Laparo-Assisted Vaginal Hysterectomy safe option to Abdominal Radical Hysterectomy in Early Cervical Cancer

A new study published in Gynecologic Oncology reveals that Laparo-Assisted Vaginal Hysterectomy could represent a valid and safe option to Abdominal Radical Hysterectomy in Early stage Cervical Cancer. However Laparo-Assisted Vaginal Hysterectomy (LAVRH) appears to have no effect on disease-free survival (DFS) or overall survival (OS) in patients with early-stage cervical carcinoma (ECC).

The conventional therapy for early-stage cervical cancer is radical hysterectomy and pelvic lymphadenectomy. Following the release of a recent prospective randomized trial, the minimally invasive approach to this operation has been questioned (Laparoscopic Approach to Cervical Cancer, LACC trial). It showed that Minimal Invasive Surgery had worse oncological results in ECC. However, the reasons behind this are still being debated. Abdominal Radical Hysterectomy appears to be a viable alternative to Laparoscopic-Assisted Vaginal Hysterectomy (ARH). Therefore, Carlo Ronsini and team conducted this meta-analysis to prove it.

The Pubmed and Scopus databases were systematically searched since early first articles in January 2022, in accordance with the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. There were no restrictions imposed on the country. Only articles in English were examined. Studies with data on Disease-free Survival, Overall Survival, and Recurrence Rate (RcR) were considered.

The key findings of this study were as follow:

1. Nineteen studies met the inclusion criteria.

2. The meta-analysis included 9 comparable studies.

3. Patients were compared to ARH in terms of surgical method (Laparo-Assisted Vaginal Radical Hysterectomy).

4. Oncological outcomes such as DFS and OS were taken into account.

5. The review covered 3196 patients.

6. A 1988 meta-analysis of them revealed a non-statistically substantial difference between LARVH and ARH. Only four studies were OS-capable.

7. A sub-analysis was carried out for tumors with a maximal diameter bigger than 2 cm.

8. Data on the type of recurrences (local vs distant) were gathered.

In conclusion,

The projected outcomes appear to be equivalent to the open approach group of the LACC study, which is now the gold standard for treating this condition. More research is needed to determine the safety and effectiveness of LARVH in the ECC.

Reference:

Ronsini, C., Köhler, C., De Franciscis, P., La Verde, M., Mosca, L., Solazzo, M. C., & Colacurci, N. (2022). Laparo-assisted vaginal radical hysterectomy as a safe option for Minimal Invasive Surgery in early stage cervical cancer: A systematic review and meta-analysis. In Gynecologic Oncology. Elsevier BV. https://doi.org/10.1016/j.ygyno.2022.04.010