Minimally invasive radical hysterectomy doubles death risk in women with cervical cancer

Canada: Minimally invasive radical hysterectomy increases the risk of death and cancer recurrence compared to open radical hysterectomy in patients with early-stage cervical cancer, according to a recent study published in the journal American Journal of Obstetrics and Gynecology.

A review of about 1000 patients found that people with early-stage cervical cancer who underwent minimally invasive surgery (MIS) were at double the risk of cancer recurrence and death even after controlling for surgeon volume, compared with those who had an open radical hysterectomy.

"Although there may be a subset of patients with microscopic 88 early-stage disease for whom minimally invasive hysterectomy remains safe, additional studies are required," write the authors.

Women with early-stage cervical; cancer is treated with radical hysterectomy by an open (OH) or minimally invasive approach (MH). Retrospective cohort studies have shown MH to be superior to OH in reducing perioperative morbidity and shorter hospital stays. Although may such studies have limitation such as inadequate follow up for the survival outcomes of the patients. strong evidence for the safety of minimally invasive surgery in endometrial cancer has fueled widespread adoption of MH for cervical cancer over the last decade.

However, the recent Laparoscopic Approach to Cervical Cancer (LACC) trial has questioned MH approach and shown that MH was associated with a 4-fold higher rate of recurrence and 6-fold higher rate of all-cause death compared to OH in women with early-stage cervical cancer.

Maria C. Cusimano, Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada, and colleagues conducted this population cohort study to determine if the surgical approach is associated with oncologic outcomes in cervical cancer patients undergoing minimally invasive or open radical hysterectomy while accounting for mechanistic factors including surgeon volume.

The researchers reviewed 958 cervical cancer patients undergoing primary radical hysterectomy by a gynecologic oncologist from 2006-2017 in Ontario, Canada (MH 475; OH 483), and followed for 6 years. They then tested for interactions between surgical approach and either pathologic stage or surgeon volume.

Also Read: Brachytherapy improves Survival in Locally Advanced Cervical Cancer

Key findings of the study include:

• MH procedures, 89.6% were performed laparoscopically and 10.4% robotically.


• The unadjusted 5-year cumulative incidences of all-cause death (MH 12.5%; 79 OH 5.4%), cervical cancer death (MH 9.3%; OH 3.3%), and recurrence (MH 16.2%; OH 8.4%) were significantly increased for MH in patients with stage IB disease, but not the cohort overall.


• After adjusting for patient factors and surgeon volume, MH was associated with increased rates of death and recurrence compared to OH in patients with stage IB disease (n=534), but not IA disease (n=244).

Also Read: Scaling up screening and vaccination may prevent millions of cervical cancer cases: Lancet

"Patients who still want to undergo less invasive surgery should be "guided appropriately", suggest the authors, in order to make a more informed decision about which approach they would prefer their surgeon to take.

To read the complete study follow the link: https://doi.org/10.1016/j.ajog.2019.07.009.