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02 April 2020, Volume 36 Issue 4 Previous Issue    Next Issue

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Views on the LACC outcome and NCCN guide update from the point of management. YANG Zhuo，WANG Dan-bo 2020, 36(4): 308-311.  DOI: 10.19538/j.fk2020040104 Abstract ( )   In 2018，LACC study presented the results that minimally invasive laparoscopic surgery for cervical cancer significantly increased the risk of recurrence，and NCCN guidelines also revised the treatment regimen for cervical cancer based on the new FIGO （2018）stage，indicating that the standard and historical approach for radical hysterectomy is with an open abdominal approach.As a manager，we should pay attention to medical quality and safety issues such as adverse medical events and medical defects.Also we should rationally analyze the status of minimally invasive laparoscopic surgery for cervical cancer，and scientifically guide the minimally invasive surgery for cervical cancer on the basis of standardized diagnosis and treatment，so as to achieve better development.

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Should we abandon laparoscopic surgery in the management of early stage cervical cancer? CAI Jing，WANG Ze-hua 2020, 36(4): 311-313.  DOI: 10.19538/j.fk2020040105 Abstract ( )   Laparoscopy has been widely used in the surgical treatment of early stage cervical cancer.However，the unexpected results of LACC reported by Pedro T.Ramirez，et al.in the New England Journal of Medicine that minimally invasive surgery was associated with significantly increased risks of disease recurrence and death of cervical cancer patients sounded the warning bell.Meanwhile，the less rigorous study design of the trail of Ramirez，et al，particularly the disparity of surgical competency and experience of the included centers，has been criticized，because that possibly led to bias in the results.That triggered a great debate and caused a choice dilemma over surgery approaches.Hereby，we analyzed the limitations of LACC trial and the potential problems and advantages of laparoscopic surgery to find out the answer to the question whether laparoscopic surgery should be abandoned in cervical cancer or not and the direction  which we should head towards in the post-LACC era.

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How to see laparoscopic surgery for cervical cancer from the perspective of a gynecological oncologist. WANG Deng-feng，ZHANG Guo-nan 2020, 36(4): 313-317.  DOI: 10.19538/j.fk2020040106 Abstract ( )   Radical hysterectomy（RH）with bilateral pelvic lymph node dissection is recommended as the standard treatment for early-stage cervical cancer.Compared with open surgery，minimally invasive surgery（MIS） has some advantages in perioperative outcomes and comparable prognosis，so MIS has been adopted as an optimal treatment for early cervical cancer.Until November 2018，there were two articles published in The New England Journal of Medicine （NEJM），which reversed the situation.The result suggested that，for early-stage cervical cancer patients，MIS group had higher recurrence rates and worse overall survival compared with open surgery group.In December 2019，a retrospective study with a large sample size was published in Gynecologic Oncology，which was undoubtedly an even worse test for MIS.The result showed that compared with the open surgery，the incidence of surgery-related major complications in MIS group was higher.We will analyse and discuss the situation and give some suggestions on tumor-free principle，tumor-free technology and laparoscopic operation details from the perspective of a gynecological oncologist.

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Controversy and improvements of laparoscopic surgery for early cervical cancer. ZHOU Li，QIN Juan 2020, 36(4): 317-320.  DOI: 10.19538/j.fk2020040107 Abstract ( )   In recent years，the controversy on the treatment of laparoscopic surgery for cervical cancer is a hot issue in the treatment of cervical cancer.We analyzed the reason of higher recurrence and mortality rates after laparoscopy surgery for early cervical cancer，which may be related to the inadequate adherence to the non-tumor principle and appliance of uterine lifters in laparoscopic cervical cancer surgery.This article discusses the procedure of laparoscopic surgery for cervical cancer based on non-tumor and no-lifting principles.

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What we learned in LACC study. QU Qing-xi，ZHANG Yuan-li 2020, 36(4): 320-324.  DOI: 10.19538/j.fk2020040108 Abstract ( )   LACC study showed that early-stage cervical cancer patients who underwent minimally invasive surgery had higher recurrence rates and worse overall survival compared to those that underwent open radical hysterectomy.Based on these research results，multitudinous medical institutions at home and abroad，include MD Anderson cancer center，had stopped or reduced laparoscopic radical hysterectomy for stage IA2-IB1 cervical cancer.In this report，we reviewed the LACC trial findings in depth，and investigated gynecologic oncologists’ questions on the unexpected results.Besides，we also explored the clinical significance of randomized controlled trial in the study of malignant tumor such as cervical cancer and the current status of China.

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Laparoscopic radical hysterectomy in Japan：perspectives from the Japan Gynecologic Oncology Group. Eiji Kobayashi 2020, 36(4): 324-325.  DOI: 10.19538/j.fk2020040109 Abstract ( )   Since the publication of Laparoscopic Approach to Cervical Cancer （LACC）trial，a huge controversy regarding laparoscopic radical hysterectomy （LRH）for cervical cancer has been raised.This article will introduce the history of LRH in Japan，current status of LRH and prospects.We suggest a strict indication and care should be taken during the colpotomy when applying LRH to treat cervical cancer.

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Study on the surgical approach to radical trachelectomy. LU Qi，LIU Chong-dong 2020, 36(4): 325-328.  DOI: 10.19538/j.fk2020040110 Abstract ( )   Radical trachelectomy is a surgical method that can preserve the fertility of patients in the treatment of early cervical cancer，which can be performed by vagina，laparotomy or laparoscopy，but different surgical approaches have different indications and have different effects on tumor prognosis and fertility outcome.For patients with early stage cervical cancer whose tumor diameter is ＜2 cm，the three surgical approaches have the same tumor prognosis.However，the pregnancy rate of LVRT and LRT is significantly higher than that of ART.For patients whose tumor diameter is 2-4 cm，ART or NACT followed by LVRT or LRT is also safe and effective，when the diameter is reduced by neoadjuvant chemotherapy.