Article Data

  • Views 675
  • Dowloads 165

Systematic reviews

Open Access Special Issue

Surgical approach in early stage cervical cancer: the Asian view point

  • Hiroko Machida1,2
  • Hiroshi Yoshida1
  • Kenji Izumi1
  • Rie Nakajima1
  • Miwa Yasaka1
  • Tetsuji Iida1
  • Masae Ikeda1
  • Masako Shida1
  • Takeshi Hirasawa1
  • Mikio Mikami1,*,

1Department of Obstetrics and Gynecology, Tokai University School of Medicine, Shimokasuya, Isehara, 259-1100 Kanagawa, Japan

2Department of Obstetrics and Gynecology, Toyohashi general hospital, 440-0001 Toyohashi, Japan

DOI: 10.31083/j.ejgo.2021.01.2270 Vol.42,Issue 1,February 2021 pp.30-37

Submitted: 15 October 2020 Accepted: 20 November 2020

Published: 15 February 2021

(This article belongs to the Special Issue Minimally Invasive Surgery in Gynecologic Oncology)

*Corresponding Author(s): Mikio Mikami E-mail:


Objective: To examine the current practice of radical hysterectomy for early-stage cervical cancer in Asia after the Laparoscopic Approach to Cervical Cancer (LACC) trial. Methods: A cross-sectional study was conducted in Asia to examine the prevalence and management of women with early-stage cervical cancer. The study was conducted among gynecologic oncologists at leading hospitals in the Asian Society of Gynecologic Oncology Council members. A systematic literature review was performed to examine the association between survival outcomes and surgical approach after the LACC trial. Results: Seven countries participated voluntarily in the study. The incidence, mortality, and centralization of treatment in early-stage cervical cancer were different among the seven countries. The number of specialized centers per population density in Japan was higher than that in the other countries. Minimally invasive surgery (MIS) approach for cervical cancer was common in Korea (56%) and Hong Kong (80-90%), but not in the other countries (2-20%). In the systematic review, there was a significant difference in survival outcomes between MIS and open surgery (recurrence, hazard ratio 1.83, 95% confidence interval 1.27-2.62). MIS without a uterine manipulator or making a vaginal cuff closure produced similar recurrence rates compared with open surgery (MIS without uterine manipulator vs open-surgery: 10.5% vs 10.1%, and MIS with cuff closure vs open-surgery 7.2% vs 10.1%; all P > 0.05). Conclusion: The prevalence of MIS for early-stage cervical cancer varies across Asian regions after the LACC trial. Surgical methods to avoid tumor spillage may be useful for improving survival.


Cervical cancer; Radical hysterectomy; Minimally invasive surgery; Uterine ma-nipulator; Vaginal cuff closure; Survival

Cite and Share

Hiroko Machida,Hiroshi Yoshida,Kenji Izumi,Rie Nakajima,Miwa Yasaka,Tetsuji Iida,Masae Ikeda,Masako Shida,Takeshi Hirasawa,Mikio Mikami. Surgical approach in early stage cervical cancer: the Asian view point. European Journal of Gynaecological Oncology. 2021. 42(1);30-37.


[1] WHO. Global Health Observatory data: Death rate for Noncommunicable Diseases (NCDs). 2020; Available at: https://www. (Accessed: 28 September 2020).

[2] Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. New England Journal of Medicine. 2018; 379: 1895-1904.

[3] Kanao H, Matsuo K, Aoki Y, Tanigawa T, Nomura H, Okamoto S, et al. Feasibility and outcome of total laparoscopic radical hysterectomy with no-look no- touch technique for FIGO IB1 cervical cancer. Journal of Gynecologic Oncology. 2019; 30: e71.

[4] Lee C, Wu K, Huang K, Lee P, Yen C. Long-term survival outcomes of laparoscopically assisted radical hysterectomy in treating early-stage cervical cancer. American Journal of Obstetrics and Gynecology. 2010; 203: 165.e1-165.e7.

[5] Nam JH, Park JY, Kim DY, Kim JH, Kim YM, Kim YT. Laparo-scopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Annals of Oncology. 2012; 23: 903-911.

[6] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339: b2700-b2700.

[7] Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. International Journal of Gynecology & Obstetrics. 2009; 105: 107-108.

[8] Kong TW, Son JH, Paek J, Chang SJ, Ryu HS. Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer. Journal of Gynecologic Oncology. 2020; 31: e7.

[9] Parmar MKB, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Statistics in Medicine. 1998; 17: 2815-2834.

[10] Woods BS, Hawkins N, Scott DA. Network meta-analysis on the loghazard scale, combining count and hazard ratio statistics accounting for multiarm trials: a tutorial. BMC Medical Research Methodology. 2010; 10: 54.

[11] Higgins JPT. Measuring inconsistency in meta-analyses. British Medical Journal. 2003; 327: 557-560.

[12] Alfonzo E, Wallin E, Ekdahl L, Staf C, Rådestad AF, Reynisson P, et al. No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study. European Journal of Cancer. 2019; 116: 169-177.

[13] Brandt B, Sioulas V, Basaran D, Kuhn T, LaVigne K, Gardner GJ, et al. Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecologic Oncology. 2020; 156: 591-597.

[14] Chen B, Ji M, Li P, Liu P, Zou W, Zhao Z, et al. Comparison between robot-assisted radical hysterectomy and abdominal radical hysterectomy for cervical cancer: a multicentre retrospective study. Gynecologic Oncology. 2020; 157: 429-436.

[15] Chiva L, Zanagnolo V, Querleu D, Martin-Calvo N, Arévalo-Serrano J, Căpîlna ME, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. International Journal of Gynecologic Cancer. 2020; 30: 1269-1277.

[16] Cusimano MC, Baxter NN, Gien LT, Moineddin R, Liu N, Dossa F, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. American Journal of Obstetrics and Gynecology. 2019; 221: 619.e1-619.e24.

[17] Doo DW, Kirkland CT, Griswold LH, McGwin G, Huh WK, Leath CA, et al. Comparative outcomes between robotic and abdominal radical hysterectomy for IB1 cervical cancer: Results from a single high volume institution. Gynecologic Oncology. 2019; 153: 242-247.

[18] Kim SI, Cho JH, Seol A, Kim YI, Lee M, Kim HS, et al. Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer. Gynecologic Oncology. 2019; 153: 3-12.

[19] Melamed A, Margul DJ, Chen L, Keating NL, del Carmen MG, Yang J, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. New England Journal of Medicine. 2018; 379: 1905-1914.

[20] Paik ES, Lim MC, Kim M, Kim YH, Song ES, Seong SJ, et al. Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment: Ancillary analysis of a Korean Gynecologic Oncology Group Study (KGOG 1028). Gynecologic Oncology. 2019; 154: 547-553.

[21] Uppal S, Gehrig PA, Peng K, Bixel KL, Matsuo K, Vetter MH, et al. Recurrence rates in patients with cervical cancer treated with abdominal versus minimally invasive radical hysterectomy: a multi-institutional retrospective review study. Journal of Clinical Oncology. 2020; 38: 1030-1040.

[22] Yuan Z, Cao D, Yang J, Yu M, Shen K, Yang J, et al. Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China. Frontiers in Oncology. 2019; 9: 1107.

[23] Demange MK, Fregni F. Limits to clinical trials in surgical areas. Clinics. 2011; 66: 159-161.

[24] Cady B. Basic principles in surgical oncology. Archives of Surgery. 1997; 132: 338-346.

[25] APAGE. Minimally invasive therapy versus open radical hysterectomy study meeting. 2019; Available at: http://www.apagemit .com/page/news/show.aspx?num=88 (Accessed: 28 September 2020).

[26] BGCS. Comparisons of overall survival in women diagnosed with early stage cervical cancer during 2013-2016, treated by radical hysterectomy using minimal access or open approach. 2019; Available at: (Accessed: 30 September 2020).

[27] Köhler C, Hertel H, Herrmann J, Marnitz S, Mallmann P, Favero G, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff - a multicenter analysis. International Journal of Gynecologic Cancer. 2019; 29: 845-850.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time