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Minimally invasive surgery leads to worse survival for cervical cancer patients

Popular surgery has a 3.8 percent worse overall survival at four years than open surgery

Surgery
Open surgery requires several days of recovery in the hospital.

Minimally invasive hysterectomy, a popular procedure for early-stage cervical cancer, turns out to result in worse overall survival for cancer patients than traditional open surgery, reports a new national study from Northwestern Medicine and other institutions.

Among women undergoing minimally invasive surgery, the risk of death within four years was 9.1 percent as compared to 5.3 percent in the open surgery group, a 3.8 percent difference. This equates to patients being about 1.65 times more likely to die over this time frame than if they received open surgery. 

The study was published Oct. 31 in the New England Journal of Medicine.

“The results of these studies raise concerns about the safety of minimally invasive radical hysterectomy for cervical cancer,” said Dr. Edward Tanner, 

associate professor and chief of gynecologic oncology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. 

“Clearly, we need more research on this issue,” Tanner said. “It’s possible that some patients with cervical cancer can still undergo minimally invasive surgery safely. Until that time, surgeons offering a minimally invasive approach need to counsel patients about the risks, so they can make an informed decision about their care.”

It is not yet known why minimally invasive surgery is associated with inferior overall survival, noted co-senior author Dr. Shohreh Shahabi, the John and Ruth Brewer Professor of Gynecology at Feinberg and a Northwestern Medicine physician. 

“Possible explanations include the potentially limited extent of tumor removal during minimally invasive surgery, or that tools used during minimally invasive hysterectomy may inadvertently disseminate tumor cells,” Shahabi said.

Tanner and Shahabi are members of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

In 2018, around 13,240 women will be diagnosed with cervical cancer in the United States, noted co-lead author Dr. Daniel Magul, who worked on the study in Shahabi’s lab as a student at Feinberg and now is a resident physician at University Hospital in Cincinnati.

This study retrospectively looked at patients in the National Cancer Database from 2010 to 2013. This database includes 70 percent of all new cancer diagnoses in the United States. The study authors identified 2,461 patients with stage IA2 or IB1 cervical cancer who were treated with a radical hysterectomy. About half of these women had open surgery and half had minimally invasive surgery. They also used the Surveillance, Epidemiology, and End Results database to look at trends in survival prior to and after the adoption of the minimally invasive approach to radical hysterectomy.

Minimally invasive radical hysterectomy first started to become popular around 2006. Over course of the study — from 2010 to 2013 — minimally invasive radical hysterectomies became progressively more common. In 2010, just more than a third of radical hysterectomies were performed with minimally invasive surgery, but by 2013, nearly 60 percent were performed minimally invasively.

Open surgery is performed with a large laparotomy incision in the middle of the abdomen. Recovery from this surgery generally requires several days in the hospital. Minimally invasive surgery is performed by inflating the abdomen with gas and operating through very small incisions using a camera and long instruments or a robot. The recovery time for minimally invasive surgery is much shorter, and patients can usually go home either the same day or day after their procedure.

Other institutions participating in the study include Harvard Medical School, M.D. Anderson Cancer Center, University of Wisconsin School of Medicine and Public Health and the Herbert Irving Comprehensive Cancer Center at Columbia University.  

Other Northwestern authors on the study include Dr. Masha Kocherginsky, co-senior author, Dr. Emma Barber and Dr. Amy Alexander. Barber and Alexander also are members of the Lurie Cancer Center.

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