Adjuvant therapy in early-stage cervical cancer after radical hysterectomy: are we overtreating our patients? A meta-analysis.

OBJECTIVE: There is a gap in knowledge regarding the ideal management of patients with early-stage cervical cancer and intermediate-risk features. Here, we present a meta-analysis of the published literature on oncological outcomes in these patients and determine trends in postoperative management. METHODS: MEDLINE and PubMed were used for literature searches. The inclusion criteria were: English language articles including ≥ 10 patients, patients who underwent radical hysterectomy, nodes negative, studies reporting oncological outcomes and complications treatment-related and compare a surgery-only cohort with a radiotherapy cohort. The PRISMA guidelines were followed. Combined relative risk was calculated using DerSimonian-Laird random-effects model and a forest plot was drawn. RESULTS: We collected 183 manuscripts on early-stage cervical cancer treated with radical hysterectomy alone or with adjuvant radiotherapy after surgery. A total of eight studies met the inclusion criteria. Regarding oncological outcomes, survival was reported in five studies. The relative risk of recurrence and the relative risk of mortality was similar in both groups independently whether receive or not adjuvant therapy. Most of the studies did not report significant differences regarding morbidity treatment related between the groups, except for a higher rate of lymphedema after radiotherapy. CONCLUSION: We found that the relative risk of recurrence and mortality was similar in both groups not depending on adjuvant therapy. Therefore, whether radiotherapy adjuvant treatment is indicated remains a topic of debate.

Histerectomía radical vaginal en cáncer cérvicouterino de estadio precoz / Radical vaginal hysterectomy in early stage cervical cancer

Objetivo: Comunicar una técnica mínimamente invasiva para el manejo quirúrgico del cáncer cérvicouterino en estadio precoz y sus resultados. Método: 40 pacientes con cáncer cérvicouterino en estadios IA2 y IB1 operadas en un período de 2,5 años. Se les efectúa linfadenectomía pelviana sistemática laparoscópica seguidas de histerectomía vaginal radical, excepto aquellas pacientes que tienen compromiso ganglionar detectado en biopsia contemporánea. Resultados: 40 pacientes son sometidas a esta técnica. Cuatro pacientes son abortadas de su cirugía, 3 por presentar ganglios positivos para carcinoma en biopsia contemporánea y 1 por tener un extenso compromiso cervical al momento de efectuar la histerectomía vaginal radical. Los 36 casos restantes tienen una edad promedio de 43,9 años, ninguna nulípara y 8 tienen el antecedente de cesárea. El IMC promedio fue de 30,49 y 14 conizadas previas. El tiempo operatorio promedio fue de 238 minutos. La estadía postoperatoria promedio fue de 2,9 días. El sangrado estimado fue de 139 cc y ninguna paciente requirió transfusión. Se conservan los anexos en 13 pacientes y en todas se suspenden por vía laparoscópica. El promedio de ganglios obtenidos fue de 30. Cuatro pacientes sufren lesión vesical, 1 fístula vesicovaginal y 3 disfunciones vesicales. Conclusión: El cáncer cérvicouterino en estadio precoz es factible de ser tratado con esta técnica y brinda las ventajas de la cirugía laparoscópica y vaginal con mínimas complicaciones.

Objective: To communicate a minimally invasive technique for surgical handling of early stage cervical cancer and its results. Methods: 40 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 2.5 years, are presented. Laparoscopic systemic pelvic lymphadenectomy with posterior radical vaginal hysterectomy was performed, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: 40 patients were submitted to this technique. 4 patients had their surgery aborted: 3 presented positive nodes for carcinoma in contemporary biopsy and 1 had extensive cervical compromise when performing radical vaginal hysterectomy. Analysis of the remaining 36 cases shows an average age of 43.9 years, all of them had given birth before, 8 of them through Cs-section. BMI averaged 30.49 and 14 had had cone surgery performed previously. Average duration of surgery was of 238 minutes. Postoperative hospitalization averaged 2.9 days. Bleeding volume was estimated at 139 cc and no patient required blood transfusion. 13 uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 30 nodes were obtained. 4 patients suffered bladder injury, one had vesicovaginal fistula and there were 3 bladder dysfunctions. Conclusion: The early stage cervical cancer is likely to be treated with this technique and provides de benefits of laparoscopic and vaginal surgery with minimal complications.