For early-stage cervical cancer, radical hysterectomy is the primary course of treatment. However, open abdominal radical hysterectomy is accompanied by complications such as lymphedema in the legs and bladder, and sexual dysfunction. In an effort to reduce surgical morbidity, minimally invasive techniques such as robot-assisted radical hysterectomy have been widely adopted.
However, according to a population-based study published in the New England Journal of Medicine, the adoption of minimally invasive radical hysterectomy coincided with a progressive decline in the 4-year relative survival rate of 0.8% per year that coincided with the initial period of adoption of robot-assisted surgery in the United States from 2007 to 2010. The interrupted time-series study focused on women who underwent radical hysterectomy for cervical cancer between 2000 and 2012 and utilized data from the Surveillance, Epidemiology, and End Results (SEER) program database.
“Our findings differ from those of earlier retrospective studies and conflict with a consensus within the field of gynecologic oncology that supports the use of minimally invasive surgery in early-stage cervical cancer,” wrote the authors. They also performed a cohort study of 2461 women who underwent radical hysterectomy for early-stage cervical cancer (IA2 or IB1 stage) during 2010 to 2013 at Commission on Cancer (CoC)-accredited hospitals in the United States.
Approximately 49.8% of the women underwent minimally invasive surgery. Women who underwent minimally invasive surgery were more commonly white, privately insured, and from ZIP Codes with higher socioeconomic status. They also tended to have smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery.
Over a median follow-up period of 45 months, the 4-year mortality rate was 9.1% for women who underwent minimally invasive surgery. In comparison, women who underwent open surgery had a 4-year survival rate of 5.3%. The discovery coincides with another published study and corroborates the finding that minimally invasive hysterectomy is associated with poorer survival rates compared with open hysterectomy in patients with early-stage cervical cancer.2
1. Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer [published online October 31, 2018]. N Engl J Med. doi: 10.1056/NEJMoa1804923
2. Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer [published online October 31, 2018]. N Engl J Med. doi: 10.1056/NEJMoa1806395