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Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer.
Gynecol Oncol. 2019 04; 153(1):3-12.GO

Abstract

OBJECTIVE

To compare survival outcomes of minimally invasive surgery (MIS) and conventional open surgery for radical hysterectomy (RH) among patients with early-stage cervical cancer (CC).

METHODS

We retrospectively identified stage IB1-IIA2 CC patients who underwent either laparoscopic or open Type C RH between 2000 and 2018. Patients' clinicopathologic characteristics and survival outcomes were compared according to the surgical approach. For a more robust statistical analysis, we narrowed the study population down to the patients with stage IB1 who underwent pre-operative MRI.

RESULTS

In total, 435 and 158 patients were assigned to open surgery and MIS groups, respectively. MIS group had significantly less parametrial invasion (6.3% vs. 15.4%; P = 0.004). Despite similar proportions of patients received adjuvant treatment, concurrent chemoradiation therapy was performed less frequently in MIS group. After a median follow up of 114.8 months, the groups showed similar overall survival; however, MIS group displayed poorer progression-free survival (PFS; 5-year rate, 78.5% vs. 89.7%; P < 0.001). Multivariate analyses identified MIS as an independent poor prognostic factor for PFS (adjusted HR, 2.883; 95% CI, 1.711-4.859; P < 0.001). Consistent results were observed among 349 patients with stage IB1: MIS was associated with higher recurrence rates (adjusted HR, 2.276; 95% CI, 1.039-4.986; P = 0.040). However, MIS did not influence PFS of stage IB1 patients with cervical mass size ≤2 cm on pre-operative MRI (adjusted HR, 1.146; 95% CI, 0.278-4.724; P = 0.850).

CONCLUSIONS

Overall, MIS RH was associated with higher recurrence rates than open RH in patients with early-stage CC. However, MIS was not a poor prognostic factor among those with stage IB1 and cervical mass size ≤2 cm on pre-operative MRI.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: marialeemd@gmail.com.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30642625

Citation

Kim, Se Ik, et al. "Comparison of Survival Outcomes Between Minimally Invasive Surgery and Conventional Open Surgery for Radical Hysterectomy as Primary Treatment in Patients With Stage IB1-IIA2 Cervical Cancer." Gynecologic Oncology, vol. 153, no. 1, 2019, pp. 3-12.
Kim SI, Cho JH, Seol A, et al. Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer. Gynecol Oncol. 2019;153(1):3-12.
Kim, S. I., Cho, J. H., Seol, A., Kim, Y. I., Lee, M., Kim, H. S., Chung, H. H., Kim, J. W., Park, N. H., & Song, Y. S. (2019). Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer. Gynecologic Oncology, 153(1), 3-12. https://doi.org/10.1016/j.ygyno.2019.01.008
Kim SI, et al. Comparison of Survival Outcomes Between Minimally Invasive Surgery and Conventional Open Surgery for Radical Hysterectomy as Primary Treatment in Patients With Stage IB1-IIA2 Cervical Cancer. Gynecol Oncol. 2019;153(1):3-12. PubMed PMID: 30642625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer. AU - Kim,Se Ik, AU - Cho,Jae Hyun, AU - Seol,Aeran, AU - Kim,Young Im, AU - Lee,Maria, AU - Kim,Hee Seung, AU - Chung,Hyun Hoon, AU - Kim,Jae-Weon, AU - Park,Noh Hyun, AU - Song,Yong-Sang, Y1 - 2019/01/12/ PY - 2018/10/17/received PY - 2018/12/30/revised PY - 2019/01/05/accepted PY - 2019/1/16/pubmed PY - 2019/5/14/medline PY - 2019/1/16/entrez KW - Cervical cancer KW - Laparoscopic surgery KW - Minimally invasive surgery KW - Radical hysterectomy KW - Survival outcome SP - 3 EP - 12 JF - Gynecologic oncology JO - Gynecol. Oncol. VL - 153 IS - 1 N2 - OBJECTIVE: To compare survival outcomes of minimally invasive surgery (MIS) and conventional open surgery for radical hysterectomy (RH) among patients with early-stage cervical cancer (CC). METHODS: We retrospectively identified stage IB1-IIA2 CC patients who underwent either laparoscopic or open Type C RH between 2000 and 2018. Patients' clinicopathologic characteristics and survival outcomes were compared according to the surgical approach. For a more robust statistical analysis, we narrowed the study population down to the patients with stage IB1 who underwent pre-operative MRI. RESULTS: In total, 435 and 158 patients were assigned to open surgery and MIS groups, respectively. MIS group had significantly less parametrial invasion (6.3% vs. 15.4%; P = 0.004). Despite similar proportions of patients received adjuvant treatment, concurrent chemoradiation therapy was performed less frequently in MIS group. After a median follow up of 114.8 months, the groups showed similar overall survival; however, MIS group displayed poorer progression-free survival (PFS; 5-year rate, 78.5% vs. 89.7%; P < 0.001). Multivariate analyses identified MIS as an independent poor prognostic factor for PFS (adjusted HR, 2.883; 95% CI, 1.711-4.859; P < 0.001). Consistent results were observed among 349 patients with stage IB1: MIS was associated with higher recurrence rates (adjusted HR, 2.276; 95% CI, 1.039-4.986; P = 0.040). However, MIS did not influence PFS of stage IB1 patients with cervical mass size ≤2 cm on pre-operative MRI (adjusted HR, 1.146; 95% CI, 0.278-4.724; P = 0.850). CONCLUSIONS: Overall, MIS RH was associated with higher recurrence rates than open RH in patients with early-stage CC. However, MIS was not a poor prognostic factor among those with stage IB1 and cervical mass size ≤2 cm on pre-operative MRI. SN - 1095-6859 UR - https://www.unboundmedicine.com/medline/citation/30642625/Comparison_of_survival_outcomes_between_minimally_invasive_surgery_and_conventional_open_surgery_for_radical_hysterectomy_as_primary_treatment_in_patients_with_stage_IB1_IIA2_cervical_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-8258(19)30041-1 DB - PRIME DP - Unbound Medicine ER -