In Cervical Cancer, Minimally Invasive Surgery Reduces Survival Rate

A greater focus has shifted toward the development of minimally invasive surgical procedures in recent years in hopes of reducing surgical morbidity. Cervical cancer surgeries were no exception to this endeavor.

However, new research suggests that, among women with early-stage cervical cancer, minimally invasive radical hysterectomy is tied to lower rates of survival compared with open abdominal radical hysterectomy.¹

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Pedro T Ramirez, MD, of the University of Texas MD Anderson Cancer Center, and colleagues arrived at their conclusion following a phase 3 trial of women with stage IA1, IA2, or IB1 cervical cancer and a histologic subtype of squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma.

Participants were randomly assigned to minimally invasive surgery (n = 319) or to open surgery (n = 312), with disease-free survival at 4.5 years as the primary outcome of the study. In the group assigned to minimally invasive surgery, 84.4% and 15.6% of participants underwent laparoscopy and robot-assisted surgery, respectively.

The trial was ultimately stopped after an interim analysis revealed a 10.6% difference in survival between treatment groups. The disease-free survival rate at 4.5 years was 86.0% among patients receiving minimally invasive surgery compared with 96.5% in patients with open surgery.

Corresponding rates of disease-free survival at 3 years were 91.2% and 97.1%, respectively, with a hazard ratio (HR) for disease recurrence or death from cervical cancer of 3.74. This difference remained significant following adjustment for age, body mass index, disease stage, lymphovascular invasion, and lymph-node involvement.

The researchers also found that minimally invasive surgery was associated with a lower rate of overall survival (93.8%) at 3 years compared with open surgery (99.0%). The HR for death from any cause was 6.00.

“Until further details are known, however, surgeons should proceed cautiously, counsel their patients regarding these collective study results, and assess each woman’s individual risks and benefits with respect to minimally invasive as compared with open radical hysterectomy,” wrote Amanda N Fader, MD, of Johns Hopkins Medicine, in an accompanying editorial.²

—Christina Vogt

References:

1. Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer [Published online October 31, 2018]. N Eng J Med. doi:10.1056/NEJMoa1806395.

2. Fader AN. Surgery in cervical cancer [Published online October 31, 2018]. N Eng J Med. doi:10.1056/NEJMe1814034.