Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis

Carlo Ronsini; Christhardt Köhler; Pasquale De Franciscis; Marco La Verde; Lavinia Mosca; Maria Cristina Solazzo; Nicola Colacurci

doi:10.1016/j.ygyno.2022.04.010

Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis

Gynecol Oncol. 2022 Jul;166(1):188-195. doi: 10.1016/j.ygyno.2022.04.010. Epub 2022 May 2.

Authors

Carlo Ronsini¹, Christhardt Köhler², Pasquale De Franciscis³, Marco La Verde³, Lavinia Mosca³, Maria Cristina Solazzo³, Nicola Colacurci³

Affiliations

¹ Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy. Electronic address: carlo.ronsini@unicampania.it.
² Department of Gynecology, Medical Faculty of the University of Cologne, Koln, Germany; Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Germany. Electronic address: ch.koehler@asklepios.com.
³ Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.

PMID: 35513934
DOI: 10.1016/j.ygyno.2022.04.010

Abstract

Background: Radical hysterectomy and pelvic lymphadenectomy are considered the standard treatment for early-stage cervical cancer (ECC). Minimal Invasive approach to this surgery has been debated after the publication of a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC trial). It demonstrated poorer oncological outcomes for Minimal Invasive Surgery in ECC. However, the reasons are still an open debate. Laparo-Assisted Vaginal Hysterectomy (LAVRH) seems to be a logical option to Abdominal Radical Hysterectomy (ARH). This meta-analysis has the aim to prove it.

Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the Pubmed database and Scopus database were systematically searched in January 2022 since early first publications. No limitation of the country was made. Only English article were considered. The studies containing data about Disease-free Survival (DFS) and/or Overall Survival (OS) and/or Recurrence Rate (RcR) were included.

Results: 19 studies fulfilled inclusion criteria. 9 comparative studies were enrolled in meta-analysis. Patients were analyzed concerning surgical approach (Laparo-Assisted Vaginal Radical Hysterectomy) and compared with ARH Oncological outcomes such as DFS and OS were considered. 3196 patiets were included for the review. Meta-analysis of 1988 0f them highlighted a non-statistic significant difference between LARVH and ARH (RR 0.8 [95% CI 0.55-1.16] p = 0.24; I² = 0%; p = 0.98). OS was feasible only for 4 studies (RR 0.84 [95% CI 0.23-3.02] p = 0.79; I² = 0 p = 0.44). Sub-analysis for tumor with a maximum diameter greater than 2 cm was performed. Data about the type of recurrences (loco-regional vs distant) were collected.

Conclusion: LARVH does not appear to affect DFS and OS in ECC patients. The proposed results seem to be comparable with the open approach group of the LACC trial, which today represents the reference standard for the treatment of this pathology. More studies will be needed to test the safety and efficacy of LARVH in the ECC.

Keywords: Early stage cervical cancer; LARVH; Laparo-Assisted Vaginal Radical Hysterectomy; MIS; Minimal Invasive Surgery; Vaginal cuff.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Female
Humans
Hysterectomy / methods
Hysterectomy, Vaginal / methods
Laparoscopy* / methods
Neoplasm Staging
Retrospective Studies
Uterine Cervical Neoplasms* / pathology