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Regional Outcomes for Surgical Management of Early Stage Cervical Cancer

Regional Outcomes for Surgical Management of Early Stage Cervical Cancer. Dr S Coleridge Clinical Fellow Gynaeoncology Musgrove Park Hospital, Taunton ST6 OOPR. Why?. LACC data presented Consensus to inform women about to undergo a radical hysterectomy of unpublished trial findings

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Regional Outcomes for Surgical Management of Early Stage Cervical Cancer

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  1. Regional Outcomes for Surgical Management of Early Stage Cervical Cancer Dr S Coleridge Clinical Fellow Gynaeoncology Musgrove Park Hospital, Taunton ST6 OOPR

  2. Why? • LACC data presented • Consensus to inform women about to undergo a radical hysterectomy of unpublished trial findings • Informed consent • Montgomery ruling • Women want to know why we are recommending a particular treatment • Can provide local data to help inform shared decision making

  3. Randomised Controlled Trial Vs Retrospective Cohort • Randomly assign participants to control group (open surgery) or intervention group (minimal access surgery) • Gold standard of evidence based medicine • Minimise bias • Control for confounding factors • Observational • Middle of the hierarchy of evidence • Useful to inform clinical practice

  4. Laparoscopic radical hysterectomy

  5. LACC Hypothesis • Minimal access surgery is cost effective, improves QoL and pelvic floor function with equivalent overall survival to open surgery • Decreased treatment related morbidity (8%) • Shorter hospital stay • Less post op pain • Reduced analgesic consumption • Equivalence measured by disease free survival(DFS) within 7.2% of open DFS rate

  6. Laparoscopic Radical Hysterectomy “I'm 5 weeks post op now and feel great. I'm starting back to work next week. My incision sites are still a little sore” “I wanted to say that I felt keyhole surgery was right option for me as the recovery time is quicker and this was important for me as a single parent of 3 kids and limited family support” https://www.jostrust.org.uk/forum

  7. Open Abdominal Hysterectomy “It's taken 4 months to start to feel ok-ish” “I'd say for anyone having the abdominal surgery....this is a hard recovery but it does get better, from speaking to people having had this op it does take a couple of months more than keyhole to get to the milestones they give you. Take it steady!” https://www.jostrust.org.uk/forum

  8. Inclusion criteria • FIGO stage • 1a1 with LVSI • 1a2 • 1b1 • Histological subtype • Adenocarcinoma • Squamous cell carcinoma • Adenosquamous carcinoma • Tumour size < 4cm

  9. Exclusions

  10. Baseline Data

  11. Post operative Histopathology

  12. Post operative Histopathology contd

  13. Post op chemoradiotherapy • LACC criteria - LVSI / tumour size / stromal invasion

  14. Surgery Vs. Chemoradiotherapy “I went on to have chemo-rads anyway and have been cancer-free ever since, but it is my firm belief that the outcome would have been the same without the unnecessary loss of body parts. …………But in all honesty, I could have done without losing the top 50% of my vagina”

  15. Post operative Histopathology contd

  16. Intra operative complications

  17. Post operative complications

  18. Site of first recurrence

  19. SWAGGER progression free survival

  20. LACC Progression free survival

  21. Cause of death

  22. SWAGGER Overall Survival Cancer Specific

  23. LACC OVERALL Survival

  24. Going Forward What Next?

  25. Thank You • Mr Milliken • Miss Morrison • Miss Newton • Mr Rolland • Mr Hannemann

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