A multi-institutional retrospective study reported in the Journal of Clinical Oncology by Shitanshu Uppal, MBBS, and colleagues showed that minimally invasive radical hysterectomy was associated with a higher risk of disease recurrence vs open abdominal hysterectomy in women undergoing surgery for cervical cancer. No difference in overall survival was observed.
Shitanshu Uppal, MBBS
Study Details
The study included data from 815 consecutive patients from academic medical institutions with no prior history of pelvic radiation therapy who underwent radical hysterectomy for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 2010 and December 2017.
Recurrence Risk
Among 815 patients, 255 (29.1%) received open radical hysterectomy and 560 (70.9%) received minimally invasive radical hysterectomy. Patients undergoing open surgery had larger tumors (median size = 2 vs 1.3 cm) and longer follow-up (median = 44.6 vs 30.7 months).
Recurrence was observed in 7.5% of the open radical hysterectomy group vs 9.1% of the minimally invasive radical hysterectomy group (P = .43). On risk-adjusted analysis, minimally invasive radical hysterectomy was independently associated with increased risk of recurrence (adjusted hazard ratio [HR] = 1.88, 95% confidence interval [CI] = 1.04–3.25). Other factors independently associated with increased risk were tumor size, tumor grade, and adjuvant radiation. Conization prior to surgery was associated with lower risk (adjusted HR = 0.4, 95% CI = 0.23–0.71).
KEY POINTS
- Minimally invasive radical hysterectomy was associated with increased recurrence risk on risk-adjusted and propensity score-matching analyses.
- Overall, disease recurrence was observed in 7.5% of the open radical hysterectomy group vs 9.1% of the minimally invasive radical hysterectomy group.
Among 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor), recurrence was observed in 2 (2.4%) of 82 patients in the open radical hysterectomy group vs 16 (8.8%) of 182 in the minimally invasive radical hysterectomy group (P = .058). In propensity score-matching analysis, recurrence was observed in 7 (4.4%) of 159 patients in the open radical hysterectomy group vs 18 (11.5%) of 156 in the minimally invasive radical hysterectomy group (P = .019), with survival analysis in this population showing a hazard ratio of 2.83 (95% CI = 1.1–7.18) for the minimally invasive vs open groups.
In the total population, there was no significant difference in overall survival for the minimally invasive vs open groups on unadjusted analysis (HR = 1.14, 95% CI = 0.61–2.11) or in risk-adjusted analysis (adjusted HR = 1.01, 95% CI = 0.5–2.2).
The investigators concluded, “In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior [disease-free survival] but not overall survival in the entire cohort.”
Dr. Uppal, of the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
