Minimally Invasive Sx May Up Mortality in Early Cervical Cancer
Two studies show increased mortality and reduced disease-free, overall survival versus open surgery
THURSDAY, Nov. 1, 2018 (HealthDay News) -- For patients with early-stage cervical cancer, minimally invasive surgery is associated with increased mortality and worse survival than open surgery, according to two studies published online Oct. 31 in the New England Journal of Medicine.
Alexander Melamed, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues conducted a cohort study involving 2,461 women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during 2010 to 2013 (49.8 percent underwent minimally invasive surgery). The researchers found that during a median follow-up of 45 months, the four-year mortality was 9.1 and 5.3 percent among those who underwent minimally invasive and open surgery, respectively (hazard ratio, 1.65; 95 percent confidence interval [CI], 1.22 to 2.22; P = 0.002).
Pedro T. Ramirez, M.D., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues randomly assigned patients with early-stage cervical cancer to undergo minimally invasive (319 patients) or open surgery (312 patients). The researchers found that the rate of disease-free survival at 4.5 years was 86.0 and 96.5 percent with minimally invasive surgery and open surgery, respectively. Compared with open surgery, minimally invasive surgery correlated with a lower rate of disease-free survival (three-year rate, 91.2 versus 97.1 percent; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95 percent CI, 1.63 to 8.58) and with a lower rate of overall survival (three-year rate, 93.8 versus 99.0 percent; hazard ratio, 6.00; 95 percent CI, 1.77 to 20.30).
"Until further details are known, however, surgeons should proceed cautiously, counsel their patients regarding these collective study results, and assess each woman's individual risks and benefits with respect to minimally invasive as compared with open radical hysterectomy," write the authors of an accompanying editorial.
Two authors from the Melamed study disclosed financial ties to the pharmaceutical industry. Several authors from the Ramirez study disclosed ties to the pharmaceutical industry; the study was partially funded by Medtronic.