A new analysis is questioning the true benefits of minimally invasive surgery for women with early-stage cervical cancer. Alexander Melamed, MD, Massachusetts General Hospital, Boston, and colleagues report inThe New England Journal of Medicine that minimally invasive surgery appears to be associated with a higher risk of death compared with open surgery among women who undergo radical hysterectomy for early-stage cervical cancer.1
The researchers conducted a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer between 2010 and 2013 at Commission on Cancer–accredited hospitals. The team also conductedan interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the period of 2000 to 2010 using Surveillance, Epidemiology, and End Results (SEER) Program data.
The researchers found that at a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery compared with 5.3% among those who underwent open surgery (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.22 to 2.22; P= .002). The 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer had been stable before the adoption of minimally invasive radical hysterectomy (during the period from 2000 to 2006). However, the adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8%, according to the analysis.
These findings conflict with earlier retrospective studies and the general consensus supporting the use of minimally invasive surgery in early-stage cervical cancer. However, the authors note that the previous studies were considerably smaller, and most had shorter follow-up periods.
- Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer [published online October 31, 2018]. N Engl J Med.doi: 10.1056/NEJMoa1804923