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Cervical CancerSOLUTIONNCT04370496

Safety of Minimally Invasive Surgery Using Endoscopic Stapler in Early Stage Cervical Cancer Patients (SOLUTION)

A study testing Minimally invasive surgery using endoscopic stapler in people with Cervical Cancer and Cervical Cancer Stage IB1, run by Seoul National University Hospital at 3 sites in South Korea.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The SOLUTION trial aims to show the efficacy and safety of performing radical hysterectomy by minimally invasive surgery using an endoscopic stapler in patients with cervical cancer stage IB1 (FIGO staging 2009) and thus to prove that minimally invasive surgery is non-inferior to open surgery. Read more about this study

Who is it for?
Ages 20 years and older, women only
What is being tested?
Minimally invasive surgery using endoscopic stapler
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
124 participants
Where
3 sitesSouth Korea
Study dates
2 Jul 2020to 31 Dec 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Females, aged 20 years or older
  • Histologically confirmed primary squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma of the uterine cervix
  • Patients with FIGO stage IB1 (FIGO staging 2009)
  • : stromal invasion>5 mm or 7 mm <lesion size ≤4 cm
  • Patients undergoing either type B or C hysterectomy (Querleu-Morrow classification)
  • Patients with normal bone marrow, renal and hepatic function
Show all 13Show fewer
  • WBC > 3.0x10^9 cells/L
  • Platelets > 100x10^9 cells/L
  • Serum creatinine ≤1.5 mg/dL
  • Serum total bilirubin <1.5 x normal range and AST/SGOT or ALT/SGPT <3 x normal range
  • ECOG performance status 0 or 1
  • Synchronous cancer with no evidence of recurrence during the past 5 years
  • Informed consent of patient

Who cannot join

  • Any histological type other than squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma of the uterine cervix
  • Tumor size greater than 4 cm
  • Patients with FIGO less than stage IA2 or greater than IB2 (FIGO staging 2009)
  • stromal invasion ≤5 mm and lesion size ≤7 mm (less than IA2)
  • or lesion size> 4 cm (greater than IB2)
  • Patients with evidence of metastatic disease by conventional imaging studies, enlarged pelvic or aortic lymph nodes greater than 2 cm, or histologically positive lymph nodes
Show all 14Show fewer
  • Patients in pregnancy
  • Patients with a history of pelvic or abdominal radiotherapy
  • Patients with contraindication of surgery (serious concomitant systemic disorders incompatible with the study to be decided at the discretion of the investigator)
  • Patients who agree to intra-operative lymphatic mapping (IOLM) must not have:
  • Known allergies to triphenylmethane compounds
  • History of retroperitoneal surgery.
  • History of pelvic irradiation.
  • Cold knife or LEEP cone biopsy within 4 weeks of enrollment

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Soo Jin Park, M.D. contact

+82-02-2072-0897

soojin.mdpark@gmail.com

Jaehee Mun, M.D. contact

+82-02-2072-2388

jhee1315@gmail.com

South Korea3 sites, 3 recruiting
  • Seoul National University Hospital

    Seoul, 03080

    Soo jin Park, MD, 82-2-2072-0897, soojin.mdpark@gmail.com

    Maria Lee, MD

    Recruiting
  • Samsung Medical Center, Sungkyunkwan University School of Medicine

    Seoul

    Yoo Young Lee, MD

    Chel Hun Choi, MD

    Recruiting
  • Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine

    Suwon

    Tae Wook Kong, MD

    Suk Joon Chang, MD

    Recruiting

Other trials in South Korea

About this study

Official title: Safety Of Laparoscopic or Robotic Radical Hysterectomy Using Endoscopic sTapler for Inhibiting tumOr Spillage of Cervical Neoplasms (SOLUTION): a Phase II Study

The SOLUTION trial aims to show the efficacy and safety of performing radical hysterectomy by minimally invasive surgery using an endoscopic stapler in patients with cervical cancer stage IB1 (FIGO staging 2009) and thus to prove that minimally invasive surgery is non-inferior to open surgery.

Read the detailed description

Cervical cancer is the 4th most common gynecologic cancer and treatment in early stages consists of surgery, chemotherapy, or radiation therapy. Surgical methods are simple or radical hysterectomy and pelvic and para-aortic lymph node dissection either done in an open manner or minimally invasive surgery (robotic or laparoscopic). However, a phase III cinical trial in 2018 comparing the safety and efficacy between minimally invasive surgery and open surgery in performing radical hysterectomy, 'Laparoscopic Approach to Cervical Cancer' (LACC), showed that open surgery is safer than minimally invasive surgery. Possible causes of such results are as follows:

  1. Carbon dioxide is supplied during laparoscopic operations to maintain capnoperitoneum, which can cause the implantation and proliferation of tumor cells exposed to the peritoneal cavity.
  2. Insertions of uterine manipulators into the endometrial cavity is commonly done, which can cause tumor cells to travel to both salpinges.
  3. Tumor cells can be exposed to the peritoneal cavity when the cervix is exposed during intracorporeal colpotomy.
  4. Tumor cells exposed to the peritoneal cavity can travel upwards when the patient's position is maintained in the Trendelenburg position during minimally invasive operations, leading to distant metastasis.

Based on the above-mentioned hypothesis, the following methods could be applied to minimize the exposure of tumor cells to the peritoneal cavity.

  1. The application of a vaginal tube instead of a uterine manipulator to prevent tumor cells from traveling to the salpinges.
  2. The ligation of both salpinges prior to insertion of a vaginal tube to block the travel of tumor cells.
  3. The performance of extracorporeal colpotomy instead to prevent the exposure of tumor cells inside the peritoneal cavity.

Although it would be favorable to perform all the forementioned methods, extracorporeal colpotomy is difficult to perform especially in menopausal patients with atrophic vaginitis or patients with no sexual experience. Thus, an alternative method is to use an endoscopic stapler which can simultaneously cut and suture the cervix into a vaginal stump, which can prevent tumor cells from being exposed to the peritoneal cavity.

In conclusion, this clinical trial aims to show the efficacy and safety of performing radical hysterectomy by minimally invasive surgery using an endoscopic stapler in patients with cervical cancer stage IB1 (FIGO staging 2009) and thus to prove that minimally invasive surgery is non-inferior to open surgery.

Being tested
Minimally invasive surgery using endoscopic stapler
Keywords
Cervical cancer, Cervical Cancer Stage IB1, Minimally invasive surgery
Medical subject headings
Uterine Cervical Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Minimally invasive surgery using endoscopic staplerProcedure or surgery

    Radical hysterectomy by minimally invasive surgery (laparoscopic or robotic) will be done with the help of an endoscopic stapler in cutting and suturing the uterine cervix.

Study groups in NCT04370496
Study groupRoleWhat they receive
SOLUTION groupExperimentalPatients enrolled in this clinical trial will undergo radical hysterectomy through minimally invasive surgery using an endoscopic stapler which both cuts and simultaneously sutures the open vaginal stump.
Receives: Procedure: Minimally invasive surgery using endoscopic stapler

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 4.5 year disease-free survival [DFS] rate

    Probability of no recurrence from the day of surgery until post-operative 4.5 years

    Measured: Examined at post-operative 4.5 years

Secondary outcomes (3)
  1. 4.5 year overall survival [OS] rate

    Rate of survival from the day of surgery until post-operative 4.5 years

    Measured: Examined at post-operative 4.5 years

  2. Pattern of recurrence sites

    Anatomical site of recurrent cancer according to imaging modalities

    Measured: Examined every 3 months during post-operative 1 year, every 2 months during post-operative 2 years, and every 6 months during post-operative 4.5 years

  3. Morbidity

    Intra-operative and post-operative complications occurring in less than post-operative 4 weeks and between post-operative 4 and 6 weeks. Other morbidity include estimated blood loss during surgery, post-operative pain and amount of analgesic consumption

    Measured: Examined during operation and post-operative 4 and 6 weeks.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 May 2020
  2. Study start2 Jul 2020
  3. Primary completion31 Dec 2028 (estimated)
  4. Study completion31 Dec 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Patients enrolled in this clinical trial will undergo surgery for early stage cervical cancer. They will receive either laparoscopic or robotic radical hysterectomy using an endoscopic stapler. The efficacy and safety of this surgical technique will be compared to that of open radical hysterectomy studied in previous trials.
Masking
None (open label)
Enrolment
124 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04370496
Sponsor's protocol ID
IRB No. 2002-101-1103
Acronym
SOLUTION
Status last verified
Jun 2023
First submitted
19 Apr 2020
Last updated
26 Jun 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: The plan whether to share IPD will be decided once enrollment of the clinical trial starts.

Publications

  • Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019 Jan 12;393(10167):169-182. doi: 10.1016/S0140-6736(18)32470-X.

    PubMed 30638582
  • Wood DE. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Lung Cancer Screening. Thorac Surg Clin. 2015 May;25(2):185-97. doi: 10.1016/j.thorsurg.2014.12.003. Epub 2015 Jan 28.

    PubMed 25901562
  • Nam JH, Park JY, Kim DY, Kim JH, Kim YM, Kim YT. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol. 2012 Apr;23(4):903-11. doi: 10.1093/annonc/mdr360. Epub 2011 Aug 12.

    PubMed 21841155
  • Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer. J Surg Oncol. 2013 Jul;108(1):63-9. doi: 10.1002/jso.23347. Epub 2013 Jun 5.

    PubMed 23737035
  • Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, Buda A, Yan X, Shuzhong Y, Chetty N, Isla D, Tamura M, Zhu T, Robledo KP, Gebski V, Asher R, Behan V, Nicklin JL, Coleman RL, Obermair A. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med. 2018 Nov 15;379(20):1895-1904. doi: 10.1056/NEJMoa1806395. Epub 2018 Oct 31.

    PubMed 30380365
  • Kohler C, Hertel H, Herrmann J, Marnitz S, Mallmann P, Favero G, Plaikner A, Martus P, Gajda M, Schneider A. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff - a multicenter analysis. Int J Gynecol Cancer. 2019 Jun;29(5):845-850. doi: 10.1136/ijgc-2019-000388.

    PubMed 31155516
  • Kim SI, Cho JH, Seol A, Kim YI, Lee M, Kim HS, Chung HH, Kim JW, Park NH, Song YS. 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. Gynecol Oncol. 2019 Apr;153(1):3-12. doi: 10.1016/j.ygyno.2019.01.008. Epub 2019 Jan 12.

    PubMed 30642625
  • Park SJ, Kong TW, Kim T, Lee M, Choi CH, Shim SH, Yim GW, Lee S, Lee EJ, Lim MC, Chang SJ, Lee SJ, Lee SH, Song T, Lee YY, Kim HS, Nam EJ. Safety and efficacy study of laparoscopic or robotic radical surgery using an endoscopic stapler for inhibiting tumour spillage of cervical malignant neoplasms evaluating survival (SOLUTION): a multi-centre, open-label, single-arm, phase II trial protocol. BMC Cancer. 2022 Mar 26;22(1):331. doi: 10.1186/s12885-022-09429-z.

    PubMed 35346103
  • Mun J, Park SJ, Yim GW, Chang SJ, Kim H; Trial Monitoring Committee of SOLUTION trial. Solution to prevent tumor spillage in minimally invasive radical hysterectomy using the endoscopic stapler for treating early-stage cervical cancer: Surgical technique with video. J Gynecol Obstet Hum Reprod. 2021 Dec;50(10):102211. doi: 10.1016/j.jogoh.2021.102211. Epub 2021 Sep 1.

    PubMed 34481135

Questions about this trial

What is this clinical trial studying?

A study testing Minimally invasive surgery using endoscopic stapler in people with Cervical Cancer and Cervical Cancer Stage IB1, run by Seoul National University Hospital at 3 sites in South Korea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 26 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Soo Jin Park, M.D. (+82-02-2072-0897, soojin.mdpark@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

4.5 year disease-free survival [DFS] rate (time frame: Examined at post-operative 4.5 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04370496, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Jun 2023.

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