Effect of using a vaginal pipe to reduce tumour spillage during minimally invasive radical hysterectomy for cervical cancer

초록

Introduction/Background Radical hysterectomy is a cornerstone treatment for early-stage cervical cancer. Since the 2018 Laparoscopic Approach to Cervical Cancer (LACC) trial, minimally invasive radical hysterectomy (MIRH) has been reassessed, emphasising tumour containment to minimise intraoperative tumour spillage. This study investigates whether using a vaginal pipe during MIRH effectively reduces spillage. Methodology This retrospective study reviewed records of patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1–IIA2 cervical cancer undergoing radical hysterectomy (2014–2022). Of 216 patients, 35 had abdominal radical hysterectomy (ARH) and 181 had MIRH. The MIRH group was subdivided by vaginal pipe usage: pipe group (MIRH-Y, n=77) and non-use group (MIRH-N, n=104). Results ARH and MIRH groups differed only in age (p=0.004) and tumour size (p=0.003). No significant differences were found in 2-year disease-free survival (DFS) (94.3% vs. 91.2%, p=0.578) or 5-year overall survival (OS) (97.1% vs. 93.9%, p=0.532). Tumour size >2 cm was a significant predictor of recurrence (Hazard Ratio [HR]=0.29, p=0.033). In MIRH subgroups, a trend favoured the MIRH-Y group for 2-year DFS (96.1% vs. 87.5%, p=0.060) and 5-year OS (98.7% vs. 90.4%, p=0.051). For tumours ≤2 cm, the MIRH-Y group showed significantly better DFS (p=0.037) and a favourable OS trend (p=0.080). No survival differences were seen for tumours >2 cm. Conclusion Using a vaginal pipe during MIRH may reduce recurrence from tumour spillage, particularly for patients with tumours ≤2 cm. Tumour containment measures should be routinely implemented in MIRH.