3 Laparoscopic radical hysterectomy for cervical cancer

doi:10.1016/S0950-3552(05)80391-8

Baillière's Clinical Obstetrics and Gynaecology

Volume 9, Issue 4, December 1995, Pages 675-689

https://doi.org/10.1016/S0950-3552(05)80391-8 Get rights and content

Summary

A laparoscopic approach for radical hysterectomy is described. The laparoscopic procedures are similar to those achieved previously by laparotomy, the extent of surgery being adapted to the volume of the tumour and to the associated treatments. From the results obtained in a preliminary study of 15 patients, this approach appears to be safe. This surgical treatment of cervical cancer which associates a radical procedure complying with oncological rules with a decreased morbidity seems very promising. However, laparoscopic radical hysterectomy should be considered investigational and reserved for oncology surgeons trained in extensive laparoscopic procedures. Large studies with long follow-up are necessary before this approach can be proposed as an alternative to conventional surgical approaches.

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Cited by (53)

Outcomes of Minimally Invasive versus Open Radical Hysterectomy for Early Stage Cervical Cancer Incorporating 2018 FIGO Staging
2021, Journal of Minimally Invasive Gynecology
To compare outcomes after minimally invasive surgery (MIS) vs open radical hysterectomy for early stage cervical cancer incorporating 2018 Federation of Gynecology and Obstetrics (FIGO) staging.
A retrospective analysis.
A single teaching hospital.
Patients after radical hysterectomy for stage IA1 with lymphovascular invasion, IA2, or IB1 squamous, adenosquamous, or adenocarcinoma of the cervix between 2007 and 2018, mirroring the Laparoscopic Approach to Cervical Cancer trial criteria.
The use of MIS surgery for performing radical hysterectomy.
The outcomes were compared between patients undergoing MIS vs open approaches. A total of 126 patients met the inclusion criteria. The approach was open in 44 patients (35%) and MIS in 82 patients (65%); 49% were laparoscopic and 51% were robotic. Distribution based on the 2009 FIGO staging showed 1 stage IA1 with lymphovascular invasion, 15 stage IA2, and 110 stage IB1 patients. Although not statistically significant, the 3-year disease-free survival (DFS) was higher in the open compared to the MIS group (95% vs 87%; p = .17), and the overall survival was higher in the open compared to the MIS group (97% vs 92%; p = .25).
Fourteen patients whose disease recurred were Stage IB1 by FIGO 2009 staging; 11/14 were reclassified to a higher stage by 2018 FIGO staging (5/5 open, 6/9 MIS). Adjuvant therapy was recommended for all these patients based on the Sedlis criteria (10/14) or other risk factors (4/14). Despite this, only 1/9 of MIS patients whose disease recurred received adjuvant therapy compared with 3/5 patients whose disease recurred in the open group (p = .05).
In a cohort of patients similar to that of the Laparoscopic Approach to Cervical Cancer trial, 2018 FIGO staging may be useful to refine indications for MIS radical hysterectomy in early stage cervical cancer. However, disparate outcomes between MIS and open approaches may be explained by differences in compliance with National Comprehensive Cancer Network guidelines for adjuvant therapy.
Laparoendoscopic Single-site Radical Hysterectomy With Pelvic Lymphadenectomy: Initial Multi-institutional Experience for Treatment of Invasive Cervical Cancer
2014, Journal of Minimally Invasive Gynecology
Citation Excerpt :
Our multi-institutional report presents the first series of women wherein LESS was used to perform radical hysterectomy with pelvic lymphadenectomy for primary surgical therapy of cervical cancer. A laparoscopic radical hysterectomy with pelvic lymphadenectomy was first reported in 1992 and was followed by a publication of larger patient series establishing the feasibility and safety of the technique [20–25]. A randomized controlled trial comparing radical hysterectomy for treatment of cervical cancer via laparotomy versus laparoscopy is currently enrolling patients [26].
To describe the feasibility, safety, and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH).
A retrospective descriptive study (Canadian Task Force classification III).
Multiple academic teaching hospitals.
Women with Fédération Internationale de Gynécologie et d'Obstétrique FIGO stage IA1 to IB1 cervical cancer.
LESS-RH as the primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device; a flexible-tipped 5-mm laparoscope; and a multifunctional instrument were used in all cases. Clinicopathologic, surgical, and perioperative outcomes were analyzed.
Twenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 in whom pelvic lymphadenectomy (PLND) was completed. Of the 2 converted procedures, 1 patient underwent 2-port laparoscopy secondary to truncal obesity, and 1 patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. The median age and body mass index were 46 years and 23.3 kg/m², respectively. The median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. The margins of excision were negative. One patient with 2 positive pelvic nodes and 1 patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected.
LESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice.
Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2-IIA cervical cancer?
2012, Gynecologic Oncology
Citation Excerpt :
Laparoscopic radical hysterectomy with lymphadenectomy for the treatment of early stage cervical cancer was initially introduced by Nezhat et al. and Querleu et al. in the early 1990s [1,2]. Since then, several groups have reported the feasibility and the safety of this procedure [3,4]. Laparoscopic radical hysterectomy resulted in lower morbidity rates, including less postoperative pain, less blood loss, and shorter hospital stays with oncological outcomes comparable to open procedures, as noted by many studies [5–7].
To determine if laparoscopic radical hysterectomy (LRH) can be substituted for radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IA2–IIA cervical cancer.
We retrospectively reviewed the medical records of cervical cancer patients who underwent LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) from March 2003 to December 2011.
Of 118 enrolled patients, six were in FIGO stage IA2, 66 were in IB1, 41 were in IB2, one was in IIA1, and four were in IIA2. The median operating time, perioperative hemoglobin change, the number of harvested pelvic and para-aortic lymph nodes were 270 min (range, 120–495), 1.7 g/dL (range, 0.1–5), 26 (range, 9–55), and 7 (range, 1–39), respectively. There was no unplanned conversion to laparotomy. Intra- and postoperative complications occurred in 16 (13.5%) and 8 (6.7%) patients, respectively. In a median follow-up of 31 months (range, 1–89), 5-year recurrence-free and overall survival rates were 90% and 89%, respectively. Univariate analysis showed that cervical stromal invasion (P = 0.023) and lymph node metastasis (P = 0.018) affected survival rate. Cox-proportional hazards regression analysis showed that lymph node metastasis was the only independent factor for poor prognosis (hazard ratio = 7.0, P = 0.022).
LRH with LPL and/or LPAL in women with stage IA2–IIA cervical cancer is safe and feasible in terms of survival and morbidity. Our data suggest the need for larger prospective trials which could support this approach as a new standard of care for stage IA2–IIA cervical cancer.
Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy in Early Invasive Cervical Cancer
2011, Journal of Minimally Invasive Gynecology
Citation Excerpt :
Blood transfusion during surgery or in the immediate postoperative period is also a common complication; however, only Zakashansky et al [32] reported significant differences in patients requiring transfusion, in favor of the laparoscopic approach. Intraoperative injuries to the bladder [18,20,24,25,34,40] and less frequently to the ureters [9,20,24,25,29] are relatively frequent intraoperative complications of laparoscopy. In a review of intraoperative urinary tract lesions in laparoscopic surgery (50 patients) and open surgery (48 patients), no statistically significant differences were observed [42].
Laparoscopic radical hysterectomy is one surgical procedure currently performed to treat gynecologic cancer. The objective of this review was to update the current knowledge of laparoscopic radical hysterectomy in early invasive cervical cancer. Articles indexed in the MEDLINE database using the key words “Laparoscopic radical hysterectomy” and “Cancer of the cervix” were reviewed. Studies of laparoscopic radical hysterectomy for treatment of early cervical cancer with a minimum study population of 10 patients were selected. The laparoscopic approach was associated with less surgical morbidity (surgical bleeding) and with shorter length of hospital stay, although the duration of the operation may be longer. Laparoscopic radical hysterectomy with endoscopic pelvic lymphadenectomy, and paraaortic lymphadenectomy if needed, is a safe surgical option for treatment and staging of early invasive cervical cancer considering surgical risk, intraoperative bleeding, intraoperative and postoperative complications, and patient recovery. It is important to respect the learning curve. Surgical advances including new laparoscopic instrumentation and, in particular, use of robotics will contribute to reducing the duration of the operation and to facilitating learning and teaching of the procedure.
Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review
2011, Gynecologic Oncology
The aim of this study was to review current literature on total laparoscopic (TLRH) and robot-assisted radical hysterectomy (RRH) with pelvic lymphadenectomy in the treatment of early stage cervical cancer by analyzing data published in individual case series in order to compare surgical and oncological outcomes.
Up to January 2010, 27 studies were identified that met the inclusion criteria, together with our own unpublished data of patients, accounted for 342 RRH patients and 914 TLRH patients.
There was no statistical difference between the methods in terms of age, BMI or prior abdominal surgery. Estimated mean operative time, blood loss and number of lymph nodes retrieved did not statistically differ between the RRH and TLRH method. Less blood transfusions were needed in patients treated by RRH (5.4%) versus TLRH (9.7%, p < 0.05). Both methods were similar in respect to adjuvant chemo- or (chemo)radiation and recurrence rate. When complications were prioritized to severity, major post-operative complications where more frequent in RRH patients (9.6%) than in TLRH patients (5.5%, p < 0.05). The length of hospital stay was significantly shorter in RRH compared to TLRH treatment (3.3 versus 6.2 days respectively; p:0.04).
Robot-assisted and total laparoscopic radical hysterectomy appears to be equally adequate and feasible. RRH studies had small patient populations and further experience beyond the learning curve phase may improve operative time and complication rate. Both minimal invasive techniques should be investigated in a randomized manner.
Long-term survival outcomes of laparoscopically assisted radical hysterectomy in treating early-stage cervical cancer
2010, American Journal of Obstetrics and Gynecology
The objective of the study was to determine the long-term disease-free and overall survival outcomes of laparoscopic treatment of early-stage cervical cancer.
This was a longitudinal study of prospectively registered patients of cervical cancer undergoing laparoscopic surgery from June 1994 to December 2005.
A total of 139 patients were included, in which 60 patients were in International Federation of Gynecology and Obstetrics stage IA, 76 in IB, and 3 in IIA. Mean operation time was 231.1 ± 6.1 minutes. Median number of pelvic lymph node retrieval was 16. Major intraoperative complications included 1 great vessel injury, 1 ureteral injury, 1 colon injury, and 6 cystotomies. In a median follow-up of 92.1 months, the mean ± SEM cumulative disease-free and overall survival rates were 91.01% ± 2.77% and 92.78% ± 3.06%, respectively.
The laparoscopic approach has favorable long-term survival outcomes and perioperative morbidity. With the advantage of minimal invasiveness, laparoscopic treatment by experienced surgeons is an ideal alternative for early-stage cervical cancer.

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3 Laparoscopic radical hysterectomy for cervical cancer

Summary

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

Gynecologic Oncology

Operative Laparoscopy

La chirurgie endoscopique a-t-elle une place dans la chirurgie radicale du cancer du col utérin?

Journal de Gynecologie Obstetrique et Biologie de la Reproduction

Vaginally assisted laparoscopic radical hysterectomy

Journal of Gynecologic Surgery

The role of laparoscopic surgery in gynecologic oncology

Current Opinion in Obstetrics and Gynecology

Hystérectomie élargie laparoscopico-vaginale

Journal de Gynecologie Obstetrique et Biologie de la Reproduction

Laparoscopic surgery and gynecologic cancer

Current Opinion in Obstetrics and Gynecology

L'hysterectomie élargie dans le traitement du cancer du col utérin

MD thesis, University of Lyon