Open Hysterectomy Has Better Outcomes Than Minimally Invasive Surgery in Cervical Cancer
Women with early-stage cervical cancer have higher recurrence rates and worse overall survival with minimally invasive radical hysterectomy than abdominal radical hysterectomy, according to the results of two studies published in the New England Journal of Medicine.
In a phase III randomized clinical trial (https://www.nejm.org/doi/full/10.1056/NEJMoa1804923), researchers enrolled 631 patients in a 1:1 ratio to undergo either minimally invasive or open radical hysterectomy. The minimally invasive surgery cohort had a threefold increase in disease progression compared to open hysterectomy. Disease-free survival at 4.5 years and overall survival at 3 years was 86.0% and 91.2%, respectively, in the minimally invasive surgery group and 96.5% and 97.1%, respectively, in the open hysterectomy group.
And researchers in a retrospective, epidemiologic study (https://www.nejm.org/doi/10.1056/NEJMoa1806395) of data from the National Cancer Database and Surveillance, Epidemiology, and End Results database found that four-year mortality risks were 9.1% with minimally invasive hysterectomy versus 5.3% for open hysterectomy. Additionally, national adoption of the minimally invasive surgery coincided with a 0.8% annual decline in four-year relative survival rates from 2006–2010.
Both studies’ authors noted that minimally invasive surgery’s acceptance was based on surgical outcomes and improved recovery measures. These studies are the first to evaluate the approach based on oncologic outcomes now that long-term follow-up data are available. The authors called for practice change for treatment of early-stage cervical cancer, as well as additional studies to evaluate minimally invasive versus open fertility-sparing surgeries such as radical trachelectomy.