In a systematic review and meta-analysis of observational studies reported in JAMA Oncology, Nitecki et al found that minimally invasive radical hysterectomy was associated with increased risk of recurrence and all-cause mortality vs open surgery in women with early-stage cervical cancer.
Study Details
The meta-analysis included 15 observational studies reported between 2012 and 2020 that used survival analyses to compare outcomes after minimally invasive (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics 2009 stage IA1–IIA) cervical cancer. The analysis included 9,499 patients who underwent radical hysterectomy; of these, 4,684 (49%) underwent minimally invasive surgery, with 2,675 (57% of the minimally invasive cohort) undergoing robot-assisted laparoscopy. Minimally invasive surgery was predominantly robot-assisted in seven studies (79%–100% of patients) and traditional laparoscopy in eight (85%–100% of patients). Overall, recurrence was reported in 530 patients and death from any cause was reported in 451.
“This systematic review and meta-analysis of observational studies found that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence and death compared with open surgery.”— Nitecki et al
Tweet this quote
Key Findings
The pooled hazards of disease recurrence or death (hazard ratio [HR] = 1.71, P < .001) and all-cause mortality (HR = 1.56, P = .004) were significantly higher among patients who underwent minimally invasive radical hysterectomy vs those who underwent open surgery.
No association was observed between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive approaches and hazard of recurrence or death (2.0% increase in HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% confidence interval (CI) = −3.4%–7.7%]) or death (3.7% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI = −4.5%–12.6%]).
In a stratified analysis, the minimally invasive approach was associated with increased risk of recurrence or death in studies in which robot-assisted laparoscopy was predominant (HR = 1.88, 95% CI = 1.36–2.60) and in those in which traditional laparoscopy was predominant (HR = 1.54, 95% CI = 1.10–2.16). A minimally invasive approach was associated with significantly higher risk of all-cause mortality in studies in which robot-assisted laparoscopy was predominant (HR = 1.74, 95% CI = 1.18–2.56) and a nonsignificantly higher risk in studies in which traditional laparoscopy was predominant (HR = 1.35, 95% CI = 0.81–2.25).
The investigators concluded, “This systematic review and meta-analysis of observational studies found that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence and death compared with open surgery.”
Alexander Melamed, MD, MPH, of the Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was funded by grants from the National Cancer Institute and National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
