Challenging and continuing laparoscopic radical hysterectomy for more than 30 Years at a single institution. After the LACC trial, should minimally invasive surgery for early-stage cervical cancer really be discarded?

Abstract

Objective: The laparoscopic approach to cervical cancer (LACC) trial highlighted the necessity of an open approach for radical hysterectomy due to its negative impact on oncological outcomes. While minimally invasive surgery is an option for other organ cancers, its application in cervical cancer remains a challenge for surgeons. In this study, we aimed to assess the oncological outcomes of patients with early-stage cervical cancer who underwent minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology at a single institution.

Materials and methods: This study was a retrospective chart review conducted at Chang Gung Memorial Hospital, Linkou, between 2014 and 2023. We retrospectively analyzed clinical data from patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1 to IB1 cervical cancer. Patients underwent laparoscopic radical hysterectomy performed by experienced oncologic endoscopists in gynecology.

Results: Our analysis included 22 patients, with 5 at FIGO stage IA1, 3 at IA2, and 14 at IB1. The median operation time was 274 min (range: 173-410 min), with an estimated blood loss of 125 mL (range: 50-300 mL). While no major intraoperative complications were observed, one patient reported a poor sensation of urination postoperatively. No recurrences or mortality occurred during the follow-up period.

Conclusion: Our findings suggest that minimally invasive radical hysterectomy performed by experienced oncologic endoscopists in gynecology is a viable treatment option for early-stage cervical cancers with a diameter of ≤2 cm.

Keywords: Early-stage cervical cancer; Minimally invasive surgery; Radical hysterectomy.