Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm

Abstract

ObjectiveThere is recent evidence that demonstrates worse oncologic outcomes associated with minimally invasive radical hysterectomy when compared with open radical hysterectomy, particularly in patients with tumors >2 cm. The aim of our study was to retrospectively evaluate the oncological outcomes between laparoscopic and open radical hysterectomy in International Federation of Gynecology and Obstetrics(FIGO) 2009 stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm.MethodsA retrospective review of medical records was performed to identify patients who underwent either laparoscopic or open radical hysterectomy during January 2010 and December 2018. Inclusion criteria were: (1) histologically confirmed cervical cancer including all histological types; (2) FIGO 2009 stage IB1; (3) tumor size ≤2 cm (determined by pelvic examination, magnetic resonance imaging or transvaginal ultrasound); (4) had undergone radical hysterectomy (type II or III) with pelvic and/or para-aortic lymphadenectomy as primary surgical treatment; (5) had follow-up information. Patients with FIGO 2009 stage IA1 or IA2, tumor size >2 cm, or who received neo-adjuvant chemotherapy before surgery, those with cervical cancer incidentally found after simple hysterectomy, or with insufficient data were excluded. Concurrent comparison between the laparoscopic and open cohorts was made for disease-free survival and overall survival.ResultsA total of 325 cervical cancer patients were included; of these, 129 patients underwent laparoscopic surgery and 196 patients had open surgery. The median follow-up times were 51.8 months (range 2–115) for laparoscopic surgery and 49.5 months (range 3–108) for open surgery. Patients in the laparoscopic group had significantly worse 5 year disease-free survival than those in the open group (90.4% vs 97.7%; p=0.02). There was no significant difference in 5 year overall survival between groups (96.9% vs 99.4%, p=0.33). The Cox proportional hazards regression analysis indicated that laparoscopic surgery was associated with lower disease-free survival compared with open surgery (adjusted hazard ratio 4.64, 95% CI 1.26 to 17.06; p=0.02). In patients with non-squamous cell carcinoma or with grade II–III, laparoscopic surgery had a significantly worse 5 year disease-free survival compared with the open surgery group (74% vs 100%, p=0.01, and 88.8% vs 98.0%, p=0.02, respectively).ConclusionLaparoscopic radical hysterectomy was associated with worse disease-free survival for stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm compared with open radical hysterectomy. Further studies may shed additional light on the impact of minimally invasive surgery in this low-risk patient population.

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

“…The flaws are dependent on outdated methodology, confounding factors, heterogeneity of reporting of results, lack of replication, and a failure to interpret findings within the limitations of observational research methodology [29][30][31] Overall, the results reflect that in this large European population findings were consistent with recently published prospective data and confirmed by several retrospective population-based analyzes published since the LACC trial. [8][9][10][11][12][13][14][15] There are two prospective randomized trials exploring the role of minimally invasive surgery in patients with cervical cancer. The first is the RACC trial, 28 a Swedish multicentric prospective trial comparing robotic vs open surgery for the treatment of early-stage cervical cancer.…”

“…[4][5][6][7] However, two recent manuscripts published in October of 2018 in NEJM (the LACC trial and a large epidemiologic study involving women from Cancer-Accredited hospitals in the United States) 8 9 demonstrated higher rates of recurrence and death in patients that underwent minimally invasive radical hysterectomy. Subsequently, a number of retrospective studies corroborated these findings, [10][11][12][13][14][15] resulting in a recent modification of the NCCN, European Society of Gynecological Oncology (ESGO), and ESMO guidelines. [16][17][18] The unexpected results of the LACC trial and other retrospective studies led to an ongoing discussion regarding the ideal surgical approach in patients with early cervical cancer.…”

Risk Factors for Recurrence after Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer: A Multicenter Retrospective Study

“…Recent studies evaluated the oncological outcomes in patients with cervical tumors ≤ 20 mm [24][25][26]; in particular, the study of Anchora et al [27] [27]. However, in a retrospective study of 815 women with tumor size ≤ 20 mm, in whom radical hysterectomy was performed by MIS in 255 cases and open surgery in 560 cases, the MIS approach was noted to be independently associated with a higher likelihood of recurrence (adjusted HR, 6.31; 95% CI 1.24-31.9) [28].…”

Comparison of Survival Outcomes after Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Patients with Cervical Cancer

“…Study design Matched 10 (5,11,13,15,16,19,28,30,41,43) 1.49 (1.19-1.88) 0.001 27.5 Fixed effect Retrospective 26 (6-10, 12, 14, 17, 18, 20-27, 29, 31-34, 42, 44-46) 1. (12,13,19,23,24,(27)(28)(29)(30)(31)(32)(33)(34)(42)(43)(44)(45)(46) 1. Small (at least one arm < 90) 18 (5-11, 14-18, 20-22, 25, 26, 41) 0.90 (0.67-1.20)…”

“…Before LACC trial 22 (5-24, 41, 42) 0.89 (0.71-1.11) 0.289 0.0 Fixed effect After LACC trial 14 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(43)(44)(45)(46) 1. 17 (5, 11, 12, 17, 19, 21, 22, 24-26, 29, 31, 32, 41-43, 45) 1.06 (0.87-1.30) 0.555…”