A recent systematic review and meta-analysis found that women with early-stage cervical cancer treated with minimally invasive radical hysterectomy had a 71% increased risk of disease recurrence and a 56% increased risk of death compared with those treated with open radical hysterectomy.1 “These results provide real-world evidence that may aid patients and clinicians engaged in shared decision-making about surgery for early-stage cervical cancer,” the reviewers concluded.
“I would encourage both clinicians and patients to first look at the results of the randomized trial published in 2018, because that has given even a higher level of evidence than our meta-analysis,” gynecologic oncologist and corresponding author Alexander Melamed, MD, MPH, said in an interview with The ASCO Post. That study, the Laparoscopic Approach to Cervical Cancer (LACC) trial, found that women with early-stage cervical cancer randomly assigned to minimally invasive hysterectomy had four times the risk of disease recurrence and six times the risk of death compared with those assigned to open surgery.2 Dr. Melamed is Assistant Professor of Obstetrics and Gynecology at New York Presbyterian/Columbia University Vagelos College of Physicians and Surgeons.
“Our paper highlights the fact that the results of this randomized trial we already knew about seem to hold up in the real world as well,” Dr. Melamed added. “There is potential harm associated with minimally invasive surgery for cervical cancer. It is important for doctors and patients to consider that when making these decisions.”
Very Small Tumors
Some argue that minimally invasive radical hysterectomy might be appropriate for patients with very small tumors, at very low risk of recurrence and death, “However, it is very hard to measure whether or not minimally invasive surgery actually affects that risk,” Dr. Melamed said.
“Some studies suggest that for very small tumors, it doesn’t matter what you do. Other studies suggest that for very small tumors, the risk is elevated by minimally invasive surgery,” Dr. Melamed said. “This is a complex issue, where a patient at very low risk might be increasing the risk of recurrence from 2% to 3% with minimally invasive surgery, but that individual might have special circumstances necessitating a quicker recovery time, such as being the caregiver for another person.”
DISCLOSURE: Dr. Melamed reported no conflicts of interest.
REFERENCES
1. Nitecki R, Ramirez PT, Frumovitz M, et al: Survival after minimally invasive vs open radical hysterectomy for early-stage cervical cancer: A systematic review and meta-analysis. JAMA Oncol. June 11, 2020 (early release online).
2. Ramirez PT, Frumovitz M,Pareja R, et al: Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379:1895-1904, 2018.
