Short-term surgical complications after radical hysterectomy-A nationwide cohort study

Laparoscopic Modified Radical Hysterectomy for Severe Endometriosis: A Single-Center Case Series

STUDY OBJECTIVE

The main objective is to describe the feasibility and report a single-center experience of a standardized laparoscopic modified radical hysterectomy technique among patients with severe endometriosis and pouch of Douglas obliteration.

DESIGN

A single-center case series of laparoscopic modified radical hysterectomy performed at the Poissy Hospital between December 2012 and May 2021.

SETTINGS

Single-center, gynecology unit (level III) with a focus on endometriosis.

PATIENTS

Patients with severe endometriosis (stage 4 American Fertility Society) and pouch of Douglas obliteration.

MEASUREMENTS AND MAIN RESULTS

Fifty-two patients with severe endometriosis underwent the surgical procedure. Of these patients, 23.1% underwent a rectal shaving (n = 12), 1.9% a discoid resection (n = 1), and 17.3% a rectal resection (n = 9), including a protective ileostomy in 1 case. Ureterolysis was performed on 82.7% of patients (n = 43). The average hospital stay was 3.3 days. Seven patients required intermittent self-catheterization (13.5%). Minor complications (Clavien-Dindo grade 1 and 2) occurred in 25.9% of the patients and severe complications in 3.8% of them (Clavien-Dindo grade 3, no grade 4). Two patients (3.8%) were reoperated: one for a postoperative occipital alopecia (balding) and the other for vaginal dehiscence with evisceration. Approximately 50 patients (96.2%) had a complete resection of endometriosis. The median follow-up was 14 months (interquartile range, 6-23 mo) with 94.3% of them improved (much and very much) and 3.8% minimally improved.

CONCLUSION

In our experience, laparoscopic modified radical hysterectomy is a reliable procedure with a low rate of severe complications. This technique needs to be assessed by other surgeons and others centers across the country and abroad, to determine the likelihood of it succeeding.

Predictors of significant distress in cervical cancer patients: a cross sectional study

PURPOSE

This cross-sectional study aims to investigate parameters that predict relevant levels of distress in women in a perioperative setting undergoing treatment for cervical cancer.

MATERIALS AND METHODS

Data from 495 patients with cervical cancer that were treated at the university hospital Aachen between 2010 and 2022 were analysed based on their respective National Comprehensive Cancer Network (NCCN) Distress Thermometer score (DT) and Problem List (PL) and their clinical history. 105 patients were enrolled in the study. 18 medical and demographic variables were analysed using multivariate logistic regression.

RESULTS

Three variables contributed significantly to the prediction of a DT score ≥ 5. Significant distress was defined as a DT score of ≥ 5, which was observed in 70.5% of the participants (mean: 5.58 ± 2.892). Women who chose to receive psycho-oncological counselling were more likely to have a DT score ≥ 5 (Odds Ratio(OR) = 3.323; Confidence Interval (CI95%): 1.241-8.900; p-value: 0.017). In addition, women who did not receive chemoradiation had significantly higher DT scores (OR = 3.807; CI 95%:1.185-12.236; p-value: 0.025), as did women whose Distress Thermometer was assessed in the first month after their initial diagnosis (OR = 3.967; CI 95%:1.167-13.486; p-value: 0.027).

CONCLUSION

Increased distress in women with cervical cancer is common especially in the first month after diagnosis, in patients who do not receive chemoradiation and in patients who seek psycho-oncological counselling. Surgical factors do not play a major role in patient distress.

Prevalence and Risk Factors of Urinary Retention in Patients With Cervical Cancer: A Meta-analysis and Systematic Review

BACKGROUND

The literature is inconsistent on the prevalence and risk factors of urinary retention in patients with cervical cancer.

OBJECTIVE

The aim of this study was to review the literature on the prevalence of urinary retention in patients with cervical cancer and consolidate the risk factors.

METHODS

For this meta-analysis, eligible articles published in English or Chinese by December 10, 2021, were systematically searched for and retrieved from PubMed, Cochrane Library, Ovid-Embase Medline, Web of Science, PsycINFO, CINAHL, and Scopus. Prevalence, odds ratios (ORs), and 95% confidence intervals (CIs) were used for meta-analysis.

RESULTS

Twenty-five studies were included in the analysis. The pooled overall prevalence was 0.26 (95% CI, 0.21-0.30, I2 = 95.0%). The identified risk factors were age (OR, 1.13; 95% CI, 1.08-1.19), urinary tract infection (UTI) (OR, 3.33; 95% CI, 1.48-7.49), surgical extent (OR, 2.95; 95% CI, 1.27-6.85), and catheter indwelling time (OR, 3.44; 95% CI, 2.43-3.87).

CONCLUSIONS

The prevalence of urinary retention in patients with cervical cancer is 0.26. Older age, UTI, longer catheter indwelling time, and a larger surgical extent may increase the risk of urinary retention. Clinicians should identify patients at risk and adopt interventions such as individualized catheter care.

IMPLICATIONS FOR PRACTICE

Nursing staff should assess the risk of urinary retention in a patient with cervical cancer according to her age, presence of UTI, surgical extent, and catheterization time. A carefully chosen surgical procedure and interventions such as individualized education, timely catheter removal, treatment of UTI, and rehabilitation should be offered.

Urinary retention between nerve-sparing radical hysterectomy and radical hysterectomy for cervical cancer: A meta-analysis

This study intended to assess the urinary retention between nerve-sparing radical hysterectomy and radical hysterectomy in cervical cancer. Relevant studies were selected from databases of PubMed, Embase, Wanfang, and China National Knowledge Internet with the last report up to January 15, 2022. Hazard ratio (HR) and 95% confidence interval (CI) were chosen as the evaluation index. Heterogeneity was assessed using Cochran Q test and I2 test. Subgroup analysis was conducted based on areas and cancer types (primary and metastatic cancer). A total of 8 articles (retrospective cohort studies) were selected in the meta-analysis. There were significant correlations between nerve-sparing radical hysterectomy and radical hysterectomy in related with urinary retention (HR [95% CI] = 1.78 [1.37, 2.31], P < .001) and (HR [95% CI] = 2.49 [1.43, 4.33], P = .001) of cervical cancer patients. Egger test revealed a significant publication bias (P = .014). Sensitivity analysis via omitting 1 study at each time showed that omission of any study made significant difference (P < .05), indicating reliability and good stability for the analysis. Additionally, there were significant heterogeneities in most subgroups.

Role of laparoscopic hysterectomy in cervical and endometrial cancer: a narrative review

Endometrial cancer is the most common carcinoma of the female genital organs and cervical cancer is the leading cause of cancer death in women worldwide. The aim of this review is to evaluate the role of laparoscopic hysterectomy in patients with endometrial and cervical cancer in this period, and analyze the outcome of hysterectomy in terms of survival. Moreover, we present the historical background, new techniques, the anatomical features, and surgical steps of radical hysterectomy. According to new evidence, minimally invasive surgery in patients with cervical cancer is associated with higher rates of recurrence and mortality compared to the open approach. Despite the numerous explanations offered for this phenomenon, the reasons for these results are unclear. Additional large trials have been launched to reevaluate the above-mentioned data. On contrary, the laparoscopic approach provides surgical outcomes and similar survival rates as open surgery in patients with early endometrial carcinoma. Furthermore, the radicality of hysterectomy does not influence local recurrence rates or overall survival in cases with complete surgical removal of the tumor. A laparoscopic radical hysterectomy is no longer an option in patients with cervical cancer. When minimally invasive surgery is offered, the patients must be counseled in detail about the current debate.

Total mesometrial resection (TMMR) for cervical cancer FIGO IB-IIA: first results from the multicentric TMMR register study

Available data on total mesometrial resection and therapeutic lymphadenectomy (TMMR+tLNE) for the treatment of cervical cancer show excellent locoregional control rates without adjuvant chemoradiation. In 116 patients with cervical cancer stages IB–IIA the overall recurrence rate was 7.8% in a median follow-up time of 24 months. Locoregional recurrences occurred in 6.0% of patients.

Objective

The surgical concept of total mesometrial resection (TMMR) and therapeutic lymphadenectomy (tLNE) for the treatment of early cervical cancer is based on the ontogenetic cancer field model. Unicentric data show excellent locoregional control rates without adjuvant chemoradiation. However, there are so far no prospective, multicentric data supporting the method.

Methods

The multicentric TMMR register study was designed to answer the question whether the concept of TMMR+tLNE could be transferred to different centers and surgeons without compromising the outstanding oncologic results described in a unicentric setting.

Results

In 116 patients with cervical cancer stages IB–IIA, (International Federation of Gynecology and Obstetrics [FIGO] 2018), who underwent TMMR/tLNE, 25.0% were lymph node-positive. pT stages were pT1a in 3 patients (2.6%), pT1b1 in 82 (70.7%), pT1b2 in 18 (15.5%), pT2a in 4 (3.5%) and pT2b in 9 (7.8%). The overall recurrence rate was 7.8% in a median follow-up time of 24 months (6–80). Locoregional recurrences occurred in 6.0% of patients. One patient (0.9%) died from the disease during the observation period.

Conclusion

These are the first multicentric data on the surgical concept of TMMR and tLNE for the treatment of cervical cancer FIGO IB–IIA. We were able to reproduce the excellent oncologic data described for the method albeit with a relatively short median observation time. A randomized controlled trial seems warranted to definitely establish TMMR+tLNE as the method of choice for the treatment of early cervical cancer.

Trial Registration

ClinicalTrials.gov Identifier: NCT01819077

Less extensive surgery for patients with FIGO stage IA2 cervical cancer: A population-based study

OBJECTIVES

The objectives of this study were to study the feasibility of less extensive surgeries for stage IA2 cervical cancer and to examine the incidence of positive nodes in stage IA2 cervical cancer.

METHODS

Patients with stage IA2 cervical cancer treated surgically between 1998 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and cervical cancer-specific survival (CCSS) were compared among patients who underwent different types of surgery (simple hysterectomy VS radical hysterectomy, lymphadenectomy VS without lymphadenectomy). The Cox proportional hazards regression model was applied to evaluate multiple prognostic factors.

RESULTS

1343 patients were included in this study. The overall incidence of positive nodes in stage IA2 was 2.53%. For well-differentiated IA2 cervical cancer, the incidence of regional lymph node involvement was as low as 1.42%. Compared with patients who underwent lymphadenectomy, the patients who did not undergo lymphadenectomy had the same OS (HR, 1.336; 95% CI, 0.923 to 1.933; P = 0.149) and CCSS (HR, 1.038; 95% CI, 0.504 to 2.140; P = 0.920). The log-rank test also indicated that simple hysterectomy was not associated with decreased OS (HR, 1.048; 95% CI, 0.750 to 1.466; P = 0.781) and CCSS (HR, 1.259; 95% CI, 0.655 to 2.420; P = 0.490). Multivariable analyses showed that lymphadenectomy and type of hysterectomy were not independent predictors of survival for patients with stage IA2 cervical cancer.

CONCLUSIONS

The incidence of nodal involvement in well-differentiated stage IA2 cervical cancer was fairly low, lymphadenectomy may be omitted in these patients. The excision range of parametrial tissue was not associated with the oncological survival of women with stage IA2 cervical cancer, simple hysterectomy may be an appropriate alternative for this group of patients.

Simple Hysterectomy for Patients with Stage IA2 Cervical Cancer: A Retrospective Cohort Study

Objective

The purpose of this study was to compare long-term survival outcomes of simple hysterectomy versus radical hysterectomy in stage IA2 cervical cancer.

Methods

A total of 440 patients who underwent simple hysterectomy (SH group) or radical hysterectomy (RH group) between 2014 and 2019 were included in this study. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan–Meier method and compared by the Log rank test. The Cox proportional hazards regression model was employed to control for confounders.

Results

There were 258 patients in the RH group and 182 patients in the SH group. The two groups had similar 5-year DFS rate (89.25% vs 91.14%, P=0.562) and 5-year OS rate (95.71% vs 94.76%, P=0.482). Multivariable analysis showed that simple hysterectomy was not independently associated with poorer DFS (aHR, 1.608; 95% CI, 0.640–4.041; P=0.312) and OS (aHR, 1.122; 95% CI, 0.319–3.493; P=0.858) than radical hysterectomy for women with stage IA2 cervical cancer.

Conclusion

For stage IA2 cervical cancer, a simple hysterectomy is safe and effective. Further studies are needed to testify against our findings.

A Systematic Review of Clinical Trials Assessing Sexuality in Hysterectomized Patients

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.