Minimally invasive surgery for cervical cancer

The present study aimed to evaluate the oncologic outcomes of minimally invasive radical hysterectomy with no tumor exposure. Briefly, a multicenter, retrospective analysis was conducted between January 2017 and June 2020 involving 350 women with early-stage cervical cancer. Eligible patients were informed of the potential complications and benefits of abdominal radical hysterectomy and laparoscopic radical hysterectomy. During surgery, the use of a uterine manipulator was avoided. Myoma drill and uterine suture techniques were employed, accompanied by protective measures for vaginal closure of the colpotomy, such as clamps, vaginal cuffs or sutures. Specimens were placed in a collection bag, which was extracted through the vaginal route. Over a median follow-up period of 51 months (range, 30-72 months), five patients were lost to follow-up and three refused treatment following surgery; therefore, a total of 342 women with cervical cancer were followed up to the end of the study. The initial stage, according to the International Federation of Gynecology and Obstetrics 2018 classification system, was identified as IA1 with lymphovascular space invasion in 22 cases (6.29%), IA2 in 36 cases (10.29%), IB1 in 137 cases (39.14%), IB2 in 126 cases (36.00%), IIA1 in 14 cases (4.00%) and IIIC1P in 15 cases (4.29%). Histologically, squamous cell carcinoma was diagnosed in 269 patients (76.86%), adenocarcinoma in 75 patients (21.43%) and adenosquamous carcinoma in six patients (1.71%). Lymphovascular invasion was confirmed in 80 patients (22.86%). Lymph nodes were tumor-free in 335 patients (95.71%). After radical hysterectomy, 53 patients underwent brachytherapy and teletherapy, and 30 received chemotherapy alongside brachytherapy and teletherapy. After a median follow-up time of 51 months (range, 30-72 months), the disease-free and overall survival rates were recorded as 95.71% (335/350) and 98.86% (346/350) respectively. In conclusion, minimally invasive surgery using maneuvers to avoid peritoneal contamination yields good oncologic outcomes for patients with early-stage cervical cancer. The findings from the current retrospective analysis suggest that laparoscopic surgery could present a safe oncological option; however, further validation through randomized trials is essential.