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Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes.
Gynecol Oncol. 2020 03; 156(3):591-597.GO

Abstract

OBJECTIVE

To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma.

METHODS

We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007-12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders.

RESULTS

We identified 196 evaluable cases-117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (53.2% vs. 33.3%, P = 0.006). Median follow-up was ~4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04).

CONCLUSIONS

MIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma.

Authors+Show Affiliations

Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA.Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, USA. Electronic address: leitaom@mskcc.org.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31918996

Citation

Brandt, Benny, et al. "Minimally Invasive Surgery Versus Laparotomy for Radical Hysterectomy in the Management of Early-stage Cervical Cancer: Survival Outcomes." Gynecologic Oncology, vol. 156, no. 3, 2020, pp. 591-597.
Brandt B, Sioulas V, Basaran D, et al. Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecol Oncol. 2020;156(3):591-597.
Brandt, B., Sioulas, V., Basaran, D., Kuhn, T., LaVigne, K., Gardner, G. J., Sonoda, Y., Chi, D. S., Long Roche, K. C., Mueller, J. J., Jewell, E. L., Broach, V. A., Zivanovic, O., Abu-Rustum, N. R., & Leitao, M. M. (2020). Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes. Gynecologic Oncology, 156(3), 591-597. https://doi.org/10.1016/j.ygyno.2019.12.038
Brandt B, et al. Minimally Invasive Surgery Versus Laparotomy for Radical Hysterectomy in the Management of Early-stage Cervical Cancer: Survival Outcomes. Gynecol Oncol. 2020;156(3):591-597. PubMed PMID: 31918996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes. AU - Brandt,Benny, AU - Sioulas,Vasileios, AU - Basaran,Derman, AU - Kuhn,Theresa, AU - LaVigne,Katherine, AU - Gardner,Ginger J, AU - Sonoda,Yukio, AU - Chi,Dennis S, AU - Long Roche,Kara C, AU - Mueller,Jennifer J, AU - Jewell,Elizabeth L, AU - Broach,Vance A, AU - Zivanovic,Oliver, AU - Abu-Rustum,Nadeem R, AU - Leitao,Mario M,Jr Y1 - 2020/01/07/ PY - 2019/10/31/received PY - 2019/12/16/revised PY - 2019/12/23/accepted PY - 2020/1/11/pubmed PY - 2020/7/3/medline PY - 2020/1/11/entrez KW - Cervical cancer KW - Laparoscopy KW - Laparotomy KW - Minimal invasive surgery KW - Radical hysterectomy KW - Robotic surgery SP - 591 EP - 597 JF - Gynecologic oncology JO - Gynecol. Oncol. VL - 156 IS - 3 N2 - OBJECTIVE: To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma. METHODS: We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007-12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders. RESULTS: We identified 196 evaluable cases-117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (53.2% vs. 33.3%, P = 0.006). Median follow-up was ~4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04). CONCLUSIONS: MIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma. SN - 1095-6859 UR - https://www.unboundmedicine.com/medline/citation/31918996/Minimally_invasive_surgery_versus_laparotomy_for_radical_hysterectomy_in_the_management_of_early_stage_cervical_cancer:_Survival_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-8258(19)31868-2 DB - PRIME DP - Unbound Medicine ER -