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. 2020 Jan;31(1):e7.
doi: 10.3802/jgo.2020.31.e7. Epub 2019 Jul 22.

Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer

Tae Wook Kong  1 , Joo Hyuk Son  1 , Jiheum Paek  1 , Suk Joon Chang  1 , Hee Sug Ryu  2
Affiliations

Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer

Tae Wook Kong et al. J Gynecol Oncol. 2020 Jan.

Abstract

Objective: To evaluate oncologic outcomes of minimally invasive radical hysterectomy (RH) in early cervical cancer before and after the application of parametrial invasion (PMI) criterion on magnetic resonance imaging (MRI) and vaginal colpotomy (VC).

Methods: A total of 216 International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer patients who underwent minimally invasive RH was identified between April 2006 and October 2018. Patients were classified into the pre-PMI intracorporeal or VC (IVC) (n=117) and post-PMI VC groups (n=99). In the pre-PMI IVC group, PMI criterion (intact stromal ring) on MRI was not applied and the patients received IVC. In the post-PMI VC group, surgical candidates were selected using the PMI criterion on MRI and all patients received VC only. Oncologic outcomes and prognostic factors associated with disease recurrence were analyzed.

Results: The rate of positive vaginal cuff margins in the pre-PMI IVC group was higher than that in the post-PMI VC group (11.1% vs. 1.0%, p=0.003). Two-year disease-free survival was different between the 2 groups (84.5% in pre-PMI IVC vs. 98.0% in post-PMI VC groups, p=0.005). Disrupted stromal ring on MRI (hazard ratio [HR]=20.321; 95% confidence interval [CI]=4.903-84.218; p<0.001) and intracorporeal colpotomy (HR=3.059; 95% CI=1.176-7.958; p=0.022) were associated with recurrence.

Conclusion: The intact cervical stromal ring on MRI might identify the low-risk group of patients in terms of PMI and lymphovascular/stromal invasion in early cervical cancer. Minimally invasive RH should be performed in optimal candidates with an intact stromal ring on MRI, using VC.

Keywords: Colpotomy; Hysterectomy; Minimally Invasive Surgical Procedures; Recurrence; Uterine Cervical Neoplasms.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Total laparoscopic intracorporeal colpotomy under laparoscopic view.
Fig. 2
Fig. 2. Prevention of intraperitoneal tumor spillage using vaginal colpotomy after laparoscopic parametrectomy and dissection of paracolpos.
Fig. 3
Fig. 3. Kaplan-Meier analysis of 2-year disease-free survival between the pre-PMI IVC and post-PMI VC groups in International Federation of Gynecology and Obstetrics stage IB–IIA cervical cancer patients treated with minimally invasive radical hysterectomy.
IVC, intracorporeal or vaginal colpotomy; PMI, parametrial invasion; VC, vaginal colpotomy.
See this image and copyright information in PMC

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