Researchers verify link between minimally invasive surgery, higher recurrence risk in early-stage cervical cancer
Click Here to Manage Email Alerts
Women who underwent minimally invasive radical hysterectomy for early-stage cervical cancer had higher risk for recurrence than women who had open surgery, according to results of a retrospective, multi-institutional review published in Journal of Clinical Oncology.
Researchers observed the elevated risk among women with tumors smaller than or equal to 2 cm.
However, investigators observed no difference in OS based on surgery type.
“Results of the Laparoscopic Approach to Carcinoma of the Cervix [LACC] trial were a surprise to a lot of U.S. gynecologic oncologists,” Shitanshu Uppal, MBBS, associate professor and obstetrician-gynecologist at University of Michigan, told Healio. “Another study by Melamed and colleagues was published at the same time as the LACC trial, which used data from the National Cancer Database. However, that study included many centers in the U.S. and was not necessarily reflective of high-quality care at high-volume centers. In addition, neither study concluded anything about patients with tumors less than 2 cm, and many gynecologic oncologists continued to perform radical hysterectomies after publication of both studies. We therefore conducted the current study to verify the results of the LACC trial.”
Uppal and colleagues sought to compare DFS and OS between women who underwent open surgery (n = 255) or minimally invasive surgery (n = 560) for stage IA1 with lymphovascular invasion, stage IA2 and stage IB1 squamous, adeno- or adeno-squamous carcinoma across academic medical institutions between 2010 and 2017. The researchers also aimed to compare preoperative and postoperative tumor size.
Women who underwent minimally invasive surgery were more likely to be black (9.8% vs. 4.7%) and younger than aged 50 years (71.8% vs. 69%), and to have missing grade information (13% vs. 4.7%). Women who underwent open surgery had larger tumors (median size, 2 cm vs. 1.3 cm) and longer duration of follow-up (44.6 months vs. 30.7 months).
Among women in the minimally invasive surgery group, 89.3% underwent robotic-assisted surgery and 10.7% underwent laparoscopic surgery.
Results showed similar rates of recurrence in the open surgery and minimally invasive groups (7.5% vs. 9.1%).
A risk-adjusted analysis showed a higher likelihood of recurrence with minimally invasive surgery (adjusted HR [aHR] = 1.88; 95% CI, 1.04-3.25). Tumor size, grade and adjuvant radiation also appeared independently associated with a higher recurrence hazard.
Researchers also found that women who underwent conization before surgery had a lower risk for recurrence (aHR = 0.39; 95% CI, 0.22-0.68).
However, the investigators observed no differences in OS in the unadjusted analysis (HR = 1.14; 95% CI, 0.61-2.11) or risk-adjusted analysis (aHR = 1.01; 95% CI, 0.5-2.2).
Among women with tumors smaller than or equal to 2 cm on final pathology — excluding those with no residual tumor on final pathology — two (2.4%) in the open surgery group and 16 (8.8%) in the minimally invasive surgery group experienced recurrence.
Results of a propensity score-matched analysis that included 159 open surgery cases matched to 156 minimally invasive cases showed seven recurrences (4.4%) in the open surgery group and 18 recurrences (11.5%) in the minimally invasive surgery group (P = .019). Moreover, a survival analysis among this cohort showed higher odds of recurrence with minimally invasive surgery (HR = 2.83; 95% CI, 1.1-7.18).
“These findings verify the results of the LACC trial,” Uppal told Healio. “Our ultimate goal is to now design a clinical trial with modification of techniques of minimally invasive surgery to reduce risk [for] recurrence in this population of patients.” – by Jennifer Southall
For more information:
Shitanshu Uppal, MBBS, can be reached at University of Michigan, 1500 E. Medical Drive, Ann Arbor, MI 48109; email: uppal@med.umich.edu.
Disclosures: Uppal reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Collapse
Click Here to Manage Email Alerts