Does Conization Matter? Recurrence Rates in Women with Early-stage Cervical Cancer who Underwent Preoperative Cold Knife Conization Followed by Minimally Invasive Versus Abdominal Radical Hysterectomy

2020 ◽  
Vol 156 (3) ◽  
pp. e37
Author(s):  
E. Garcia ◽  
R. Guerra ◽  
A. Freeman ◽  
W. Pierson ◽  
J. Chapman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Recurrence Rates ◽  
Early Stage Cervical Cancer ◽  
Cold Knife ◽  
Cold Knife Conization

scholarly journals Challenges and Controversies in the Surgical Treatment of Cervical Cancer: Open Radical Hysterectomy versus Minimally Invasive Radical Hysterectomy

2021 ◽  
Vol 10 (17) ◽  
pp. 3761
Author(s):  
Jona Röseler ◽  
Robert Wolff ◽  
Dirk O. Bauerschlag ◽  
Nicolai Maass ◽  
Peter Hillemanns ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Disease Free Survival ◽  
Recurrence Rates ◽  
Systematic Assessment ◽  
Significant Difference ◽  
Early Stage Cervical Cancer

Objective: The aim of the study was to perform a systematic assessment of disease-free survival (DFS), overall survival, and morbidity rates after open radical hysterectomy (ORH) and minimally invasive surgery (MIS) for early-stage cervical cancer and discuss with experts the consequences of the LACC trial (published by Ramirez et al. in 2018) on clinical routine. Methods: A total of 5428 records were retrieved. After exclusion based on text screening, four records were identified for inclusion. Five experts from three independent large-volume medical centers in Europe were interviewed for their interpretation of the LACC trial. Results: The LACC trial showed a significantly higher risk of disease progression with MIS compared to ORH (HR 3.74, 95% CI 1.63 to 8.58). This was not seen in one epidemiological study and was contradicted by one prospective cohort study reported by Greggi et al. A systematic review by Zhang et al. mentioned a similar DFS for robot-assisted radical hysterectomy (RRH) and LRH. Recurrence rates were significantly higher with MIS compared to ORH in the LACC trial (HR 4.26, 95% CI 1.44 to 12.60). In contrast, four studies presented by Greggi reported no significant difference in recurrence rates between LRH/RRH and ORH, which concurred with the systematic reviews of Zhang and Zhao. The experts mentioned various limitations of the LACC trial and stated that clinicians were obliged to provide patients with detailed information and ensure a shared decision-making process. Conclusions: The surgical treatment of early-stage cervical cancer remains a debated issue. More randomized controlled trials (RCT) will be needed to establish the most suitable treatment for this condition.

Does obesity influence the preferred treatment approach for early-stage cervical cancer? A cost-effectiveness analysis

2021 ◽  
pp. ijgc-2021-003004
Author(s):  
Jacqueline A Bohn ◽  
Miriam L Hernandez-Zepeda ◽  
Alyssa R Hersh ◽  
Elizabeth G Munro ◽  
Jenna M Kahn ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Minimally Invasive ◽  
Body Mass ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Chemoradiation Therapy ◽  
The Body ◽  
Early Stage Cervical Cancer

ObjectiveAbdominal radical hysterectomy in early-stage cervical cancer has higher rates of disease-free and overall survival compared with minimally invasive radical hysterectomy. Abdominal radical hysterectomy may be technically challenging at higher body mass index levels resulting in poorer surgical outcomes. This study sought to examine the influence of body mass index on outcomes and cost effectiveness between different treatments for early-stage cervical cancer.MethodsA Markov decision-analytic model was designed using TreeAge Pro software to compare the outcomes and costs of primary chemoradiation versus surgery in women with early-stage cervical cancer. The study used a theoretical cohort of 6000 women who were treated with abdominal radical hysterectomy, minimally invasive radical hysterectomy, or primary chemoradiation therapy. We compared the results for three body mass index groups: less than 30 kg/m2, 30–39.9 kg/m2, and 40 kg/m2 or higher. Model inputs were derived from the literature. Outcomes included complications, recurrence, death, costs, and quality-adjusted life years. An incremental cost-effectiveness ratio of less than $100 000 per quality-adjusted life year was used as our willingness-to-pay threshold. Sensitivity analyses were performed broadly to determine the robustness of the results.ResultsComparing abdominal radical hysterectomy with minimally invasive radical hysterectomy, abdominal radical hysterectomy was associated with 526 fewer recurrences and 382 fewer deaths compared with minimally invasive radical hysterectomy; however, abdominal radical hysterectomy resulted in more complications for each body mass index category. When the body mass index was 40 kg/m2 or higher, abdominal radical hysterectomy became the dominant strategy because it led to better outcomes with lower costs than minimally invasive radical hysterectomy. Comparing abdominal radical hysterectomy with primary chemoradiation therapy, recurrence rates were similar, with more deaths associated with surgery across each body mass index category. Chemoradiation therapy became cost effective when the body mass index was 40 kg/m2 or higher.ConclusionWhen the body mass index is 40 kg/m2 or higher, abdominal radical hysterectomy is cost saving compared with minimally invasive radical hysterectomy and primary chemoradiation is cost effective compared with abdominal radical hysterectomy. Primary chemoradiation may be the optimal management strategy at higher body mass indexes.

scholarly journals Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer

JAMA Oncology ◽  
2020 ◽  
Vol 6 (7) ◽  
pp. 1019 ◽  
Author(s):  
Roni Nitecki ◽  
Pedro T. Ramirez ◽  
Michael Frumovitz ◽  
Kate J. Krause ◽  
Ana I. Tergas ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Early Stage Cervical Cancer

scholarly journals Updated Opinion of the Uterus Commission of the Gynecological Oncology Working Group (AGO) and the Gynecological Endoscopy Working Group (AGE) of the German Society of Gynecology and Obstetrics (DGGG) on the Randomized Study Comparing Minimally Invasive with Abdominal Radical Hysterectomy for Early-stage Cervical Cancer (LACC)

2019 ◽  
Vol 79 (02) ◽  
pp. 145-147 ◽  
Author(s):  
Peter Hillemanns ◽  
Sara Brucker ◽  
Bernd Holthaus ◽  
Rainer Kimmig ◽  
Björn Lampe ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Working Group ◽  
Early Stage ◽  
Randomized Study ◽  
Published Data ◽  
Gynecological Oncology ◽  
Gynecology And Obstetrics ◽  
Early Stage Cervical Cancer

AbstractIn this opinion on the randomized study comparing minimally invasive with abdominal radical hysterectomy for early-stage cervical cancer (LACC), the Uterus Commission of the Gynecological Oncology Working Group (AGO) and the Gynecological Endoscopy Working Group (AGE) of the Germany Society of Gynecology and Obstetrics (DGGG) state that, based on their examination of the published data, patients with FIGO stage IA1 (with LVSI), IA2 or IB1 cervical cancer must be informed about the results of this LACC study prior to making a decision on the route for radical hysterectomy.

Impact of facility volume on the outcomes of minimally invasive radical hysterectomy for early-stage cervical cancer

2021 ◽  
Vol 162 ◽  
pp. S178
Author(s):  
Dimitrios Nasioudis ◽  
Leslie Andriani ◽  
Maureen Byrne ◽  
Emily Ko ◽  
Ashley Haggerty ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Early Stage Cervical Cancer

scholarly journals Early cervical cancer recurred with uterine fundus metastasis after laparoscopic fertility-sparing surgery: A case report

2020 ◽  
Author(s):  
yuanming shen ◽  
Xiaoyun Wan ◽  
Jihong Liu ◽  
Xing Xie
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Squamous Cell ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Radical Trachelectomy ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Uterine Fundus

Abstract Purpose: Recently, the safety of minimally invasive radical hysterectomy for cervical cancer caused widespread controversy. The value of minimally invasive fertility-sparing surgery for early stage cervical cancer is still lacking evidence of randomized controlled trial (RCT).Methods: Here we present a case of stage IB3 (FIGO2018) cervical carcinoma undergone neoadjuvant chemotherapy plus laparoscopic radical trachelectomy (A clinical trial NCT02624531) because of strongly desiring to preserve the fertility. Nine months after the initial treatment, the patient was presented with a uterine fundus mass and elevated serum squamous cell antigen (SCC Ag) and OC125 antigen (CA125).Results: Cervical cancer uterine fundus involvement may occur with advanced tumor stage. Early stage cervical cancer relapsed with a uterine fundus metastasis after laparoscopic radical trachelectomy is exceptionally rare. The patient was treated and cured by a radical hysterectomy. Post-operative pathology confirmed an isolated implanted squamous cell carcinoma in uterine fundus and no previous surgical margins and endometria were involved.Conclusions: This firstly reported case indicates that the safety of laparoscopic radical trachelectomy is still uncertain for advanced stage cervical cancer even if neoadjuvant and post-surgery chemotherapy is given, and also suggests that it is needed to discuss carefully the benefit and risk of such a strategy with the patient when the fertility preservation is considered.

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