy. Measurements and Main Results Mean operative time 80 minutes. Blood loss 100ml. Conclusion Thus, this video makes an effort in understanding the anatomy of anterior parametrium. The failure to recognize it or incompetence to achieve it leads to higher rates of recurrences and lower survival rates in minimally invasive approach for cervical cancer as highlighted in the LACC trial.

The impact of surgical learning curve on survival – reopening the door for minimally invasive surgery in the management of cervical cancer?

Minimally invasive surgery has been widely adopted in gynaecological oncology with a significant surge since 2010 associated with the introduction of robot-assisted surgery. Up until 2018, virtually all testimonials of minimally invasive surgery for cervical cancer indicated equal oncological outcomes compared with laparotomy. The unexpected results from the only randomised controlled trial (Ramirez et al. N Engl J Med 2018;379:1895–904) seriously challenge the use of minimally invasive surgery for cervical cancer. However, the lack of plausible explanations for the inferior survival has made it hard for many gynaecological oncologists to accept the results at face value. Suggested causes such as the use of intrauterine manipulators and intracorporeal colpotomy may to some extent account for the detrimental outcomes but as practice differs widely worldwide, none of these factors seem convincing. In the current paper by Baeten et al., a different aspect of novel surgical technologies has been explored (BJOG 2020; https://doi.org/10.1111/1471-0528.16399). The adoption of any new modality/technology is clearly associated with a learning curve and it is well known from surgery that procedural outcomes, such as operative time, improve with increasing case numbers. However, the potential impact of learning curve on hard outcomes such as survival has scarcely been reported. Baeten et al. convincingly demonstrate that a substantial number of robot-assisted radical hysterectomies are required to overcome an initial harm. The authors point out that the learning curve should be considered institutional; suggesting that an individual learning curve may benefit from previous experiences at the specific institution. Intriguingly, similar data have not been presented for endometrial cancer, which may be related to the higher complexity of radical hysterectomy for cervical cancer. Although no specific changes were made over time in the current study, a learning curve may include modifications of surgical routines based on early experiences. Which specific improvements during the learning curve account for the increased survival are unclear but reduction of complications that could delay adjuvant treatment may be one. The data presented by Baeten et al. signify a solid effort to elucidate the underlying cause of the outcomes from the LACC trial, especially as the trial was launched at a time when most surgeons had limited experience from laparoscopic/robotic radical hysterectomy. The study should raise the awareness of surgical learning curve in the context of survival in oncological surgery. It also brings us to the most important question – how do we avoid harming our patients when novel technologies are adopted? The authors suggest that centralisation and structured training represent two of the most important strategies to mitigate the effects of early errors. Interestingly, recent population-based studies from countries with high levels of centralisation do not corroborate the findings from the LACC trial (Alfonzo et al. Eur J Cancer 2019;29:1072–6; Jensen et al. Eur J Cancer 2020;128:47–56). Although the current study may reopen the door for robotic surgery in the management of cervical cancer, prospective randomised trials are needed to ensure its safety. The impact of surgical learning curve should be considered in any future trial exploring oncological safety for procedural interventions. HF is a proctor for Intuitive Surgical Inc. A completed disclosure of interests form is available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer.

BackgroundAfter radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function.MethodsA multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.ResultsTwo hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P < 0.001). A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO, while radiotherapy exerted a stronger effect than chemotherapy. Additionally, patients who received chemoradiotherapy frequently developed a DMCC. The follow-up time was not correlated with bladder storage function.ConclusionA nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.

Trends in mortality after surgery for early-stage cervical cancer in the United States after introduction of minimally invasive radical hysterectomy: An interrupted time series analysis

Objective: The aim of this study was to examine trends in 4-year all-cause mortality among women undergoing radical hysterectomy for cervical cancer during the period of rapid adoption of minimally invasive radical hysterectomy (MIRH), and to compare these trends with those of other surgically treated solid tumor malignancies.

Regional trends of minimally invasive radical hysterectomy for cervical cancer and exploration of perioperative outcomes

Objective: Radical hysterectomy with bilateral pelvic lymph node dissection is the standard treatment for early-stage cervical cancer. Until recently, in addition to the standard open approach, the procedure was frequently performed by a minimally invasive (MIS) approach. Randomized control trial data presented in 2018 demonstrated that patients who underwent MIS radical hysterectomy had higher rates of disease recurrence and worse overall survival when compared to open radical hysterectomy. The aim of this study was to examine practice trends in New York state.

867P Patterns of recurrence after minimally invasive and open abdominal radical hysterectomy for cervical cancer: A propensity-matched analysis

867P Patterns of recurrence after minimally invasive and open abdominal radical hysterectomy for cervical cancer: A propensity-matched analysis

Effectiveness and Long-term Outcomes of Nerve-Sparing Radical Hysterectomy for Cervical Cancer.

Radical hysterectomy (RH) is a type of radical surgery for cervical cancer. Urinary dysfunction due to RH worsens postoperative quality of life of patients with cervical cancer. Nerve-sparing RH (NSRH) technique has been used as an effective means to conserve urinary function. However, few reports have examine long-term outcomes after NSRH. This study describes the details and long-term outcomes of our nerve-sparing technique. Sixty-one patients underwent radical hysterectomy in a 5-year period during which nerve-sparing technique was introduced; of these, 31 patients underwent NSRH and 30 underwent conventional RH. We retrospectively examined their medical records and compared postoperative urinary function and treatment outcomes between these two groups. The median time required for urinary residual volume to fall to ≤50 mL after removal of the urinary catheter was 6 days (range, 2-20 days) in the NSRH group and 13.5 days (range, 3-46 days) in the RH group. The results were significantly better in the NSRH group (p < 0.05). The mean follow-up period was 2456.3 days (range, 48-4,213 days). Analysis of curability revealed no significant difference between the two groups in local recurrence or long-term survival rates. The 5-year survival rate was 0.861 in the NSRH group and 0.782 in the RH group; the 10-year survival rate was 0.861 in the NSRH group and 0.679 in the RH group. NSRH significantly improved postoperative urinary function without worsening local recurrence rates or long-term outcomes.

Is Adjuvant Therapy Necessary for Patients with Intermediate-Risk Cervical Cancer after Open Radical Hysterectomy?

Introduction: Adjuvant therapy is usually recommended for patients with intermediate-risk cervical cancer (deep stromal invasion [DSI], lymphovascular space invasion [LVSI], and bulky tumor) after radical hysterectomy. However, we previously reported that DSI, LVSI, and bulky squamous cell carcinoma (SCC) were not correlated with prognosis in multivariate analysis; therefore, the indications we use for adjuvant therapy include complete stromal invasion, not DSI or LVSI or bulky SCC. The objective of this study was to evaluate the adequacy of our therapeutic strategy for cervical cancer after radical hysterectomy. Methods: We performed 321 type III open radical hysterectomies for cervical cancer between 2001 and 2013. Eighty-two patients with DSI, LVSI, or bulky SCC did not receive adjuvant therapy after radical hysterectomy under informed consent. We retrospectively evaluated the prognosis of these 82 patients. Results: Forty-two patients had >2/3 DSI and 35 patients had 1/3–2/3 DSI. Five patients had LVSI alone. The mean patient age was 43 years (range, 27–72). Six patients (7%) experienced recurrence during a median follow-up period of 84 months (range, 1–206). Two of the 6 patients with recurrence suffered cervical cancer-related deaths, but the remaining 4 cases are alive without evidence of disease after treatment during a follow-up period of 87–165 months. The 5-year disease-free survival rate was 92.6%, and the 5-year overall survival rate was 96.3%. Conclusions: Adjuvant therapy for DSI, LVSI, or bulky SCC after open radical hysterectomy might not be necessary. Further data collection is warranted to determine the standard of care for patients with intermediate-risk cervical ­cancer.

Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real-world multicenter study of a large Chinese cohort from 2006 to 2017.

ObjectiveTo compare survival outcomes of minimally invasive surgery (MIS) and laparotomy in early‐stage cervical cancer (CC) patients.MethodsA multicenter retrospective cohort study was conducted with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage IA1 (lymphovascular invasion)‐IIA1 CC patients undergoing MIS or laparotomy at four tertiary hospitals from 2006 to 2017. Propensity score matching and weighting and multivariate Cox regression analyses were performed. Survival was compared in various matched cohorts and subgroups.ResultsThree thousand two hundred and fifty‐two patients (2439 MIS and 813 laparotomy) were included after matching. (1) The 2‐ and 5‐year recurrence‐free survival (RFS) (2‐year, hazard ratio [HR], 1.81;95% confidence interval [CI], 1.09‐3.0; 5‐year, HR, 2.17; 95% CI, 1.21‐3.89) or overall survival (OS) (2‐year, HR, 1.87; 95% CI, 1.03‐3.40; 5‐year, HR, 2.57; 95% CI, 1.29‐5.10) were significantly worse for MIS in patients with stage I B1, but not the cohort overall (2‐year RFS, HR, 1.04; 95% CI, 0.76‐1.42; 2‐year OS, HR, 0.99; 95% CI, 0.70‐1.41; 5‐year RFS, HR, 1.12; 95% CI, 0.76‐1.65; 5‐year OS, HR, 1.20; 95% CI, 0.79‐1.83) or other stages (2) In a subgroup analysis, MIS exhibited poorer survival in many population subsets, even in patients with less risk factors, such as patients with squamous cell carcinoma, negative for parametrial involvement, with negative surgical margins, negative for lymph node metastasis, and deep stromal invasion < 2/3. (3) In the cohort treated with (2172, 54%) or without adjuvant treatment (1814, 46%), MIS showed worse RFS than laparotomy in patients treated without adjuvant treatment, whereas no differences in RFS and OS were observed in adjuvant‐treatment cohort. (4) Inadequate surgeon proficiency strongly correlated with poor RFS and OS in patients receiving MIS compared with laparotomy.ConclusionsMIS exhibited poorer survival outcomes than laparotomy group in many population subsets, even in low‐risk subgroups. Therefore, laparotomy should be the recommended approach for CC patients.