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Radical hysterectomy for early cervical cancer: what shall we do after the LACC trial?

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Abstract

Surgical treatment of cervical cancer has led to one of the greatest controversies in gynecological oncology in recent years. After laparoscopic radical hysterectomy became increasingly widespread worldwide, it lost its importance dramatically when the data from the LACC study were published. In contrast to previous assumptions, there was a significantly reduced survival after laparoscopic hysterectomy compared to the open abdominal procedure. Multiple studies were subsequently published. Some confirm these results some do not. Some consider further studies to be unethical, others point to their own non-randomized results and call for a new LACC study. This article gives an overview of the current data situation and the possible criticisms of the individual studies. And, finally, calls for new RCT’s under defined criteria.

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References

  1. Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R et al (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379(20):1895–1904. https://doi.org/10.1056/NEJMoa1806395

    Article  PubMed  Google Scholar 

  2. Zhao Y, Hang B, Xiong G-W, Zhang X-W (2017) Laparoscopic radical hysterectomy in early stage cervical cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 27(11):1132–1144. https://doi.org/10.1089/lap.2017.0022

    Article  PubMed  Google Scholar 

  3. Cao T, Feng Y, Huang Q, Wan T, Liu J (2015) Prognostic and safety roles in laparoscopic versus abdominal radical hysterectomy in cervical cancer: a meta-analysis. J Laparoendosc Adv Surg Tech A 25(12):990–998. https://doi.org/10.1089/lap.2015.0390

    Article  PubMed  PubMed Central  Google Scholar 

  4. Charo LM, Vaida F, Eskander RN, Binder P, Saenz C, McHale M et al (2020) Rapid dissemination of practice-changing information: a longitudinal analysis of real-world rates of minimally invasive radical hysterectomy before and after presentation of the LACC trial. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2020.02.018

    Article  PubMed  Google Scholar 

  5. Melamed A, Margul DJ, Chen L, Keating NL, Del Carmen MG, Yang J et al (2018) Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 379(20):1905–1914. https://doi.org/10.1056/NEJMoa1804923

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cusimano MC, Baxter NN, Gien LT, Moineddin R, Liu N, Dossa F et al (2019) Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. Am J Obstet Gynecol 221(6):619.e1–619.e24. https://doi.org/10.1016/j.ajog.2019.07.009

    Article  Google Scholar 

  7. Alfonzo E, Wallin E, Ekdahl L, Staf C, Rådestad AF, Reynisson P et al (2019) 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 116:169–177. https://doi.org/10.1016/j.ejca.2019.05.016

    Article  PubMed  Google Scholar 

  8. Jensen PT, Schnack TH, Frøding LP, Bjørn SF, Lajer H, Markauskas A et al (2020) Survival after a nationwide adoption of robotic minimally invasive surgery for early-stage cervical cancer—a population-based study. Eur J Cancer 128:47–56. https://doi.org/10.1016/j.ejca.2019.12.020

    Article  PubMed  Google Scholar 

  9. Kohler C, Hertel H, Marnitz S, Mallmann P, Favero G, Plaikner A et al (2019) Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff—a multicenter analysis. Int J Gynecol Cancer 29(5):845–850. https://doi.org/10.1136/ijgc-2019-000388

    Article  PubMed  Google Scholar 

  10. Klapdor R, Hertel H, Hillemanns P, Röttger M, Soergel P, Kuehnle E et al (2019) Peritoneal contamination with ICG-stained cervical secretion as surrogate for potential cervical cancer tumor cell dissemination: a proof-of-principle study for laparoscopic hysterectomy. Acta Obstet Gynecol Scand 98(11):1398–1403. https://doi.org/10.1111/aogs.13681

    Article  PubMed  Google Scholar 

  11. Kong T-W, Chang S-J, Piao X, Paek J, Lee Y, Lee EJ et al (2016) Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer. J Obstet Gynaecol Res 42(1):77–86. https://doi.org/10.1111/jog.12840

    Article  PubMed  Google Scholar 

  12. Kong TW, Son JH, Paek J, Chang SJ, Ryu HS (2020) Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer. J Gynecol Oncol 31(1):e7. https://doi.org/10.3802/jgo.2020.31.e7

    Article  PubMed  Google Scholar 

  13. Aviki EM, Chen L, Dessources K, Leitao MM, Wright JD (2020) Impact of hospital volume on surgical management and outcomes for early-stage cervical cancer. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2020.02.029

    Article  PubMed  Google Scholar 

  14. Eoh KJ, Lee J-Y, Nam EJ, Kim S, Kim SW, Kim YT (2020) The institutional learning curve is associated with survival outcomes of robotic radical hysterectomy for early-stage cervical cancer-a retrospective study. BMC Cancer 20(1):152. https://doi.org/10.1186/s12885-020-6660-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Matsuo K, Shimada M, Yamaguchi S, Matoda M, Nakanishi T, Kikkawa F et al (2019) Association of radical hysterectomy surgical volume and survival for early-stage cervical cancer. Obstet Gynecol 133(6):1086–1098. https://doi.org/10.1097/AOG.0000000000003280

    Article  PubMed  Google Scholar 

  16. Brandt B, Sioulas V, Basaran D, Kuhn T, LaVigne K, Gardner GJ et al (2020) Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: survival outcomes. Gynecol Oncol 156(3):591–597. https://doi.org/10.1016/j.ygyno.2019.12.038

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chao X, Li L, Wu M, Ma S, Tan X, Zhong S et al (2019) Efficacy of different surgical approaches in the clinical and survival outcomes of patients with early-stage cervical cancer: protocol of a phase III multicentre randomised controlled trial in China. BMJ Open 9(7):e029055. https://doi.org/10.1136/bmjopen-2019-029055

    Article  PubMed  PubMed Central  Google Scholar 

  18. Falconer H, Palsdottir K, Stalberg K, Dahm-Kähler P, Ottander U, Lundin ES et al (2019) Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. Int J Gynecol Cancer 29(6):1072–1076. https://doi.org/10.1136/ijgc-2019-000558

    Article  PubMed  Google Scholar 

  19. Hillemanns P, Brucker S, Holthaus B, Kimmig R, Lampe B, Runnebaum I et al (2019) Updated opinion of the uterus commission of the gynecological oncology working group (AGO) and the gynecological endoscopy working group (AGE) of the German society of gynecology and obstetrics (DGGG) on the randomized study comparing minimally invasive with abdominal radical hysterectomy for early-stage cervical cancer (LACC). Geburtshilfe Frauenheilkd 79(2):145–147. https://doi.org/10.1055/a-0824-7929

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Peter Hillemanns, Hermann Hertel & Rüdiger Klapdor

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  1. Peter Hillemanns
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  2. Hermann Hertel
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  3. Rüdiger Klapdor
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PH/HH/RK: Data collection, manuscript writing/editing.

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Correspondence to Peter Hillemanns.

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Hillemanns, P., Hertel, H. & Klapdor, R. Radical hysterectomy for early cervical cancer: what shall we do after the LACC trial?. Arch Gynecol Obstet 302, 289–292 (2020). https://doi.org/10.1007/s00404-020-05627-x

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