Cervical Cancer Surgery: Current State of Affairs

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Abstract

Cervical cancer surgery has a history of more than 100-years whereby it has transitioned from the open approach to minimally invasive surgery (MIS). From the era of clinical exploration and practice, minimally invasive gynecologic surgeons have never ceased to explore new frontiers in the field of gynecologic surgery. MIS has fewer postoperative complications, including reduction of treatment-related morbidity and length of hospital stay than laparotomy; this forms the mainstay of treatment for early-stage cervical cancer. However, in November 2018, the New England Journal of Medicine had published two clinical studies on cervical cancer surgery (Laparoscopic Approach to Cervical Cancer [LACC]). Following these publications, laparoscopic surgery for early-stage cervical cancer has come under intense scrutiny and negative perceptions. Many studies began to explore the concept of standardized surgery for early-stage cervical cancer. In this article, we performed a review of the history of cervical cancer surgery, outlined the standardization of cervical cancer surgery, and analyzed the current state of affairs revolving around cervical cancer surgery in the post-LACC era.

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Most cited references 60

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Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer

Pedro Ramirez, Michael Frumovitz, Rene Pareja … (2018)

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Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

Alexander Melamed, Daniel J Margul, Ling Chen … (2018)

BACKGROUND Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010–2013 period at Commission on Cancer–accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000–2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P = 0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000–2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, −0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P = 0.01 for change of trend). CONCLUSIONS In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.)

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Cervical cancer worldwide

Mailinh Vu, Jim Yu, Olutosin Awolude … (2018)

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Author and article information

Journal

Journal ID (nlm-ta): Gynecol Minim Invasive Ther

Journal ID (iso-abbrev): Gynecol Minim Invasive Ther

Journal ID (publisher-id): GMIT

Title: Gynecology and Minimally Invasive Therapy

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 2213-3070

ISSN (Electronic): 2213-3089

Publication date Collection: Apr-Jun 2021

Publication date (Electronic): 30 April 2021

Volume: 10

Issue: 2

Pages: 75-83

Affiliations

[1 ]Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China

[2 ]Gynecological Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China

[3 ]Mahkota Medical Centre, Melaka, Malaysia

Author notes

Address for correspondence: Dr. Zhongping Cheng, Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China. Gynecological Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China. E mail: mdcheng18@ 123456263.net

Article

Publisher ID: GMIT-10-75

DOI: 10.4103/GMIT.GMIT_81_20

PMC ID: 8140537

PubMed ID: 34040965

SO-VID: a7a4b3a5-89a3-4570-a601-d95fc633ac99

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

History

Date received : 07 June 2020

Date revision received : 21 July 2020

Date accepted : 18 January 2021

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