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Innovative operative Konzepte beim Zervixkarzinom

Innovative surgical concepts for cervical cancer

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Die Onkologie Aims and scope

An Erratum to this article was published on 20 December 2023

This article has been updated

Zusammenfassung

Hintergrund

Während der letzten Jahre beherrschen 3 wesentliche Themen die Chirurgie des frühen Zervixkarzinoms. Der Trend zur minimal-invasiven Chirurgie hatte durch die LACC-Studie (Laparoscopic Approach to Cervical Cancer, 2018) einen herben Rückschlag hinnehmen müssen. Die beiden anderen Themen sind die verminderte chirurgische Radikalität mit der Sentinellymphknotendiagnostik und die Vermeidung der radikalen Hysterektomie.

Material und Methoden

Eine selektive Literatursuche und eine Auswertung eigener Patientenkollektive sowie aktueller Kongressberichte wurden durchgeführt.

Ergebnisse

Die abdominale radikale Hysterektomie wurde zum Standardverfahren des frühen Zervixkarzinoms. In sekundären Analysen, die von registerbasierten Daten über geschützte Daten bis zu multizentrischen retrospektiven Studien reichen, wird versucht, den Ursachen für das schlechte Abschneiden der Laparoskopie auf den Grund zu gehen, aber erst die bereits initiierten weiteren prospektiven randomisierten Studien werden die Antwort geben. Ein weiterer Trend ist die Vermeidung der kompletten Lymphonodektomie durch die Sentinellymphknotendiagnostik beim frühen Zervixkarzinom bis 4 cm Tumorgröße, die hauptsächlich auf dem Einsatz von Indozyaningrün beruht. Diese Frage nach der Sicherheit der Sentinellymphknoten wird durch die SENTICOL-III-Studie beantwortet. Schon seit den Studien zur Trachelektomie beim Zervixkarzinom bis 2 cm ist bekannt, dass dieses Stadium eine sehr gute Prognose hat, allerdings wies dieses Stadium im laparoskopischen Arm der LACC-Studie ein deutlich schlechteres rezidivfreies Überleben auf – jedoch war dies wegen der geringen Anzahl an Fällen nicht signifikant. Allerdings wurde nun mit Vorstellung der SHAPE-Studie zum Vergleich der einfachen mit der radikalen Hysterektomie auf dem Kongress der American Society of Clinical Oncology (ASCO) 2023 ein weiteres Kapitel zur Reduktion der operativen Radikalität eröffnet.

Abstract

Background

Three main topics have dominated the surgical treatment of early cervical cancer in recent years. The trend towards minimally invasive surgery has suffered a severe setback with the publication of the LACC trial (Laparoscopic Approach to Cervical Cancer, 2018). Reduced surgical radicalism with sentinel diagnostics and avoidance of radical hysterectomy are the two other topics.

Materials and methods

Selective literature research, evaluation of own patient collectives and current congress reports are presented.

Results

Abdominal radical hysterectomy became the standard procedure for the surgical treatment of early cervical cancer. This was followed by a plethora of secondary analyses ranging from registry-based data, proprietary data, to multicenter retrospective studies to identify the causes of laparoscopy’s poor performance. However, only the initiated prospective randomized trials will give us the answer. Another trend is the avoidance of complete lymphadenectomy by sentinel diagnostics in early cervical cancer up to 4 cm, which are mainly based on indocyanine green. Fortunately, this question will be answered with the SENTICOL-III study. Even with the introduction of trachelectomy for cervical carcinoma up to 2 cm, we know that this stage has a very good prognosis. However, this FIGO (Fédération Internationale de Gynécologie et d’Obstétrique) stage in the laparoscopic arm of the LACC study also had a significantly worse recurrence-free survival—although not significant due to the small number of cases. With the presentation of the SHAPE study comparing simple and radical hysterectomy at the American Society of Clinical Oncology (ASCO) 2023 congress, a further chapter on the reduction of surgical radicalism was opened.

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Change history

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    Peter Hillemanns, Rüdiger Klapdor & Hermann Hertel

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  1. Peter Hillemanns
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  2. Rüdiger Klapdor
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  3. Hermann Hertel
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Correspondence to Peter Hillemanns.

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Interessenkonflikt

P. Hillemanns, R. Klapdor und H. Hertel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hillemanns, P., Klapdor, R. & Hertel, H. Innovative operative Konzepte beim Zervixkarzinom. Onkologie 29, 956–966 (2023). https://doi.org/10.1007/s00761-023-01407-9

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