Cervical cancer: minimal invasive approach tied to higher recurrence rate

  • Uppal S & al.
  • J Clin Oncol
  • 7 Feb 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Patients with early cervical cancer undergoing minimally invasive radical hysterectomy show worse recurrence-free survival vs those undergoing open surgery.
  • No difference is, however, observed in the OS.
  • Preoperative conization was associated with a lower risk for recurrence with either surgical approach.

Why this matters

  • The results confirm findings of LACC study which showed that the oncologic outcomes of minimally invasive surgery were inferior to open surgery.

Study design

  • Retrospective multicenter study of 815 patients with stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma of cervix underwent undergoing radical hysterectomy between 2010 and 2017.
  • Funding: None disclosed

Key results

  • Open surgery was performed in 29.1% and minimally invasive surgery in 70.9% of patients.
  • Minimally invasive surgery was independently associated with a higher risk for recurrence (aHR, 1.88; 95% CI, 1.04-3.25).
  • Propensity score-matching analysis:
    • Recurrence rate was significantly higher in the minimally invasive group (4.4% vs 11.5% [P=.019]; HR, 2.83 [95% CI, 1.10-7.18]).
  • Conization before surgery was associated with a lower risk for recurrence overall (aHR, 0.4; 95% CI, 0.23- 0.71).
  • OS was similar between groups (aHR, 1.01; 95% CI, 0.50-2.2).
  • Similar recurrence rate was observed with either approach in patients with tumor size ≤2 cm (P=.058) and >2 cm (P=.375).

Limitations

  • Retrospective design.