Minimally invasive radical treatment for invasive cervical cancer
Experience at gynecotological clinic "A"
Abstract
Introduction:
Cervical cancer is the fourth most frequent cancer in women around the world. Surgery is the first choice for treatment in early stages.
The standard surgical treatment is Type C1 Radical Hysterectomy and pelvic lymphadenectomy. Laparotomy is the typical surgical approach used in Uruguay. Oncologic results are similar for the different surgical approaches. The study presents the first case series of minimally invasive cervical treatment of cervical cancer published in Uruguay.
Method:
descriptive, prospective study of a series of cases. All patients operated at the Gynecological Clinic “A”, Pereira Rossell Hospital from January 2013 until December 2016 for invasive cervical cancer with minimally invasive approach as the primary treatment were included in the study.
Results:
17 patients were operated: 14 Radical Laparoscopic hysterectomy + laparoscopic pelvic lymphadenectomy and 3 radical vaginal hysterectomy + laparoscopic pelvic lymphadenectomy. Average ager: 44 years old. Average surgical time: 261 minutes. Average post-surgery hospital stay: 5 days. 2 cases changed into laparotomy. An average of 14.4 pelvic lymph nodes were resected. In no case were margins compromised. Two bladder lesions, no cases of severe bleeding, transfusion, intestine, vascular or ureteral lesions. No cases of infection, deshicence, thrombosis, reoperation or readmission. NO recurrence, average follow up was 29 months.
Conclusions:
minimally invasive surgery is a feasible treatment for early stages cervical cancer in our country, obtaining good anatomopathological, surgical and oncological results, morbility being low.
References
(1) Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. 2012. Disponible en: http://globocan.iarc.fr Consulta: 1 diciembre 2017.
(2) Barrios E, Garau M, Alonso R, Musetti C. IV Atlas de incidencia de cáncer en el Uruguay 2007-2011. Montevideo: CHLCC, 2014.
(3) Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350(9077):535-40.
(4) National Comprehensive Cancer Network. Cancer cervix. Fort Washington, PA: NCCN, 2018. Disponible en: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Consulta: 1 dicimebre 2017
(5) Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol 2008; 9(3):297-303.
(6) Pearcey R, Brundage M, Drouin P, Jeffrey J, Johnston D, Lukka H, et al. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 2002; 20:966-72.
(7) Abu-Rustum NR, Gemignani ML, Moore K, Sonoda Y, Venkatraman E, Brown C, et al. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy. Gynecol Oncol 2003; 91:402-9.
(8) Magrina JF. Outcomes of laparoscopic treatment for endometrial cancer. Curr Opin Obstet Gynecol 2005; 17:343-6.
(9) Magrina JF, Mutone NF, Weaver AL, Magtibay PM, Fowler RS, Cornella JL. Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol 1999; 181:376-81.
(10) Canis M, Mage G, Wattiez A, Pouly JL, Manhes H, Bruhat MA. Does endoscopic surgery have a role in radical surgery of cancer of the cervix uteri? J Gynecol Obstet Biol Reprod (Paris) 1990; 19(7):921.
(11) Nezhat CR, Burrell MO, Nezhat FR, Benigno BB, Welander CE. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol 1992; 166(3):864-5.
(12) Canis M, Mage G, Pouly JL, Pomel C, Wattiez A, Glowaczover E, et al. Laparoscopic radical hysterectomy for cervical cancer. Baillieres Clin Obstet Gynaecol 1995; 9(4):675-89.
(13) Spirtos NM, Schlaerth JB, Kimball RE, Leiphart VM, Ballon SC. Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy. Am J Obstet Gynecol 1996; 174(6):1763-7.
(14) Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC. Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. Am J Obstet Gynecol 2002; 187:340-8.
(15) Abu-Rustum NR, Gemignani ML, Moore K, Sonoda Y, Venkatraman E, Brown C, et al. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy. Gynecol Oncol 2003; 91(2):402-9.
(16) Ramirez PT, Slomovitz BM, Soliman PT, Coleman RL, Levenback C. Total laparoscopic radical hysterectomy and lymphadenectomy: the M. D. Anderson Cancer Center experience. Gynecol Oncol 2006; 102(2):252-5.
(17) Gil-Moreno A, Díaz-Feijoo B, Roca I, Puig O, Pérez-Benavente MA, Aguilar I, et al. Total laparoscopic radical hysterectomy with intraoperative sentinel node identification in patients with early invasive cervical cancer. Gynecol Oncol 2005; 96(1):187-93.
(18) Frumovitz M, dos Reis R, Sun CC, Milam MR, Bevers MW, Brown J, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol 2007; 110(1):96-102.
(19) Hong JH, Choi JS, Lee JH, Eom JM, Ko JH, Bae JW, et al. Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2-IIA cervical cancer? Gynecol Oncol 2012; 127(1):102-6.
(20) van Gent MD, Romijn LM, van Santen KE, Trimbos JB, de Kroon CD. Nerve-sparing radical hysterectomy versus conventional radical hysterectomy in early-stage cervical cancer. A systematic review and meta-analysis of survival and quality of life. Maturitas 2016; 94:30-8.
(21) Mendivil AA, Rettenmaier MA, Abaid LN, Brown JV 3rd, Micha JP, Lopez KL, et al. Survival rate comparisons amongst cervical cancer patients treated with an open, robotic-assisted or laparoscopic radical hysterectomy: a five year experience. Surg Oncol 2016; 25(1):66-71.
(22) Geetha P, Nair MK. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: a systematic review. J Minim Access Surg 2012; 8(3):67-73.
(23) Puntambekar SP, Palep RJ, Puntambekar SS, Wagh GN, Patil AM, Rayate NV, et al. Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases. J Minim Invasive Gynecol 2007; 14(6):682-9.
(24) Kong TW, Chang SJ, Paek J, Park H, Kang SW, Ryu HS. Learning curve analysis of laparoscopic radical hysterectomy for gynecologic oncologists without open counterpart experience. Obstet Gynecol Sci 2015; 58(5):377-84.
(25) Philp L, Covens A, Vicus D, Kupets R, Pulman K, Gien LT. Feasibility and safety of same-day discharge after laparoscopic radical hysterectomy for cérvix cancer. Gynecol Oncol 2017; 147(3):572-6.
(26) Park JY, Nam JH. Laparotomy conversion rate of laparoscopic radical hysterectomy for early-stage cervical cancer in a consecutive series without case selection. Ann Surg Oncol 2014; 21(9):3030-5.
(27) O'Neill M, Moran PS, Teljeur C, O'Sullivan OE, O'Reilly BA, Hewitt M, et al. Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet 2013; 287(5):907-18.
(28) Laterza RM, Sievert KD, de Ridder D, Vierhout ME, Haab F, Cardozo L, et al. Bladder function after radical hysterectomy for cervical cancer. Neurourol Urodyn 2015; 34(4):309-15.
(29) Diver E, Hinchcliff E, Gockley A, Melamed A, Contrino L, Feldman S, et al. Minimally invasive radical hysterectomy for cervical cancer is associated with reduced morbidity and similar survival outcomes compared with laparotomy. J Minim Invasive Gynecol 2017; 24(3):402-6.
