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Grand Rounds

Cervical Cancer Treatment: Minimally Invasive Hysterectomy vs Open Surgery

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BACKGROUND AND PURPOSE:

  • The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive hysterectomy was associated with a higher risk of recurrence and death when compared to open surgery
  • Nitecki et al. (JAMA, 2020) quantified the risk of recurrence and death associated with minimally invasive vs open radical hysterectomy for early-stage cervical cancer reported in observational studies

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science through March 26, 2020
  • Inclusion criteria
    • Observational studies
    • Early-stage (FIGO stage IA1-IIA) cervical cancer
    • Studies used survival analyses to compare outcomes after minimally invasive surgery (laparoscopic or robot-assisted) vs open radical hysterectomy
  • Study design
    • Random-effects models were used to pool associations and to analyze the association between surgical approach and oncologic outcomes
  • Primary outcomes
    • Risk of recurrence or death
    • Risk of all-cause mortality

RESULTS:

  • 15 studies | 9499 participants
    • Minimally invasive laparoscopy: 49%
      • Robot assisted: 57% of minimally invasive cases
    • Recurrences: 530
    • Deaths: 451
  • Compared to open surgery, minimally invasive radical hysterectomy was associated with increased risk for
    • Recurrence or death (P < 0.001)
      • Hazard ratio (HR) 1.71 (95% CI, 1.36 to 2.15)
    • Death (P = 0.004)
      • HR 1.56 (95% CI, 1.16 to 2.11)
  • There was no association between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy

CONCLUSION:

  • Compared to open surgery, minimally invasive radical hysterectomy had a 71% higher pooled hazard of recurrence or death and a 56% higher hazard of death
  • Results did not support the hypothesis that robot-assisted surgery may mitigate risks
  • The authors conclude that

…minimally invasive radical hysterectomy was associated with shorter overall and disease-free survival than open surgery among women with early-stage cervical cancer

These results provide real-world evidence that may aid patients and clinicians engaged in shared decision-making about surgery for early-stage cervical cancer

Learn More – Primary Sources:

Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-analysis

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Related ObG Topics:

Minimally Invasive vs Abdominal Radical Hysterectomy for Cervical Cancer
Minimally Invasive Hysterectomy for Endometrial Cancer
Is There a Benefit to Robotic Teams for Minimally Invasive Sacrocolpopexy Surgeries?

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