Among patients with early-stage cervical cancer, minimally invasive radical hysterectomy is associated with an elevated risk of recurrence and death compared with open radical hysterectomy, according to a recent investigation.
A prior randomized clinical trial found that minimally invasive hysterectomy is associated with higher risk of recurrence and death compared with open surgery for early-stage cervical cancer.
Roni Nitecki, MD, department of gynecologic oncology and reproductive medicine, The University of Texas MD Anderson Cancer Center (Houston, TX), and colleagues conducted a systematic review and meta-analysis of 15 published observational studies comprising 9499 patients with early-stage cervical cancer. Of these patients, 49% (n = 4684) received minimally invasive surgery, 57% (n = 2675) of whom received robot-assisted laparoscopy.
Researchers sought to determine risk of recurrence or death associated with these surgical approaches as well as risk of all-cause mortality. Results of the analysis were published in JAMA Oncology (online June 11, 2020; doi:10.1001/jamaoncol.2020.1694).
A total of 530 disease recurrences and 451 deaths were reported. The pooled hazard of recurrence or death was 71% higher among patients who underwent minimally invasive radical hysterectomy compared with those who underwent open surgery (HR, 1.71; 95% CI, 1.36-2.15; P < .001). Additionally, the hazard of death was 56% higher (HR, 1.56; 95% CI, 1.16-2.11; P = .004).
Dr Nitecki and colleagues further found no associations between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy and hazard of recurrence or death or all-cause mortality.
“I hope that this new meta-analysis will help clinicians and patients understand that the available evidence strongly suggests that the harm of minimally invasive surgery for cervical cancer outweighs the benefits,” said Alexander Melamed, MD, MPH, assistant professor of obstetrics and gynecology, Columbia University, and co-author of the study, in a press release (June 11, 2020). “A number of medical centers, in fact, no longer even offer the option of minimally invasive radical hysterectomy for early-stage cervical cancer.”—Zachary Bessette
