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Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis
  1. Christhardt Köhler1,2,
  2. Hermann Hertel3,
  3. Jörg Herrmann4,
  4. Simone Marnitz5,
  5. Peter Mallmann1,
  6. Giovanni Favero6,
  7. Andrea Plaikner2,
  8. Peter Martus7,
  9. Mieczyslaw Gajda8 and
  10. Achim Schneider9
  1. 1 Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany
  2. 2 Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany
  3. 3 Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
  4. 4 Department of Obstetrics and Gynecology, Sophien und Hufeland Klinikum, Weimar, Germany
  5. 5 Department of Radiooncology, Medical Faculty of the University of Cologne, Koln, Germany
  6. 6 Department of Gynecology, HELIOS Mariahilf Klinik Hamburg, Hamburg, Germany
  7. 7 Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
  8. 8 Institute for Pathology, Friedrich-Schiller-University of Jena Faculty of Medicine, Jena, Germany
  9. 9 Center for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Berlin, Germany
  1. Correspondence to Professor Christhardt Köhler, Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany; Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany; ch.koehler{at}asklepios.com

Abstract

Objective Laparoscopic/robotic radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC) has demonstrated significant inferiority of the minimally invasive approach. The aim of this study is to evaluate the oncologic outcomes of combined laparoscopic-vaginal radical hysterectomy.

Methods Between August 1994 and December 2018, patients with invasive cervical cancer were treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to the LACC trial were identified. In contrast to the laparoscopic/robotic technique used in the LACC trial, all patients in our cohort underwent a combined transvaginal-laparoscopic approach without the use of any uterine manipulator.

Results A total of 1952 consecutive patients with cervical cancer were included in the analysis. Initial International Federation of Gynecology and Obstetrics (FIGO) stage was IA1 lymphovascular space invasion (LVSI+), IA2 and IB1/IIA1 in 32 (8%), 43 (11%), and 314 (81%) patients, respectively, and histology was squamous cell in 263 (68%), adenocarcinoma in 117 (30%), and adenosquamous in 9 (2%) patients. Lymphovascular invasion was confirmed in 106 (27%) patients. The median number of lymph nodes was 24 (range 2–86). Lymph nodes were tumor-free in 379 (97%) patients. Following radical hysterectomy, 71 (18%) patients underwent adjuvant chemoradiation or radiation. After a median follow-up of 99 (range 1–288) months, the 3-, 4.5-, and 10-year disease-free survival rates were 96.8%, 95.8%, and 93.1 %, and the 3-, 4.5-, and 10-year overall survival rates were 98.5%, 97.8%, and 95.8%, respectively. Recurrence location was loco-regional in 50% of cases with recurrence (n=10). Interestingly, 9/20 recurrences occurred more than 39 months after surgery.

Conclusion The combined laparoscopic-vaginal technique for radical hysterectomy with avoidance of spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery may be oncologically safe and should be validated in further randomized trials.

  • early cervical cancer
  • radical hysterectomy
  • uterine manipulator
  • laparoscopic-assisted radical vaginal hysterectomy (larvh)
  • vaginal-assisted laparoscopic radical hysterectomy (valrh)
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Footnotes

  • Contributors All authors substantially contributed to this manuscript. Collection of follow-up data was not founded by third parties and has been performed by AS, CK, MG, HH, SM, AP, and JH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available in a public, open access repository.

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