Kohler, Christhardt, Hertel, Hermann, Herrmann, Joerg, Marnitz, Simone, Mallmann, Peter, Favero, Giovanni, Plaikner, Andrea, Martus, Peter, Gajda, Mieczyslaw and Schneider, Achim (2019). Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff - a multicenter analysis. Int. J. Gynecol. Cancer, 29 (5). S. 845 - 851. LONDON: BMJ PUBLISHING GROUP. ISSN 1525-1438

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Abstract

Objective Laparoscopic/robotic radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC) has demonstrated significant inferiority of the minimally invasive approach. The aim of this study is to evaluate the oncologic outcomes of combined laparoscopic-vaginal radical hysterectomy. Methods Between August 1994 and December 2018, patients with invasive cervical cancer were treated using minimally-invasive surgery at the Universities of Jena, Charite Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to the LACC trial were identified. In contrast to the laparoscopic/robotic technique used in the LACC trial, all patients in our cohort underwent a combined transvaginal-laparoscopic approach without the use of any uterine manipulator. Results A total of 1952 consecutive patients with cervical cancer were included in the analysis. Initial International Federation of Gynecology and Obstetrics (FIGO) stage was IA1 lymphovascular space invasion (LVSI+), IA2 and IB1/IIA1 in 32 (8%), 43 (11%), and 314 (81%) patients, respectively, and histology was squamous cell in 263 (68%), adenocarcinoma in 117 (30%), and adenosquamous in 9 (2%) patients. Lymphovascular invasion was confirmed in 106 (27%) patients. The median number of lymph nodes was 24 (range 2-86). Lymph nodes were tumor-free in 379 (97%) patients. Following radical hysterectomy, 71 (18%) patients underwent adjuvant chemoradiation or radiation. After a median follow-up of 99 (range 1-288) months, the 3-, 4.5-, and 10-year disease-free survival rates were 96.8%, 95.8%, and 93.1 %, and the 3-, 4.5-, and 10-year overall survival rates were 98.5%, 97.8%, and 95.8%, respectively. Recurrence location was loco-regional in 50% of cases with recurrence (n=10). Interestingly, 9/20 recurrences occurred more than 39 months after surgery. Conclusion The combined laparoscopic-vaginal technique for radical hysterectomy with avoidance of spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery may be oncologically safe and should be validated in further randomized trials.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kohler, ChristhardtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hertel, HermannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Herrmann, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marnitz, SimoneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mallmann, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Favero, GiovanniUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Plaikner, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Martus, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gajda, MieczyslawUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, AchimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-146463
DOI: 10.1136/ijgc-2019-000388
Journal or Publication Title: Int. J. Gynecol. Cancer
Volume: 29
Number: 5
Page Range: S. 845 - 851
Date: 2019
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1525-1438
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
STAGE CERVICAL-CANCER; UTERINE MANIPULATOR; SURVIVAL OUTCOMES; LYMPHADENECTOMY; MANAGEMENT; MORBIDITY; PATHOLOGYMultiple languages
Oncology; Obstetrics & GynecologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/14646

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