Nav: Home

For early cervical cancer, open hysterectomy is safer than minimally invasive surgery

October 31, 2018

NEW YORK, NY (October 31, 2018)--A new study shows that women with early-stage cervical cancer who underwent minimally invasive hysterectomy had a 65 percent higher risk of death compared to those who had open surgery. The study, which belies the general assumption that minimally invasive surgery is safer than conventional "open" surgery, was published online today in the New England Journal of Medicine.

"We suspected that there might be a difference in survival between the two approaches, but the extent of the difference was surprising," says co-principal investigator Jason D. Wright, MD, associate professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons and chief of gynecologic oncology at NewYork-Presbyterian/Columbia University Irving Medical Center. "Our findings suggest that minimally invasive surgery may not be appropriate for many patients with early-stage cervical cancer."

Each year, about 13,000 women in the U.S. are diagnosed with cervical cancer. Most women with early-stage disease are treated with radical hysterectomy, which involves removing the uterus, cervix, and surrounding tissues. (Women with advanced cervical cancer are typically treated with radiation in conjunction with chemotherapy.)

Radical hysterectomy was largely performed through a large incision in the abdomen until 2006, when some surgeons began adopting minimally invasive laparoscopic and robotic surgery. "There was a good rationale for this trend," says Wright. "Studies had shown that for most cancers, outcomes with less invasive surgery are comparable to open surgery, with the added benefit of fewer short-term postoperative complications."

But Wright and his colleagues began to suspect that minimally invasive radical hysterectomies might not be as safe as open surgery. In an analysis of data from throughout the United States, they noted that survival for women undergoing radical hysterectomy for cervical cancer remained relatively constant until about 2006.

"Survival began to decrease after then--exactly the same time that some surgeons began performing minimally invasive hysterectomies," he says.

The researchers then analyzed data from the National Cancer Database of 2,461 women with early cervical cancer who underwent radical hysterectomy between 2010 and 2013. Half of the women had minimally invasive surgery. Within 4 years after surgery, 9.1 percent of the minimally invasive surgery group had died versus 5.3 percent in the open-surgery group, translating into a statistically significant 65 percent higher risk of death for the former, when the difference over four years is considered.

The study did not investigate why minimally invasive hysterectomy might result in a higher mortality rate. One possible explanation is that uterine manipulators, which are used to retract and visualize the pelvic area during minimally invasive hysterectomy, may inadvertently spread microscopic tumor cells. Another possibility is that minimally invasive surgery is not inherently inferior to open surgery, but the surgeons who performed minimally invasive surgery on patients in this study may have been more experienced with open surgery.

"We recommend that patients talk to their doctor about the available surgical options," Wright says. "Although minimally invasive surgery was associated with higher mortality, some patients may be willing to accept that risk, especially if they have very early cancers."

For patients with early cervical cancer who already had minimally invasive hysterectomy, Wright says they don't necessarily need more checkups or more screening. "The overall prognosis for women with early cervical cancer after minimally invasive or open hysterectomy is excellent," he adds. "In either case, they should get periodic checkups, and if they experience any symptoms, such as pain or changes in vaginal bleeding, they should consult their gynecologic oncologist."
-end-
The study is titled, "Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer." The other contributors are: Alexander Melamed (Massachusetts General Hospital and Harvard Medical School, Boston, MA), Daniel J. Margul (Prentice Women's Hospital, Chicago), Ling Chen (CUIMC and NYP), Nancy L. Keating (Massachusetts General Hospital, Harvard Medical School, and Brigham and Women's Hospital), Marcela G. del Carmen (Massachusetts General Hospital and Harvard Medical School), Junhua Yang (Prentice Women's Hospital), Brandon-Luke L. Seagle (Prentice Women's Hospital), Amy Alexander (Prentice Women's Hospital), Emma L. Barber (Prentice Women's Hospital), Laurel W. Rice (University of Wisconsin School of Medicine and Public Health, Madison, WI), Masha Kocherginsky (Prentice Women's Hospital and Northwestern University, Feinberg School of Medicine, Chicago, IL), Shohreh Shahabi (Prentice Women's Hospital), and J. Alejandro Rauh-Hain (University of Texas M.D. Anderson Cancer Center, Houston, TX).

The study was supported by grants from the National Institutes of Health (P30CA016672, 4P30CA060553-22, R25CA092203, and K12HD050121-12), the American Association of Obstetricians and Gynecologists Foundation, the Foundation for Women's Cancer, the Jean Donovan Estate, and the Phebe Novakovic Fund.

Dr. Wright receives consulting fees from Clovis Oncology and Tesaro. Additional disclosures are included in the paper.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cumc.columbia.edu or columbiadoctors.org.

NewYork-Presbyterian is one of the nation's most comprehensive, integrated academic healthcare delivery systems, whose organizations are dedicated to providing the highest quality, most compassionate care and service to patients in the New York metropolitan area, nationally, and throughout the globe. In collaboration with two renowned medical schools, Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and innovative, patient-centered clinical care.

NewYork-Presbyterian has four major divisions:
  • NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the Honor Roll of "America's Best Hospitals."

  • NewYork-Presbyterian Regional Hospital Network comprises hospitals and other facilities in the New York metropolitan region.

  • NewYork-Presbyterian Physician Services, which connects medical experts with patients in their communities.

  • NewYork-Presbyterian Community and Population Health, encompassing ambulatory care network sites and community healthcare initiatives, including NewYork Quality Care, the Accountable Care Organization jointly established by NewYork-Presbyterian Hospital, Weill Cornell Medicine and Columbia.

For more information, visit http://www.nyp.org and find us on Facebook, Twitter and YouTube.

Columbia University Irving Medical Center

Related Cervical Cancer Articles:

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.
Urine test could prevent cervical cancer
Urine testing may be as effective as the smear test at preventing cervical cancer, according to new research by University of Manchester scientists.
Cervical cancer subtype rising in some sub-populations
A new study reports that a type of cervical cancer that is less amenable to Pap testing is increasing in several subpopulations of women, pointing to the growing importance of human papillomavirus (HPV) testing and vaccination
Cervical cancer is more aggressive when human papillomavirus is not detected
Cervical cancer negative for the human papillomavirus (HPV) is rare but more aggressive: it is more frequently diagnosed at advanced stages, with more metastasis and reduced survival.
USPSTF recommendation statement on screening for cervical cancer
The US Preventive Services Task Force (USPSTF) has updated its recommendations regarding screening for cervical cancer, with the recommendations and type of screening method varying depending on the woman's age and other factors.
Does HPV vaccination prevent the development of cervical cancer?
New evidence published today in the Cochrane Library shows that human papilloma virus (HPV) vaccines protect against cervical lesions in young women, particularly in those who are vaccinated between the ages of 15 and 26.
There's a better way to screen for cervical cancer
A new study in the Journal of the National Cancer Institute indicates that high-quality cervical cancer screening can be done effectively using a completely automated approach.
More Cervical Cancer News and Cervical Cancer Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#542 Climate Doomsday
Have you heard? Climate change. We did it. And it's bad. It's going to be worse. We are already suffering the effects of it in many ways. How should we TALK about the dangers we are facing, though? Should we get people good and scared? Or give them hope? Or both? Host Bethany Brookshire talks with David Wallace-Wells and Sheril Kirschenbaum to find out. This episode is hosted by Bethany Brookshire, science writer from Science News. Related links: Why Climate Disasters Might Not Boost Public Engagement on Climate Change on The New York Times by Andrew Revkin The other kind...
Now Playing: Radiolab

An Announcement from Radiolab