Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: a retrospective database cohort study
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Authors
Hayek, Judy
Mowzoon, Mia
Demissie, Saleshi
Palileo, Albert
Serur, Eli
Goldberg, Gary L.
Alagkiozidis, Ioannis
Issue Date
2022-04-07
Type
Article
Language
en_US
Keywords
Surgical Outcomes , Minimally Invasive Hysterectomy , Cervical Cancer Stage IA , LACC Trial , Overall Survival , Length of Stay , Readmission
Alternative Title
Abstract
Background:
Recent studies comparing minimally invasive versus open radical hysterectomy in patients with early-stage cervical cancer have reported a worse overall survival with minimally invasive surgery (MIS). However, in the patients with microscopic disease, there was no survival difference and the optimal surgical approach for microscopic cervical cancer remains unclear.
Methods:
Using the National Cancer Database, we identified a cohort of women who underwent hysterectomy as the primary treatment for stage IA1/IA2 cervical cancer between January 2010 and December 2016. Using multivariable logistic regression, our primary outcome was to compare overall survival between the open and MIS groups. The data was stratified for simple and radical hysterectomies. Secondary endpoint was comparison of readmission rates and length of stay (LOS).
Results:
We identified 6230 patients with stage IA1 and IA2 cervical cancer that underwent hysterectomy as primary treatment. 4054 of these women (65%) underwent MIS. There was no difference in age, lympho-vascular invasion, number of lymph nodes retrieved and histology between the two groups. In the overall cohort, there was no difference in survival between the open and the MIS group (Hazard ratio for the open group 1.23; CI 0.92–1.63). Post-operative radiation therapy was more common in the open group (5.24% vs 4.09%, p value < 0.02). The mean LOS (1.35 days vs 3.08 days) was shorter in MIS group (p value < 0.0001). No difference was found in the readmission rates (60% for the MIS group vs 55% for the open group; p value 0.14).
Conclusions:
Our data suggest that MIS is associated with similar overall survival and shorter length of hospital stay compared to the open hysterectomy in women with stage IA cervical cancer. Based on this large data set, MIS appears to be a safe and effective surgical approach for women with stage IA1/IA2 cervical cancer.
Description
Citation
Hayek, J., Mowzoon, M., Demissie, S., Palileo, A., Serur, E., Goldberg, G. L., & Alagkiozidis, I. (2022). Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: A retrospective database cohort study. Annals of medicine and surgery (2012), 77, 103507. https://doi.org/10.1016/j.amsu.2022.103507
Publisher
Annals of Medicine and Surgery