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Open vs minimally i...
Open vs minimally invasive radical trachelectomy in early-stage cervical cancer : International Radical Trachelectomy Assessment Study
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- Salvo, Gloria (author)
- University of Texas
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- Ramirez, Pedro T. (author)
- University of Texas
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- Leitao, Mario M. (author)
- Memorial Sloan-Kettering Cancer Center
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- Cibula, David (author)
- General University Hospital in Prague
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- Wu, Xiaohua (author)
- Fudan University Shanghai Cancer Center (FUSCC)
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- Falconer, Henrik (author)
- Karolinska Institutet,Karolinska Institute
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- Persson, Jan (author)
- Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Perrotta, Myriam (author)
- Italian Hospital Of Buenos Aires
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- Mosgaard, Berit J. (author)
- Copenhagen University Hospital
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- Kucukmetin, Ali (author)
- Queen Elizabeth Hospital, Gateshead
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- Berlev, Igor (author)
- N. N. Petrov Institute of Oncology
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- Rendon, Gabriel (author)
- Instituto de Cancerología Las Américas Auna
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- Liu, Kaijiang (author)
- Shanghai Jiao Tong University
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- Vieira, Marcelo (author)
- Albert Einstein Israelite Hospital,Barretos Cancer Hospital
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- Capilna, Mihai E. (author)
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology
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- Fotopoulou, Christina (author)
- Imperial College Healthcare NHS Trust
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- Baiocchi, Glauco (author)
- A. C. Camargo Cancer Center
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- Kaidarova, Dilyara (author)
- Kazakh Institute of Oncology and Radiology
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- Ribeiro, Reitan (author)
- Hospital Erasto Gaertner
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- Pedra-Nobre, Silvana (author)
- Memorial Sloan-Kettering Cancer Center
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- Kocian, Roman (author)
- General University Hospital in Prague
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- Li, Xiaoqi (author)
- Fudan University Shanghai Cancer Center (FUSCC)
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- Li, Jin (author)
- Fudan University Shanghai Cancer Center (FUSCC)
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- Pálsdóttir, Kolbrún (author)
- Karolinska Institutet,Karolinska Institute
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- Noll, Florencia (author)
- Italian Hospital Of Buenos Aires
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- Rundle, Stuart (author)
- Queen Elizabeth Hospital, Gateshead
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- Ulrikh, Elena (author)
- North-Western State Medical University named after I.I. Mechnikov
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- Hu, Zhijun (author)
- Shanghai Jiao Tong University
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- Gheorghe, Mihai (author)
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology
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- Saso, Srdjan (author)
- Imperial College Healthcare NHS Trust
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- Bolatbekova, Raikhan (author)
- Kazakh Institute of Oncology and Radiology
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- Tsunoda, Audrey (author)
- Pilar Hospital,Albert Einstein Israelite Hospital,Hospital Erasto Gaertner
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- Pitcher, Brandelyn (author)
- University of Texas
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- Wu, Jimin (author)
- University of Texas
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- Urbauer, Diana (author)
- University of Texas
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- Pareja, Rene (author)
- Instituto Nacional de Cancerología, Colombia,Astorga Clínica de Oncología
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(creator_code:org_t)
- Elsevier BV, 2022
- 2022
- English.
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In: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 226:1, s. 1-97
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Background: Minimally invasive radical trachelectomy has emerged as an alternative to open radical hysterectomy for patients with early-stage cervical cancer desiring future fertility. Recent data suggest worse oncologic outcomes after minimally invasive radical hysterectomy than after open radical hysterectomy in stage I cervical cancer. Objective: We aimed to compare 4.5-year disease-free survival after open vs minimally invasive radical trachelectomy. Study Design: This was a collaborative, international retrospective study (International Radical Trachelectomy Assessment Study) of patients treated during 2005–2017 at 18 centers in 12 countries. Eligible patients had squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma; had a preoperative tumor size of ≤2 cm; and underwent open or minimally invasive (robotic or laparoscopic) radical trachelectomy with nodal assessment (pelvic lymphadenectomy and/or sentinel lymph node biopsy). The exclusion criteria included neoadjuvant chemotherapy or preoperative pelvic radiotherapy, previous lymphadenectomy or pelvic retroperitoneal surgery, pregnancy, stage IA1 disease with lymphovascular space invasion, aborted trachelectomy (conversion to radical hysterectomy), or vaginal approach. Surgical approach, indication, and adjuvant therapy regimen were at the discretion of the treating institution. A total of 715 patients were entered into the study database. However, 69 patients were excluded, leaving 646 in the analysis. Endpoints were the 4.5-year disease-free survival rate (primary), 4.5-year overall survival rate (secondary), and recurrence rate (secondary). Kaplan-Meier methods were used to estimate disease-free survival and overall survival. A post hoc weighted analysis was performed, comparing the recurrence rates between surgical approaches, with open surgery being considered as standard and minimally invasive surgery as experimental. Results: Of 646 patients, 358 underwent open surgery, and 288 underwent minimally invasive surgery. The median (range) patient age was 32 (20–42) years for open surgery vs 31 (18–45) years for minimally invasive surgery (P=.11). Median (range) pathologic tumor size was 15 (0–31) mm for open surgery and 12 (0.8–40) mm for minimally invasive surgery (P=.33). The rates of pelvic nodal involvement were 5.3% (19 of 358 patients) for open surgery and 4.9% (14 of 288 patients) for minimally invasive surgery (P=.81). Median (range) follow-up time was 5.5 (0.20–16.70) years for open surgery and 3.1 years (0.02–11.10) years for minimally invasive surgery (P<.001). At 4.5 years, 17 of 358 patients (4.7%) with open surgery and 18 of 288 patients (6.2%) with minimally invasive surgery had recurrence (P=.40). The 4.5-year disease-free survival rates were 94.3% (95% confidence interval, 91.6–97.0) for open surgery and 91.5% (95% confidence interval, 87.6–95.6) for minimally invasive surgery (log-rank P=.37). Post hoc propensity score analysis of recurrence risk showed no difference between surgical approaches (P=.42). At 4.5 years, there were 6 disease-related deaths (open surgery, 3; minimally invasive surgery, 3) (log-rank P=.49). The 4.5-year overall survival rates were 99.2% (95% confidence interval, 97.6–99.7) for open surgery and 99.0% (95% confidence interval, 79.0–99.8) for minimally invasive surgery. Conclusion: The 4.5-year disease-free survival rates did not differ between open radical trachelectomy and minimally invasive radical trachelectomy. However, recurrence rates in each group were low. Ongoing prospective studies of conservative management of early-stage cervical cancer may help guide future management.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Keyword
- disease-free survival
- fertility
- hysterectomy
- laparoscopy
- minimally invasive surgical procedures
- recurrence
- retrospective studies
- robotic surgical procedures
- trachelectomy
- uterine cervical neoplasms
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Salvo, Gloria
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Ramirez, Pedro T ...
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Leitao, Mario M.
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Cibula, David
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Wu, Xiaohua
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Falconer, Henrik
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show more...
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Persson, Jan
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Perrotta, Myriam
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Mosgaard, Berit ...
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Kucukmetin, Ali
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Berlev, Igor
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Rendon, Gabriel
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Liu, Kaijiang
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Vieira, Marcelo
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Capilna, Mihai E ...
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Fotopoulou, Chri ...
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Baiocchi, Glauco
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Kaidarova, Dilya ...
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Ribeiro, Reitan
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Pedra-Nobre, Sil ...
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Kocian, Roman
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Li, Xiaoqi
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Li, Jin
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Pálsdóttir, Kolb ...
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Noll, Florencia
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Rundle, Stuart
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Ulrikh, Elena
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Hu, Zhijun
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Gheorghe, Mihai
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Saso, Srdjan
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Bolatbekova, Rai ...
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Tsunoda, Audrey
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Pitcher, Brandel ...
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Wu, Jimin
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Urbauer, Diana
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Pareja, Rene
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cancer and Oncol ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Obstetrics Gynae ...
- Articles in the publication
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American Journal ...
- By the university
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Lund University
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Karolinska Institutet