Overall Survival After Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer
In a cohort study reported in The New England Journal of Medicine, Melamed et al found that minimally invasive radical hysterectomy was associated with poorer overall survival compared with open radical hysterectomy in women with early-stage cervical cancer.
Study Details
The study involved National Cancer Database data on 2,461 women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer from 2010 to 2013 at Commission on Cancer–accredited U.S. hospitals. Of these, 1,225 (49.8%) underwent minimally invasive surgery. Those undergoing minimally invasive surgery were more likely to be white; to be privately insured; to be from ZIP codes with higher socioeconomic status; to have smaller, lower-grade tumors; and to have received diagnosis later in the study period vs women undergoing open surgery.
Of the women undergoing minimally invasive surgery, 978 (79.8%) underwent robot-assisted laparoscopy. Conversion from minimally invasive surgery to open surgery occurred in 2.9% of cases, with these cases counted in the minimally invasive surgery group.
Overall Survival
Median follow-up was 45 months. In a propensity score-weighted analysis, risk of death within 4 years after diagnosis was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio [HR] = 1.65, P = .002). Subgroup analysis showed HRs indicating poorer overall survival with minimally invasive surgery for women undergoing laparoscopic surgery (HR = 1.50, 95% confidence interval [CI] = 0.97–2.31) or robot-assisted surgery (HR = 1.61, 95% CI = 1.18–2.21), squamous cell (HR = 1.65, 95% CI = 1.17–2.33) or adenocarcinoma histology (HR = 2.22, 95% CI = 1.08–4.55), and tumor size < 2 cm (HR = 1.46, 95% CI = 0.70–3.02) or ≥ 2 cm (HR = 1.66, 95% CI = 1.19–2.30).
A separate survival analysis included all women in the Surveillance, Epidemiology, and End Results-18 registry who had locoregionally confined cervical carcinoma and had undergone radical hysterectomy and lymphadenectomy during the 2000 to 2010 period. In the period 2000 to 2006, prior to the adoption of minimally invasive radical hysterectomy, there was a nonsignificant trend toward an increase in 4-year overall survival rate consisting of an annual percentage increase of 0.3% (95% CI = −0.1–0.6). The increasing use of minimally invasive surgery between 2006 and 2010 was associated with an annual decrease in 4-year survival rate of 0.8% (95% CI = 0.3–1.4) during this period, reflecting a significant change in survival trend (P = .01).
The investigators concluded, “In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma.”
The study was funded by the National Cancer Institute, National Institute of Child Health and Human Development, American Association of Obstetricians and Gynecologists Foundation, Foundation for Women’s Cancer, Jean Donovan Estate, and Phebe Novakovic Fund.
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