LAVRH as a Safe Option for Minimal Invasive Surgery

Radical hysterectomy and pelvic lymphadenectomy were found to be the gold standard treatments for early-stage cervical cancer  (ECC) in a study. Recent prospective randomized trial results have sparked debate over whether or not a less invasive technique could achieve the same results (Laparoscopic Approach to Cervical Cancer, LACC trial). It revealed that when it comes to oncological outcomes in ECC, Minimally Invasive Surgery fares poorly. Still, opinions vary as to what exactly is at play here. Laparo-Assisted vaginal hysterectomy (LAVRH) is an obvious alternative to Abdominal radical hysterectomy (ARH). This systematic review is an attempt to substantiate that assumption. In January 2022, researchers followed the guidelines laid out in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration and thoroughly searched the Scopus and Pubmed databases for primary research articles. There were no limits placed on the country. Articles in English were considered exclusively. Data from studies reporting disease-free survival (DFS), overall survival (OS), recurrence rate (RcR), or all 3 were considered. To be included, 19 studies had to meet certain criteria. About 9 papers with similar results were pooled together for the meta-analysis. The methods used during surgery (Laparoscopic-assisted vaginal radical hysterectomy) were analyzed and compared. Survival times and other oncological measures were considered. The total number of patients included in the analysis was 3,196. In 1,988 patients a non-statistical significant difference between LARVH and ARH was highlighted ARH (RR 0.8 [95% CI 0.55–1.16] P=0.24; I2=0%; P=0.98). There were only 4 studies that met the criteria for OS (RR 0.84 [95% CI 0.23-3.02] P=0.79; I2=0 P=0.44). Tumors with a maximum diameter of more than 2 centimeters were the subject of a separate analysis. Information was compiled on the different types of occurrences (local vs. distant). There is no evidence that LAVRH improves DFS or OS in patients with ECC. These expected results are comparable to those seen in the open approach group of the LACC trial, which is widely regarded as the standard of care for the treatment of this pathology at present. To determine if and how well LAVRH works in the ECC, more study is needed.


ECC: LAVRH as a Safe Option for Minimal Invasive Surgery