Open Surgery Outcomes in Cervical Cancer Were Superior to Laparoscopic or Robotic Surgery

As treatment for early-stage cervical cancer, instead of open surgery , minimally invasive / closed (laparoscopic or robotic) surgery was associated with shorter survival. These widely discussed findings emphasize once again that oncological operations must have different dynamics from other operations.

The study was stopped early because the difference between groups was marked.

Cervical cancer is the 3rd most common cancer among women worldwide, while in our country it ranks 9th among women, with approximately 1500 women diagnosed annually. It is now known that approximately %99 of cervical cancers are caused by the virus called HPV. Pap smear and HPV testing have become more widespread, and approximately %80 of cervical cancers are diagnosed at early stages (local or locally advanced).

Stage 1 cervical cancer accounts for around % 40 of all uterine cancers, and its main treatment is surgery. At stage 2, surgery is often unsuitable, and radiotherapy concurrent with chemotherapy is standard treatment.

In the figure below, stage 1 cervical cancer is illustrated:

Stage IA cervical cancer is still microscopic and can only be detected during screening. At stage IB, the cancer has become visible but is smaller than 4 cm and has not extended beyond the anatomical structure of the cervix.

Related Topic:

• Cervical Cancer Symptoms and Treatment (in Detail)

Details of the Study

• The study enrolled patients with stage IA1 (with lymphovascular invasion), stage IA2 or stage IB1 cervical cancer.
• Histological subtypes were squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma, and patients received surgery, the standard treatment for this stage (minimally invasive or open surgery).
• The primary endpoint was disease-free survival at 4.5 years.

Study Results

• Among patients, 319 underwent minimally invasive (closed) surgery and 312 underwent open surgery.
• Among those undergoing closed surgery, % 84.4 had laparoscopy and % 15.6 robotic surgery.
• The mean patient age was 46.
• Among patients, %91.9 had stage IB1 cervical cancer.
• The most important finding was that after 4.5 years, disease-free survival was %86 in the closed surgery group and % 95.6 in the open surgery group.
• The risk of recurrence or death from cervical cancer in those undergoing closed surgery was 3.7 times higher as found.
• Closed surgery also showed lower overall survival at year 3 (% 93.8 versus % 99).

Conclusion

In this large comparative study of early-stage cervical cancer treatment, minimally invasive radical hysterectomy by laparoscopy or robot resulted in lower disease-free and overall survival rates than open surgery.