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Debate 42A - Is there a Role for Minimally Invasive Radical Hysterectomy for Management of Cervical Cancer?

Yes

from Section V - Cervical Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

During the last few decades, radical hysterectomy (RH) for early-stage cervical cancer has been performed either by laparotomy or a minimally invasive (MIS) approach, which were both considered acceptable and safe. However, the results of the phase III multicentric randomized LACC trial showed that MIS radical hysterectomy was associated with worse disease-free survival and overall survival.

A recently published Swedish nationwide population-based cohort study showed that the recurrence pattern was similar after open and robotic RH for women with early-stage cervical cancer. Based on these results, the authors designed the Robot-assisted Approach to Cervical Cancer (RACC) study, a randomized non-inferiority trial of robot-assisted laparoscopic surgery versus laparotomy. A European observational study comparing MIS versus open surgery showed that MIS increased the risk of relapse and death compared with open surgery. However, by avoiding use of the uterine manipulator and utilizing maneuvers to prevent tumor spread at the time of colpotomy, MIS was associated with similar outcomes to open surgery.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Ramirez, PT, et al. minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 2018;379(20):18951904.CrossRefGoogle ScholarPubMed
Alfonzo, E, et al. No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study. Eur J Cancer 2019;116:169177.CrossRefGoogle ScholarPubMed
Falconer, H, et al. Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. Int J Gynecol Cancer 2019;29(6):10721076.CrossRefGoogle ScholarPubMed
Chiva, L, et Al. SUCCOR study. An international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 (FIGO 2009, <4 cm) cervical cancer operated in 2013–2014. Int J Gynecol Cancer 2020;30:12691277.CrossRefGoogle Scholar
Kohler, C, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis. Int J Gynecol Cancer 2019;29(5):845850.CrossRefGoogle Scholar

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