Robotic surgery for early stage cervical cancer: Evolution and current trends

The management of early stage cervical cancer often includes surgery in the form of radical hysterectomy, radical trachelectomy, or radical parametrectomy. Surgical techniques have evolved to include minimal invasive approaches, and more recently, to include robotic assisted techniques. This review highlights the evolution of surgical management of early cervical cancer and specifically explores robotic assisted radical hysterectomy, radical trachelectomy, radical parametrectomy, and the role of neoadjuvant chemotherapy. J. Surg. Oncol. 2015;112:772–781. © 2015 Wiley Periodicals, Inc.

[1]  M. Plante,et al.  The vaginal radical trachelectomy: an update of a series of 125 cases and 106 pregnancies. , 2011, Gynecologic oncology.

[2]  Jeong-Won Lee,et al.  Robotic Versus Laparoscopic Radical Hysterectomy in Cervical Cancer Patients: A Matched-Case Comparative Study , 2014, International Journal of Gynecologic Cancer.

[3]  B N Bundy,et al.  A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. , 1999, Gynecologic oncology.

[4]  J. Fanning,et al.  Robotic radical hysterectomy. , 2008, American journal of obstetrics and gynecology.

[5]  P. Dursun,et al.  Radical vaginal trachelectomy (Dargent's operation): a critical review of the literature. , 2007, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[6]  M. Frey,et al.  Robotic radical parametrectomy for unstaged invasive endometrial carcinoma , 2011, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[7]  F. Landoni,et al.  Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  Carol L. Brown,et al.  Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. , 2008, Gynecologic oncology.

[9]  Jubilee Brown,et al.  Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. , 2011, Gynecologic oncology.

[10]  J. P. Geisler,et al.  Robotically Assisted Laparoscopic Radical Hysterectomy Compared With Open Radical Hysterectomy , 2009, International Journal of Gynecologic Cancer.

[11]  F. Nezhat,et al.  Robotic Radical Hysterectomy Versus Total Laparoscopic Radical Hysterectomy With Pelvic Lymphadenectomy for Treatment of Early Cervical Cancer , 2008, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[12]  T. Kasamatsu,et al.  Reply: ‘Comment on Phase III randomised controlled trial of neoadjuvant chemotherapy plus radical surgery vs radical surgery alone for stages IB2, IIA2, and IIB cervical cancer: a Japan Clinical Oncology Group trial (JCOG 0102)' , 2013, British Journal of Cancer.

[13]  A. Maneo,et al.  Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer. , 2008, Gynecologic oncology.

[14]  R. Mannel,et al.  Surgical Treatment of Unexpected Invasive Cervical Cancer Found at Total Hysterectomy , 1992, Obstetrics and gynecology.

[15]  J. Persson,et al.  Robot-assisted abdominal laparoscopic radical trachelectomy. , 2008, Gynecologic oncology.

[16]  R. Zweemer,et al.  Oncological outcome and long‐term complications in robot‐assisted radical surgery for early stage cervical cancer: an observational cohort study , 2014, BJOG : an international journal of obstetrics and gynaecology.

[17]  L. Twiggs,et al.  Lymph node yield from laparoscopic lymphadenectomy in cervical cancer: a comparative study. , 1993, Gynecologic oncology.

[18]  M. Bernardini,et al.  Pregnancy outcomes in patients after radical trachelectomy. , 2003, American journal of obstetrics and gynecology.

[19]  C. Köhler,et al.  Radical Vaginal Trachelectomy After Laparoscopic Staging and Neoadjuvant Chemotherapy in Women With Early-Stage Cervical Cancer Over 2 cm: Oncologic, Fertility, and Neonatal Outcome in a Series of 20 Patients , 2014, International Journal of Gynecologic Cancer.

[20]  Yong-Man Kim,et al.  Reproductive outcomes after laparoscopic radical trachelectomy for early-stage cervical cancer , 2014, Journal of gynecologic oncology.

[21]  P. Gehrig,et al.  A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. , 2008, American journal of obstetrics and gynecology.

[22]  B. Rosen,et al.  A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. , 2004, Gynecologic oncology.

[23]  F. Landoni,et al.  Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer , 1997, The Lancet.

[24]  Young Tae Kim,et al.  Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. , 2008, Gynecologic oncology.

[25]  Lin Zhao,et al.  Robotic vs laparoscopic radical hysterectomy for cervical cancer: a meta‐analysis , 2016, The international journal of medical robotics + computer assisted surgery : MRCAS.

[26]  E. Cicinelli,et al.  Robotics Versus Laparoscopic Radical Hysterectomy with Lymphadenectomy in Patients with Early Cervical Cancer: A Multicenter Study , 2011, Annals of Surgical Oncology.

[27]  H. Michael,et al.  The risk of nodal metastasis in early adenocarcinoma of the uterine cervix* , 2003, International Journal of Gynecologic Cancer.

[28]  L. Roman,et al.  Influence of quantity of lymph-vascular space invasion on the risk of nodal metastases in women with early-stage squamous cancer of the cervix. , 1998, Gynecologic oncology.

[29]  G. Morley,et al.  Radical pelvic surgery versus radiation therapy for stage I carcinoma of the cervix (exclusive of microinvasion). , 1976, American journal of obstetrics and gynecology.

[30]  Huicheng Xu,et al.  The Outcome of Laparoscopic Radical Hysterectomy and Lymphadenectomy for Cervical Cancer: A Prospective Analysis of 295 Patients , 2008, Annals of Surgical Oncology.

[31]  A. Malpica,et al.  Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. , 2010, Gynecologic oncology.

[32]  P. Dottino,et al.  Laparoscopic lymphadenectomy for gynecologic malignancies. , 1999, Gynecologic oncology.

[33]  D. O'connor,et al.  Treatment of ("bulky") stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy: a phase III trial of the gynecologic oncology group. , 2007, Gynecologic oncology.

[34]  R. Barakat,et al.  Initial experience with Dargent's operation: the radical vaginal trachelectomy. , 2008, Gynecologic oncology.

[35]  G. Wagh,et al.  Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases. , 2007, Journal of minimally invasive gynecology.

[36]  R. Barakat,et al.  Expanding the Indications for Radical Trachelectomy: A Report on 29 Patients With Stage IB1 Tumors Measuring 2 to 4 Centimeters , 2013, International Journal of Gynecologic Cancer.

[37]  D. Aoki,et al.  Abdominal radical trachelectomy as a fertility-sparing procedure in women with early stage cervical cancer in a series of 61 women , 2010 .

[38]  R. Barakat,et al.  Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer. , 2011, Gynecologic oncology.

[39]  M. Tomita,et al.  Neoadjuvant chemotherapy for patients younger than 50 years with high-risk squamous cell carcinoma of the cervix. , 2001, Gynecologic oncology.

[40]  Y. Cho,et al.  Laparoscopic-assisted radical parametrectomy including pelvic and/or paraaortic lymphadenectomy in women after prior hysterectomy-three cases. , 2003, Gynecologic oncology.

[41]  R. Berkowitz,et al.  Robotic versus open radical hysterectomy: a comparative study at a single institution. , 2008, Gynecologic oncology.

[42]  M. Burrell,et al.  Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. , 1992, American journal of obstetrics and gynecology.

[43]  M. Piver,et al.  The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective. , 2010, Journal of gynecologic oncology.

[44]  R. Barakat,et al.  Surgical and pathologic outcomes of fertility-sparing radical abdominal trachelectomy for FIGO stage IB1 cervical cancer. , 2008, Gynecologic oncology.

[45]  Jubilee Brown,et al.  Robotic radical parametrectomy and pelvic lymphadenectomy in patients with invasive cervical cancer. , 2008, Gynecologic oncology.

[46]  M. Noventa,et al.  Radical trachelectomy: The first step of fertility preservation in young women with cervical cancer (Review) , 2013, Oncology reports.

[47]  D. Kushner,et al.  Uterine artery sparing robotic radical trachelectomy (AS‐RRT) for early cancer of the cervix , 2011, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[48]  D. Chi,et al.  An International Series on Abdominal Radical Trachelectomy: 101 Patients and 28 Pregnancies , 2012, International Journal of Gynecologic Cancer.

[49]  M. Plante Bulky Early-Stage Cervical Cancer (2-4 cm Lesions): Upfront Radical Trachelectomy or Neoadjuvant Chemotherapy Followed by Fertility-Preserving Surgery , 2015, International Journal of Gynecologic Cancer.

[50]  H. Shingleton,et al.  Adjuvant postoperative radiation therapy following radical hysterectomy in stage IB CA of the cervix--analysis of treatment failure. , 1988, International journal of radiation oncology, biology, physics.

[51]  A. Burnett,et al.  Robotic radical trachelectomy for preservation of fertility in early cervical cancer: case series and description of technique. , 2009, Journal of minimally invasive gynecology.

[52]  K. Hatch,et al.  The role of laparoscopic lymphadenectomy in the management of cervical carcinoma , 1993 .

[53]  K. Hatch,et al.  Surgical Treatment of Women Found to Have Invasive Cervix Cancer at the Time of Total Hysterectomy , 1986, Obstetrics and gynecology.

[54]  D. Cella,et al.  Sexual Function of Patients With Endometrial Cancer Enrolled in the Gynecologic Oncology Group LAP2 Study , 2012, International Journal of Gynecologic Cancer.

[55]  T. Hamatani,et al.  Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies. , 2013, Human reproduction.

[56]  S. Puntambekar,et al.  Duplication of Conventional Multiport Laparoscopic Radical Hysterectomy Steps with Other Minimal Access Modalities (LESS, OASIS, Robotic). , 2015, Journal of minimally invasive gynecology.

[57]  F. Ghezzi,et al.  Mini-laparoscopic versus robotic radical hysterectomy plus systematic pelvic lymphadenectomy in early cervical cancer patients. A multi-institutional study. , 2015, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[58]  F. Nezhat,et al.  Fertility-sparing robotic-assisted radical trachelectomy and bilateral pelvic lymphadenectomy in early-stage cervical cancer. , 2008, Journal of minimally invasive gynecology.

[59]  Jason D. Wright,et al.  Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer. , 2012, Gynecologic oncology.

[60]  P. Gehrig,et al.  Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience. , 2010, Gynecologic oncology.

[61]  A. Weaver,et al.  Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. , 2008, Gynecologic oncology.

[62]  V. Zanagnolo,et al.  Robotic radical trachelectomy after supracervical hysterectomy for cut-through endometrial adenocarcinoma stage IIB: a case report. , 2009, Journal of minimally invasive gynecology.

[63]  Jennifer M Wu,et al.  Cost Comparison Among Robotic, Laparoscopic, and Open Hysterectomy for Endometrial Cancer , 2010, Obstetrics and gynecology.

[64]  P. Ramirez,et al.  Management of low-risk early-stage cervical cancer: should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? , 2014, Gynecologic oncology.

[65]  K. Hua,et al.  A Comparison of Laparoscopic and Abdominal Radical Parametrectomy for Cervical or Vaginal Apex Carcinoma and Stage II Endometrial Cancer After Hysterectomy , 2013, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[66]  D. Querleu,et al.  Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study. , 2002, Gynecologic oncology.

[67]  A. Schneider,et al.  Laparoscopic assistance for extended radicality of radical vaginal hysterectomy: description of a technique. , 1998, Gynecologic oncology.

[68]  F. Ghezzi,et al.  Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? , 2009, The journal of sexual medicine.

[69]  V. Gebski,et al.  A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. , 2008, Journal of minimally invasive gynecology.

[70]  A. Gil-Moreno,et al.  Nerve sparing technique in robotic‐assisted radical hysterectomy: results , 2013, The international journal of medical robotics + computer assisted surgery : MRCAS.

[71]  P. Ramirez,et al.  Options in the management of fertility-related issues after radical trachelectomy in patients with early cervical cancer. , 2009, Gynecologic Oncology.

[72]  C. Borgfeldt,et al.  Robot‐assisted surgery in cervical cancer patients reduces the time to normal activities of daily living , 2015, Acta obstetricia et gynecologica Scandinavica.

[73]  N. Spirtos,et al.  Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. , 2002, American journal of obstetrics and gynecology.

[74]  A. Buda,et al.  Total laparoscopic radical parametrectomy, partial colpectomy, and pelvic lymphadenectomy in patients with occult cervical cancer , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[75]  P. Morice,et al.  Lymphatic Spread in Stage Ib and II Cervical Carcinoma: Anatomy and Surgical Implications , 1998, Obstetrics and gynecology.

[76]  D. Ballard,et al.  Long-term survival and sequelae after surgical management of invasive cervical carcinoma diagnosed at the time of simple hysterectomy. , 1992, Gynecologic oncology.

[77]  Zhenyu Zhang,et al.  Total laparoscopic radical trachelectomy in the treatment of early squamous cell cervical cancer: a retrospective study with 8-year follow-up. , 2013, Gynecologic oncology.

[78]  I. Zapardiel,et al.  Robotic Radical Parametrectomy in Cervical Cancer , 2011, Gynecologic and Obstetric Investigation.

[79]  P. Ramirez,et al.  Radical Trachelectomy for Early-Stage Cervical Cancer: A Survey of the Society of Gynecologic Oncology and Gynecologic Oncology Fellows-in-Training , 2015, International Journal of Gynecologic Cancer.

[80]  E. Partridge,et al.  The role of radical parametrectomy in the treatment of occult cervical carcinoma after extrafascial hysterectomy. , 2004, Gynecologic oncology.

[81]  C. Borgfeldt,et al.  Reproducibility and accuracy of robot-assisted laparoscopic fertility sparing radical trachelectomy. , 2012, Gynecologic oncology.

[82]  J. Lisý,et al.  Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer. , 2014, Gynecologic oncology.

[83]  H. Cai,et al.  Efficacy of neoadjuvant chemotherapy in patients with FIGO stage IB1 to IIA cervical cancer: an international collaborative meta-analysis. , 2013, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[84]  P. Ramirez,et al.  Fertility sparing surgery for treatment of early-stage cervical cancer: open vs. robotic radical trachelectomy. , 2011, Gynecologic oncology.

[85]  J. Magrina,et al.  Robotic nerve‐sparing radical parametrectomy: feasibility and technique , 2012, The international journal of medical robotics + computer assisted surgery : MRCAS.

[86]  N. Rueda,et al.  Long-term follow-up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. , 1997, Gynecologic oncology.

[87]  V. Moyer,et al.  Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement , 2012, Annals of Internal Medicine.

[88]  M. Plante,et al.  Combined laparoscopic and vaginal radical surgery in cervical cancer. , 2000, Gynecologic oncology.

[89]  V. Abeler,et al.  Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection--case report. , 2006, European journal of gynaecological oncology.

[90]  P. Reynisson,et al.  Hospital costs for robot-assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy. , 2013, Gynecologic oncology.

[91]  K. Hatch,et al.  The role of laparoscopic lymphadenectomy in the management of cervical carcinoma. , 1992, Gynecologic oncology.

[92]  Jeong-Won Lee,et al.  Perioperative Outcomes of Radical Trachelectomy in Early-Stage Cervical Cancer: Vaginal Versus Laparoscopic Approaches , 2014, International Journal of Gynecologic Cancer.

[93]  F. Landoni,et al.  Robotic approach for cervical cancer: comparison with laparotomy: a case control study. , 2009, Gynecologic oncology.

[94]  M. Janicek,et al.  Close vaginal margins as a prognostic factor after radical hysterectomy. , 1998, Gynecologic oncology.

[95]  T. Tillmanns,et al.  A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. , 2009, Gynecologic oncology.

[96]  Y. Li,et al.  Laparoscopic radical trachelectomy or parametrectomy and pelvic and para‐aortic lymphadenectomy for cervical or vaginal stump carcinoma: report of six cases , 2006, International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.

[97]  J. Tierney,et al.  Neoadjuvant chemotherapy plus surgery versus surgery for cervical cancer. , 2012, The Cochrane database of systematic reviews.

[98]  L. Roman,et al.  Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma. , 2003, Gynecologic oncology.

[99]  Joshua R. Smith,et al.  Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. , 1998, British journal of obstetrics and gynaecology.