Cervical cancer: minimally invasive surgery tied to worse survival

  • Melamed A & al.
  • N Engl J Med
  • 31 Oct 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • OS was significantly shorter with minimally invasive surgery (MIS) vs open surgery in women with stage IA2/IB1 cervical cancer undergoing radical hysterectomy.
  • Adoption of MIS in the United States coincided with the decline in survival rates starting 2006.

Why this matters

  • The findings differ from general consensus within the field of gynecologic oncology that supports MIS in early-stage cervical cancer.

Study design

  • Study of 2461 women with stage IA2/IB1 cervical cancer from National Cancer Database who underwent radical hysterectomy during 2010-2013.
  • Funding: National Cancer Institute; National Institute of Child Health and Human Development; others.

Key results

  • 49.8% of women underwent MIS.
  • Median follow-up, 45 months.
  • Women who underwent MIS showed significantly worse 4-year OS vs those who underwent open surgery (HR, 1.65; P=.002).
  • In the MIS vs open-surgery group:
    • mean numbers of lymph nodes evaluated were 20.2 vs 19.2.
    • parametrial invasion rates were 11.0% vs 9.5%.
    • positive margin rates were 5.0% vs 4.4%.
    • lymph-node involvement rates were 10.7% vs 8.9%.
    • lymphovascular space invasion rates were 31.9% vs 28.0%. 
  • MIS adoption coincided with the beginning of a decline in 4-year relative survival 0.8% (Ptrend=.01) per year.

Limitations

  • Information on recurrence and cause of death was not available.
  • Observational design.

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