Minimally invasive hysterectomy for stage IA cervical carcinoma: a survival analysis of the National Cancer Database

Abstract

ObjectiveTo evaluate the outcomes of minimally invasive surgery for patients with stage IA cervical carcinoma undergoing hysterectomy.MethodsPatients with pathological stage IA (IA1, IA2, IA not otherwise specified) squamous, adenocarcinoma, adenosquamous carcinoma of the cervix, no history of another tumor, who underwent radical or simple hysterectomy with known mode of surgery, diagnosed between 2010 and 2015 with at least 1 month of follow-up, were drawn from the National Cancer Database. Comparisons of demographic and clinicopathologic characteristics were made with the χ2 test. The impact of minimally invasive surgery (robotic-assisted or traditional laparoscopic) on overall survival was assessed with the log-rank test following generation of Kaplan–Meier curves. A Cox model was constructed to control for confounders.ResultsA total of 1930 patients were identified; the majority (73.3%, 1414 patients) had stage IA1 disease, while 458 (23.7%) patients had stage IA2, and 58 (3%) patients had stage IA not otherwise specified. In the present cohort, 685 patients (35.5%) had open, 438 patients (22.7%) had laparoscopic, and 807 patients (41.8%) had robotic-assisted laparoscopic hysterectomy. Patients who had an open approach were more likely to undergo lymphadenectomy (58.1% vs 52.7%, p=0.021) and have radical hysterectomy (42% vs 32.4%, p<0.001). Patients who had minimally invasive surgery had a shorter hospital stay (median 1 vs 3 days, p<0.001). There was no difference in overall survival between patients who had open and minimally invasive hysterectomy (p=0.87); 4-year overall survival rates were 97.7% and 98.6%, respectively. There was no difference in overall survival between the open and minimally invasive surgery groups for patients who had simple (p=0.61; 4-year overall survival rates 97.6% and 98.7%, respectively) or radical hysterectomy (p=0.70; 4-year overall survival rates 97.8% and 98.4%, respectively). After controlling for patient age, tumor histology, and presence of lymphovascular invasion, minimally invasive hysterectomy was not associated with worse survival (HR 0.94, 95% CI 0.49 to 1.81). In a sensitivity analysis, based on 3048 patients with clinical stage IA after controlling for confounders, minimally invasive surgery was not associated with worse survival than laparotomy (HR 1.06, 95% CI 0.65 to 1.72).ConclusionsIn a large cohort of patients with stage IA cervical carcinoma, performance of minimally invasive hysterectomy was not associated with a detrimental effect on overall survival.

Minimal risk for minimally invasive hysterectomy for stage IA cervical cancer?

“…While only one-third of the cohort underwent radical hysterectomy, even when stratified by extent of hysterectomy the findings were similar, with 4-year survival rates of 97.6% vs 98.7% for simple abdominal compared with simple minimally invasive hysterectomy, respectively, and 97.8% vs 98.4% for radical open and radical minimally invasive hysterectomy, respectively. 3 These data suggest that there may yet be a role for minimally invasive hysterectomy in the treatment of cervical cancer, at least for those women with microscopic disease. While the mechanisms by which minimal access surgery increases mortality for cervical cancer are uncertain, many have posited that tumor disruption and spread from uterine manipulation or colpotomy may be contributing factors.…”

“…Nasioudis et al examined the association between route of hysterectomy and survival in women with stage IA cervical cancer. 3 Using the National Cancer Database, the investigators identified 1930 women with stage IA cervical cancer treated from 2010 to 2015. Abdominal hysterectomy was performed in 36% of the cohort, 23% had a laparoscopic hysterectomy, and 42% a robotic-assisted procedure.…”

Laparoscopic versus open radical hysterectomy in FIGO 2018 early‐stage cervical adenocarcinoma: Long‐term survival outcomes after propensity score matching

“…14 Under the new staging system, the treatment strategy of early-stage cervical cancer follows the original content in the NCCN guidelines. Quite a few articles about arguments on laparoscopic surgery and laparotomy surgery for early-stage cervical cancer have been reported, [15][16][17][18][19] but there are few reports on the indications of laparoscopic surgery for FIGO 2018 early-stage cervical adenocarcinoma. Therefore, our study screened cases of FIGO 2018 early-stage cervical adenocarcinoma from the Four C database and compared the oncological outcomes of laparoscopic and laparotomy radical hysterectomy for early-stage cervical adenocarcinoma.…”

Impact of Initiation of Robotic Surgery in Gynecologic Cancer on Surgical and Oncologic Outcomes in a Single Institution: A Research Article

“…Laparoscopy has gain acknowledgement and popularity in the treatment of gynecologic cancer with less blood loss, faster recovery, decrease perioperative morbidity and presumably comparable oncological results compared to conventional laparotomy in the past decades [1][2][3][4][5]. Robotic surgery, in the other hands have all the benefits of laparoscopy with added value of magnified surgical field, precision in complex procedure with ergonomic benefits for surgeons as well as a superior surgical with comparable oncological outcomes [6][7][8][9][10][11].…”