European perspective on surgical approach in early cervical cancer after LACC trial. An international ESGO survey

• Published in: International journal of gynecological cancer Vol. 29; no. Suppl 4; pp. A20 - A21
• Main Authors: Chiva, L, Chacon, E, Carriles, I, Vazquez, D, Platero, M, Castellanos, T, Minguez, J, Gonzalez-Martin, A, Espinos, J, Sanchez, L, Aramendia, JM, Espinosa, I, Idoate, MA, Cambeiro, M, Martinez Monje, R, Calvo, F, Alcazar, JL
• Format: Journal Article
• Language: English
• Published: Oxford by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology 01.11.2019; BMJ Publishing Group LTD
• Subjects: Cervical cancer; Laparoscopy; Laparotomy; Robotics
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1136/ijgc-2019-ESGO.23

Introduction/BackgroundThis study aims to understand what was the impact of the LACC trial (Laparoscopy in cervical cancer) among the members of ESGO. We have explored members’ understanding of the results and changes in the clinical practice.MethodologyMethodsA questionnaire addressing multiple issues related to the LACC trial and surgical management of early cervical cancer was designed and sent to ESGO members before and after the publication of the LACC trial in the NEJM. The survey was entirely confidentially and could be completed in a short period of time. Responses from 394 and 326 members from 33 European countries were obtained. The respondents were divided into two groups depending on whether or not they belong to European countries.ResultsCharacteristics and perceptions of the responders are shown in tables 1 and 2. 97% of responders knew the results of the trial and 92% had read the manuscript. 83% did not expect the results. 56% of members confirmed that have changed their practice after the publication of the trial. Before the trial, only 29% operated cervical cancer by laparotomy and after the publication 63% does. figure 1 and 2. In cervical cancer patients who have undergone conization with clear margins 73% would offer MIS to the patient while only 49% would if the specimen margins was positive. Members consider that uterine manipulator an incorrect tumor handling occasioned the poorer result of MIS. 9 out 10 of members are willing to discuss the LACC trial with their patients and 80% consider unethical avoiding this discussion. 85% think that ESGO should promote a new randomized clinical trial and meanwhile 65% would be interested to participate in a observational study.Abstract – Table 1Responders characteristicsNumber of paritcipants394Working in ESGO zone76%Age (y) Mean49.5 (31–76)GenderM: 74%, F: 26%Years of practice after residency program16.3 (1–43)Academic public hospital69,8%Accredited fellowship72.1%Regularly operate patients with cervical cancer94%Surgical procedures for early cervical cancer per institution and year25Abstract – Table 2ESGO members perceptions after LACC trialI feel comfortable operating a radical Hysterectomy byLaparotomy:90%Laparoscopy:58%Robotics:19%Vaginally:5%I feel comfortable operating a radical Trachelectomy byLaparotomy:62%Laparoscopy:27%Robotics:11%Vaginally:26%I would offer a MIS approach in stage (FIGO 2019)IA1with LVSI: 62%IA2:63%IB1<2 cm:63%any IB1:10%I would recommend MIS to candidates for radical trachelectomyYes:34%No:36%Maybe:24%I am lost:5%I would carry out as first step the SNLB by MIS, independently of the eventual surgical approach (MIS or open) of the Radical HisterectomyYes:61%No:34%Abstract – Figure 1Surgical approach among ESGO members before LACC trialAbstract – Figure 2Surgical approach among ESGO members after LACC trialConclusionAmong ESGO members, the publication of LACC trial has objectively modified the surgical approach in early cervical cancer.DisclosureNothing to disclose.