Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review

• Published in: Journal of gynecologic oncology Vol. 34; no. 1; p. e5
• Main Authors: Fusegi, Atsushi, Kanao, Hiroyuki, Tsumura, Shiho, Murakami, Atsushi, Abe, Akiko, Aoki, Yoichi, Nomura, Hidetaka
• Format: Journal Article
• Language: English
• Published: Korea (South) 대한부인종양학회 01.01.2023
• Subjects: Adenocarcinoma - pathology; Carcinoma, Adenosquamous - pathology; Carcinoma, Squamous Cell - pathology; Female; Humans; Hysterectomy - methods; Laparoscopy - methods; Minimally Invasive Surgical Procedures - methods; Neoplasm Staging; Randomized Controlled Trials as Topic; Retrospective Studies; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; 산부인과학; Laparoscopic Surgery; Hysterectomy; Cervical Cancer; Survival; Minimally Invasive Surgery
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2023.34.e5

Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons' skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons' inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.