Laparoscopic or Open Radical Hysterectomy for Early Stage Cancer Cervix: Data Inconsistency of LACC Trial
Laparoscopic or Open Radical Hysterectomy for Early Stage Cancer Cervix: Data Inconsistency of LACC Trial Asian Pac J Cancer Prev. 2019 Oct 26;20(10):2881-2881 Authors: Shekhar S, L J PMID: 31653172 [PubMed - in process]
CONCLUSION: Laparoscopic surgery was associated with more major surgical complications, especially intraoperative ureteral injury and postoperative fistula, than abdominal surgery among women with cervical cancer. PMID: 31806399 [PubMed - as supplied by publisher]
This study is to compare the survival outcomes of laparoscopic radical hysterectomy (LRH) to those of abdominal radical hysterectomy (ARH) for patients with locally advanced cervical cancer (LACC). Patients with the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2 to IIB LACC who underwent radical hysterectomy between 2001 and 2015 were identified. The disease-free survival (DFS) and overall survival (OS) were compared according to the surgical approach and were adjusted based on clinicopathologic characteristics. A total of 396 patients were included in the study, with 179 (45.2%) and 217 (54.8%...
In a recent editorial, Chien (1) asked “How should we deal with unexpected results from randomized trials?” But why use the term “unexpected” at all? Indeed, before Ramirez et al.’s study was published in the New England Journal of Medicine (2), there was no robust evaluation of disease-free or overall survival rates in women with early-stage cervical cancer (FIGO stage IA1 to IB1) treated with the use of either laparatomy or minimal-access surgery (laparoscopic or robot-assisted). In that randomized clinical trial, which included patients with early-stage cervical cancer assigned to eith...
Study Objective: To compare the surgical and oncologic outcomes between open abdomen radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) for cervical cancer.Methods: Retrospective observational study with propensity score matching was used to ensure balanced groups for ARH and LRH. One-hundred-and-ninety-eight women with cervical cancer, 99 treated using ARH and 99 using LRH, between January 2012 and December 2014. Outcomes included disease-free survival (DFS), overall survival (OS), intra-operative factors, post-operator recovery, urinary retention, and adverse events. Moreover, the inverse probability ...
The Laparoscopic Approach to Cervical Cancer (LACC) trial  keeps stirring emotions and discussions [2 –6]. The LACC trial can be criticized  because the surgical proficiency and the adequacy of the laparoscopic radical hysterectomy was not adequately evaluated, because radicality was not appropriately assessed, and because of the poorly defined inclusion of type II and type III surgery. However , our impression is that the main reason for this ongoing debate is because the LACC trial was a randomized controlled trial (RCT) and because many of us do not like or are not ready to accept the results.
ConclusionNeoadjuvant chemotherapy followed by laparoscopic and open radical hysterectomy seems to be a safe treatment option for locally advanced cervical cancer, in terms of similar survival outcomes and morbidity of treatment with CCRT. However, the present study is too limited to permit conclusions due to its small sample size and retrospective design despite statistical methods for adjusting confounding factors.
ConclusionThe survival outcome of laparoscopic radical hysterectomy is comparable to open radical hysterectomy after completing learning curve and reducing intraperitoneal tumor exposure during surgery.
ConclusionThe incidence of complications is similar to that reported in open surgery and discretely larger than laparoscopic, however type I complications were the most frequent.The high incidence of probably due to what we are is a school hospital and surgeons are training period.
ConclusionOur preliminary experience has demonstrated that with experienced laparoscopic skills, R-LESS with the da Vinci Si system is a feasible and safe surgical approach for performance of radical hysterectomy and pelvic lymphadenectomy with conventional robotic surgical instruments. Further studies with greater number of patients in multiple settings will help us to fully elucidate the role of da Vinci Si surgical system in single-site gynecologic surgery.
To demonstrate techniques to regulate and improve the safety and completeness of laparoscopic and robotic radical hysterectomy/radical trachelectomy (L-RH/RT+R-RH/RT=MI-RH/RT) for early invasive cervical cancer. We will present our techniques and skills as well as data on our long-term outcomes for MI-RH/RT patients.