Minimally invasive hysterectomy yields worse outcomes than open surgery in cervical cancer
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Minimally invasive surgery conferred lower survival rates than open surgery among women with cervical cancer, according to randomized phase 3 trial results presented at Society of Gynecologic Oncology 2022 Annual Meeting on Women's Cancer.
“The minimally invasive surgical approach had worse DFS compared with the open approach, and we confirmed this after median follow up of 4.5 years for all patients who were eligible to be registered at the 4.5-year follow up. In addition to that, we noted that patients undergoing minimally invasive surgery also had significantly worse overall survival,” Pedro T. Ramirez, MD, professor and director of minimally invasive surgical research and education in the department of gynecologic oncology at The University of Texas MD Anderson Cancer Center, told Healio.
Background and methodology
Researchers initiated the (LACC) trial because limited data existed on whether survival outcomes after laparoscopic or robot-assisted radical hysterectomy (minimally invasive surgery) were equivalent to those after open abdominal radical hysterectomy (open surgery) among women with early-stage cervical cancer. They previously reported women with tumors 2 cm or smaller who underwent minimally invasive radical hysterectomy had a higher risk for recurrence than those who had open surgery, although they also observed no difference in OS based on surgery type.
In a final analysis of trial data, Ramirez and colleagues compared long-term outcomes of both patient groups.
The analyses included 631 women (mean age, 46 years) with FIGO 2009 stage IA1 (LVSI) to IB1 cervical cancer with a histologic subtype of squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma. Researchers randomly assigned 319 women to minimally invasive surgery and 312 to open surgery.
DFS at 4.5 years (with all patients completing follow-up) served as the primary outcome; secondary outcomes included OS. Researchers also performed subgroup analysis to determine outcomes based on factors that could impact rates of recurrence and disease-specific survival.
Key findings
Women who underwent minimally invasive surgery had lower DFS than those who underwent open surgery, with 43 (13.5%) having disease at 4.5 years vs. 11 (3.5%) in the open surgery group. Minimally invasive surgery correlated with four times higher recurrence rates vs. open surgery.
Additionally, results of subgroup analyses showed poorer DFS among women who underwent minimally invasive surgery correlated with larger tumor size ( 2 cm), and this group had higher rates of tumor spreading at disease recurrence (25%) than the open surgery group (0%).
“Similarly, the minimally invasive surgical approach had worse local regional recurrence — in other words, recurrences in the pelvis — compared with the open approach. Minimally invasive surgery also had worse disease specific survival,” Ramirez said. “These findings reaffirmed our initial evaluation that laparoscopy or robotic surgery is associated with worse oncologic outcomes when compared with the open surgery approach.”
Implications
Radical hysterectomy remains the standard recommendation for women with early-stage cervical cancer. Prior to the LACC trial, there hadn’t been prospective data on outcomes for minimally invasive surgery, Ramirez said.
“When we first learned of the results of the LACC trial, we were very surprised that the minimally invasive approach was associated with worse outcomes because, up until that time, the retrospective literature had demonstrated that the open and minimally invasive approach were equivalent,” Ramirez told Healio. “Obviously, that’s the importance of doing prospective studies because often they will show something completely different than what we had learned from retrospective data.”
Although ongoing studies are investigating how modifying the minimally invasive approach can make it equivalent to the open approach, Ramirez said they are not expected to be completed for some time.
“As it stands now, all national and international guidelines propose that the open approach is the ideal approach for a radical hysterectomy in patients with cervical cancer,” Ramirez said. “It is very, very important to understand that the standard of care today is open radical hysterectomy.”
References:
Ramirez PT, et al. Abstract LBA10. Presented at Society of Gynecologic Oncology 2022 Annual Meeting on Women's Cancer (hybrid meeting); March 18-21, 2022; Phoenix.
Minimally invasive approach to hysterectomy in cervical cancer associated with poorer disease-free survival than open surgery (press release). https://www.newswise.com/articles/minimally-invasive-approach-to-hysterectomy-in-cervical-cancer-associated-with-poorer-disease-free-survival-than-open-surgery. Published March 19, 2022. Accessed March 22, 2022.
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Ramirez PT, et al. Abstract LBA10. Presented at Society of Gynecologic Oncology 2022 Annual Meeting on Women's Cancer (hybrid meeting); March 18-21, 2022; Phoenix.
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