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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