Minimally Invasive Radical Hysterectomy for Cervical Cancer: A Systematic Review and Meta-analysis

Abstract

Objective: To compare recurrence rate, progression-free survival (PFS), and overall survival for early-stage cervical cancer after minimally invasive (MIS) vs abdominal radical hysterectomy. Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Library databases. Methods of Study Selection: We identified studies from 1990 to 2020 that included women with stage I or higher cervical cancer treated with primary radical hysterectomy and compared recurrence and/or PFS and overall survival with MIS vs abdominal radical hysterectomy. (The review protocol was registered with the International Prospective Register of Systematic Reviews: CRD4202173600). Tabulation, Integration, and Results: We performed random-effects meta-analyses overall and by length of follow-up. Fifty articles on 40 cohort studies and 1 randomized controlled trial that included 22 593 women with cervical cancer met the inclusion criteria. Twenty percent of the studies had <36 months of follow-up, and 24% had more than 60 months of follow-up. The odds of PFS were worse for women undergoing MIS radical hysterectomy (odds ratio 1.54; 95% CI [confidence interval], 1.24−1.94; 14 studies). When limited to studies with longer follow-up, the odds of PFS were progressively worse with MIS radical hysterectomy (HR [hazard ratio] 1.48 for >36 months; 95% CI, 1.21−1.82; 10 studies; HR 1.69 for >48 months; 95% CI, 1.26−2.27; 5 studies; and HR 2.020 for >60 months; 95% CI, 1.36−3.001; 3 studies). For overall survival, the odds were not significantly different for MIS vs abdominal hysterectomy (odds ratio 0.94; 95% CI, 0.66−1.35; 14 studies) (HR 0.99 for >36 months; 95% CI, 0.66−1.48; 9 studies; HR 1.05 for >48 months; 95% CI, 0.57−1.94; 4 studies; and HR 1.35 for >60 months; 95% CI, 0.73−2.51; 3 studies). Conclusion:In our meta-analysis of 50 studies, MIS radical hysterectomy was associated with worse PFS than open radical hysterectomy for early-stage cervical cancer. The emergence of this finding with longer follow-up highlights the importance of long-term, high-quality studies to guide cancer and surgical treatments.

Simple Hysterectomy for Patients with Stage IA2 Cervical Cancer: A Retrospective Cohort Study

“…3,29 Also, more and more studies have challenged the perceived oncologic safety of minimally invasive surgery for early-stage cervical cancer. [30][31][32][33] After controlling for potential confounding prognostic factors, our study identified advanced age at diagnosis, high-grade tumor, and LVSI as the independent risk factors for worse long-term survival outcomes in patients with stage IA2 cervical cancer; this result is consistent with that of other studies. [34][35][36] However, our study found that a minimally invasive surgical approach was not associated with the deterioration of survival in stage IA2 cervical cancer.…”

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

“…In 2018, the results from the Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized controlled trial, on surgery in early-stage cervical cancer showed that MIS had poorer survival outcomes compared to laparotomy 4 . Since then, a great number of regarding studies have been reported and most of them have supported that MIS had poor survival outcome in cervical cancer patients 5 - 7 . However, most of the evaluated patients who had MIS had laparoscopic radical hysterectomy (LRH), not robotic radical hysterectomy (RRH).…”

Trends in Surgical Morbidity and Survival Outcomes for Radical Hysterectomy in West China: An 11-Year Retrospective Cohort Study

“…However, Ramirez et al (4) reported a multicenter randomized controlled trial (RCT), namely, the LACC trial, which showed that MIS was associated with lower 4.5-year disease-free survival (DFS), progression-free survival (PFS), overall survival (OS), and disease-specific survival rates and a higher local recurrence rate than the laparotomic approach. Several multicenter retrospective studies from different countries have validated this finding (5)(6)(7)(8). Reasons beyond these results are unclear.…”