New study confirms superiority of open surgery for early-stage cervical cancer

June 11, 2020

NEW YORK, NY (June 11, 2020)--A study led by researchers at Columbia University Irving Medical Center confirms that minimally invasive surgery for early-stage cervical cancer is linked to higher rates of recurrence and death compared with open surgery.

The study was published online today in JAMA Oncology.

Until the early 1990s, most women with early-stage cervical cancer underwent open radical hysterectomy (removal of the uterus, as well as some surrounding tissue). When a laparoscopic, or minimally invasive, approach to radical hysterectomy was introduced in 1992, it found favor among many oncological surgeons and eventually became a standard surgical treatment. Though minimally invasive surgery leads to fewer complications and a shorter recovery than open surgery, data comparing long-term outcomes of the two approaches have been limited.

A 2018 epidemiological study also led by Columbia, and published in the New England Journal of Medicine, found the four-year mortality rate among women with cervical cancer who had minimally invasive surgery was around 9% compared with around 5% for those who had open surgery. The researchers also found that survival among women undergoing cervical cancer surgery had declined since the adoption of minimally invasive techniques.

The new JAMA Oncology study was a meta-analysis of 15 observational studies including 9,499 women with cervical cancer. Of those who had minimally invasive radical hysterectomy, 530 had a recurrence and 451 died. The combined risk of recurrence or death was 71% higher for those who had minimally invasive surgery versus open surgery, and mortality risk was 56% higher. The results were similar for those who had robot-assisted minimally invasive surgery.

"It is important to keep in mind that there may be more differences between minimally invasive and open procedures besides the size of the incisions," says the study's lead author, Alexander Melamed, MD, MPH, assistant professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons and a member of Columbia's Herbert Irving Comprehensive Cancer Center. "In the case of radical hysterectomy, these are two different operations, albeit with the same goal. Subtle technical differences may affect the oncologic efficacy of these procedures. We just don't know yet."

According to Melamed, some of the early studies were likely biased toward minimally invasive radical hysterectomy because of confounding factors that were not accounted for by the study authors. Those treated with minimally invasive surgery, for example, were more likely to be white women, to be from a higher socioeconomic class, to have private health insurance, and to have smaller, lower-grade tumors--all of which can contribute to a better prognosis. The JAMA Oncology meta-analysis only included studies that had attempted to account for some of these confounding factors.

"Since the publication of the 2018 studies," says Melamed, "there has been a lot of hand-wringing and debate. 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. A number of medical centers, in fact, no longer even offer the option of minimally invasive radical hysterectomy for early-stage cervical cancer."

"If there is a larger lesson to be learned," he adds, "it is that we should never take the status quo for granted. Conventional wisdom and tradition need to be constantly revisited."
-end-
The paper is titled "Survival After Minimally Invasive vs. Open Radical Hysterectomy for Early-Stage Cervical Cancer.

Additional authors are Roni Nitecki (University of Texas MD Anderson Cancer Center, Houston, TX), Pedro Ramirez (MD Anderson), Michael Frumovitz (MD Anderson), Kate J. Krause (MD Anderson), Ana I. Tergas (CUIMC), Jason D. Wright (CUIMC), and Alejandro Rauh-Hain (MD Anderson).

Jason Wright is a consultant for Clovis Oncology and Tesaro and receives research funding from Merck. Additional disclosures are in the paper.

The study was supported with grants from the National Cancer Institute (P30 48CA016672) and the National Institutes of Health (5T32 CA101642, K08CA234333).

Columbia University Irving Medical Center

Related Cervical Cancer Articles from Brightsurf:

HPV strains may impact cervical cancer prognosis
An analysis of cervical cancers in Ugandan women has uncovered significant genomic differences between tumours caused by different strains of human papillomavirus (HPV), signifying HPV type may impact cervical cancer characteristics and prognosis.

American Cancer Society updates guideline for cervical cancer screening
An updated cervical cancer screening guideline from the American Cancer Society reflects the rapidly changing landscape of cervical cancer prevention in the United States, calling for less and more simplified screening.

Disasters can affect cervical cancer screening for years
Screening is important for the early detection of cervical cancer, but rates were significantly affected, in some areas for years, following a devastating earthquake and tsunami in Japan.

Cervical cancer elimination possible within two decades in the US
At current levels of screening and HPV vaccination, cervical cancer incidence in the US is projected to fall below the threshold of elimination by 2038-2046.

Cervical cancer screening saves lives
Three-year interval in screening for cervical cancer is as effective as annual checkups, study finds.

Cervical cancer could be eliminated within a century
Cervical cancer could be eliminated worldwide as a public health issue within the next century.

25 years of learning to combat cervical cancer
A recent paper from the lab of Professor Sudhir Krishna at the National Centre for Biological Sciences, Bangalore, reviews the progress made in cervical cancer research over the past 25 years.

Cervical cancer screening numbers drop off in women 45-65
Virtually all cervical cancers are caused by HPV, and much of the attention in recent years has focused on preventing infections in younger women through HPV vaccination.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cost-effectiveness analysis of 12 cervical cancer screenings
This cost-effectiveness analysis incorporates women's preferences and estimates quality of life and economic outcomes for 12 cervical cancer screening strategies.

Read More: Cervical Cancer News and Cervical Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.