100% 5-Year Survival Rate in Laparoscopic Radical Hysterectomy for Early-Stage Cervical Cancer is an Achievable Task

Challenging and continuing laparoscopic radical hysterectomy for more than 30 Years at a single institution. After the LACC trial, should minimally invasive surgery for early-stage cervical cancer really be discarded?

OBJECTIVE

The laparoscopic approach to cervical cancer (LACC) trial highlighted the necessity of an open approach for radical hysterectomy due to its negative impact on oncological outcomes. While minimally invasive surgery is an option for other organ cancers, its application in cervical cancer remains a challenge for surgeons. In this study, we aimed to assess the oncological outcomes of patients with early-stage cervical cancer who underwent minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology at a single institution.

MATERIALS AND METHODS

This study was a retrospective chart review conducted at Chang Gung Memorial Hospital, Linkou, between 2014 and 2023. We retrospectively analyzed clinical data from patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1 to IB1 cervical cancer. Patients underwent laparoscopic radical hysterectomy performed by experienced oncologic endoscopists in gynecology.

RESULTS

Our analysis included 22 patients, with 5 at FIGO stage IA1, 3 at IA2, and 14 at IB1. The median operation time was 274 min (range: 173-410 min), with an estimated blood loss of 125 mL (range: 50-300 mL). While no major intraoperative complications were observed, one patient reported a poor sensation of urination postoperatively. No recurrences or mortality occurred during the follow-up period.

CONCLUSION

Our findings suggest that minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology is a viable treatment option for early-stage cervical cancers with a diameter of ≤2 cm.

Exploring molecular targets: herbal isolates in cervical cancer therapy

OBJECTIVE

Cervical cancer (CxCa) stands as a significant global health challenge, ranking fourth in cancer-related mortality among the female population. While chemotherapy regimens have demonstrated incremental progress in extending overall survival, the outlook for recurrent CxCa patients remains disheartening. An imperative necessity arises to delve into innovative therapeutic avenues, with molecular targeted therapy emerging as a promising candidate. Previous investigations have shed light on the therapeutic effectiveness of five distinct herbal compounds, epicatechin, curcumin, myricetin, jatrorrhizine, and arborinine, within the context of CxCa.

METHODS

A systems biology approach was employed to discern differentially expressed genes (DEGs) in CxCa tissues relative to healthy cervical epithelial tissues. A protein-protein interaction network (PPIN) was constructed, anchored in the genes related to CxCa. The central genes were discerned within the PPIN, and Kaplan-Meier survival curves explored their prognostic significance. An assessment of the binding affinity of the selected herbal compounds to the master regulator of prognostic markers in CxCa was conducted.

RESULTS

A significant correlation between the overexpression of MYC, IL6, JUN, RRM2, and VEGFA and an adverse prognosis in CxCa was indicated. The regulation of these markers is notably influenced by the transcription factor CEBPD. Molecular docking analysis indicated that the binding affinity between myricetin and the CEBPD DNA binding site was robust.

CONCLUSION

The findings presented herein have unveiled pivotal genes and pathways that play a central role in the malignant transformation of CxCa. CEBPD has emerged as a potential target for harnessing the therapeutic potential of myricetin in this context.

Short-term Outcome of Robotic and Laparoscopic Surgery for Gynecological Malignancies: A Single-center Experience

Objectives

Minimally invasive surgery (MIS) has become the preferred option for many gynecologic pathologies since complication rate and postoperative recovery time have decreased considerably. Postoperative complications remain an important aspect when using the MIS approach, if they are not timely or accurately diagnosed and treated. The main aim of the study is to first assess their incidence, followed by identifying possible risk factors. Furthermore, the secondary aim is to identify if the type of MIS approach used, robotic or laparoscopic, may render some additional benefits.

Materials and Methods

The database of the General Surgery Department was queried between 2008 and 2019 for patients with gynecologic pathology: 2907 cases were identified. An additional selection was performed using the following filters: MIS and neoplasia. All emergency surgeries were excluded. One hundred and ninety-eight cases were obtained.

Results

The majority of complications were urological (11.6%) with only 7.07% requiring a specific urological procedure. The second most common was lymphorrhea 4.5%. Dindo-Clavien classification correlates positively with the postoperative hospital stay (PHS) (P = 0.000), the type of surgery (P = 0.046), the primary tumor location (P = 0.011), conversion rate (P = 0.049), the expertise of the lead surgeon (P = 0.012), and the operative time (P = 0.002). The urological complications correlate positively with the type of surgery (P = 0.002), the tumor location (P = 0.001), early reintervention (P = 0.000), operative time (P = 0.006), postoperative hemorrhage (P = 0.000), pelvic abscess (P = 0.000), venous thrombosis (P = 0.011), and postoperative cardiac complications (P = 0.002). Laparoscopic and robotic approaches were comparatively assessed. The PHS (P = 0.025), the type of surgery performed (P = 0.000), and primary tumor location (P = 0.011) were statistically significantly different.

Conclusion

Postoperative complications reported after MIS for gynecological malignancies show similar incidence as in the current literature, also taking into consideration those for the open approach. The robotic approach seems to be able to perform more complex surgeries with no difference in the postoperative complication rates. The expertise of the lead surgeon in gynecology correlates with lower postoperative complications. Further prospective studies are needed to confirm these results.

Cervical Cancer Surgery: Current State of Affairs

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.

Laparoscopic Regional Radical Hysterectomy Showed Promising Clinical Outcomes in Early-stage Cervical Cancer

Objectives:

To evaluate the clinical outcomes of standardized and region-specific excision in laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer (ECC).

Materials and Methods:

This is a retrospective case–controlled study from 2011 to December 2016. A total of 328 women with ECC (IA1, IA2, IB1, or IIA1) underwent primary surgery by laparoscopy or laparotomy in our institute. Women diagnosed as stage IB1 or IIA1 were treated with radical hysterectomy (RH) by open or laparoscopic route. The total parametrium excision in the process of RH was measured and highlighted in the study.

Results:

A total of 186 patients underwent open surgery and 142 ones were treated with laparoscopic surgery. Laparoscopic surgery was associated with less blood loss (194.43 ± 84.40 ml vs. 362.68 ± 253.36 ml, P < 0.01), shorter hospital stay (11 vs. 14 days, P < 0.01), and lower risk of blood transfusion (2.8% vs. 18.8%, P < 0.01). There was no significant difference in the postoperative complications between two groups (18/142, 12.7% vs. 21/186, 11.3%; P > 0.05). The rate of 5-year overall survival (OS) was 92.8% in laparoscopy group, similar to that of 94.4% in the open group (P = 0.762). Disease-free survival (DFS) rate at 3 years in laparoscopy group was decreased when compared to open group (91.8% vs. 95.0%, P = 0.030), but there was no significant difference in 3-year DFS among the women with tumor size <2 cm (100% vs. 97.0%, P = 0.818).

Conclusion:

Laparoscopic surgery was associated with better surgical outcomes compared to open surgery in ECC. 5-Year OS was comparable between the groups and cases with tumor size <2 cm showed no difference in 3-year DFS. LRH may be a better fit for women with tumor size <2 cm. Standardized region-specific RH helps to optimize the clinical outcomes of LRH in ECC.