Yuanqing Yao

A retrospective study on the effect of surgical approaches and uterine manipulators on the prognosis of cervical cancer

Cervical cancer is a common gynecological malignancy. However, the optimal surgical approach and benefits of uterine manipulator use remain unclear in this context. This study aimed to compare patient outcomes among different surgical approaches including laparoscopic, combined vaginal and laparoscopic, abdominal, and robotic using the da Vinci surgical system. Moreover, we also aimed to examine the impact of uterine manipulator use in radical hysterectomy on the outcomes of patients with cervical cancer. This retrospective study included data from 848 patients with cervical cancer stage IA2-IIA2 that underwent a radical hysterectomy and pelvic lymphadenectomy at the Chinese PLA General Hospital between 2009 and 2019. Patient demographic and clinical characteristics, perioperative findings, and postoperative outcomes were examined. Patient characteristics, including body mass index, age, FIGO stage, pathological type, and tumor differentiation status and size, were comparable. Five-year survival rates were comparable among the groups that underwent different types of surgery regardless of disease stage. Five-year survival rates were comparable between the groups that underwent surgery with and without the use of a uterine manipulator. All surgical approaches examined in this study had comparable efficacy and safety profiles. The use of uterine manipulators during radical hysterectomy for cervical cancer does not increase the risk of death.

A retrospective study of the effects of uterine manipulators on prognosis in patients with cervical cancer

Objective This retrospective study investigated the effects of uterine manipulator use during minimally invasive radical hysterectomy on prognosis in patients with cervical cancer. Methods We collected clinical data on 762 patients with stage IA2 to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in Chinese PLA General Hospital from 2009 to 2019. Kaplan–Meier analysis and log-rank tests were used to compare the 5-year overall survival rates between patients treated with and without a uterine manipulator. Results Patient demographics did not differ between the two groups. In addition, the incidence of lymphovascular space invasion, tumor size, pathologic types, the International Federation of Gynecology and Obstetrics stage, the histologic grade, and the rate of lymphatic metastases did not differ between the groups. Meanwhile, perioperative clinical indicators were similar in the groups. Furthermore, no significant differences in 5-year survival rates and survival curves were recorded between the groups among both all patients (84.5% vs. 85.6%) and early-stage patients (89.1% vs. 89.2%). Conclusions The use of uterine manipulators during minimally invasive radical hysterectomy for cervical cancer did not affect clinicopathological markers or increase the risk of death.

Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta‐analysis

AbstractObjectiveTo evaluate the efficacy and safety of five different approaches to cervical cancer surgery.MethodsWe conducted a systematic search for comparative studies on different radical hysterectomy types for cervical cancer in PubMed, Embase, the Cochrane Library, and Web of Science databases. All included observational studies used survival analyses to compare clinical outcomes of patients undergoing different radical hysterectomy types. All studies were assessed by the Newcastle‐Ottawa Scale with scores of at least seven points. We extracted the relevant data and conducted a network meta‐analysis to compare clinical outcomes among five surgical approaches.ResultsThirty studies (n = 11 353) were included. Robotic surgery had the lowest blood loss volume and hospitalization duration; open surgery had the shortest operative time. Vaginal assisted laparoscopic surgery was associated with the highest number of resected lymph nodes and lowest rate of perioperative complications. Survival outcomes and tumor recurrence outcomes were similar among the approaches.ConclusionThe current approaches to cervical cancer surgery have comparable efficacies.