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Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm.
Int J Gynecol Cancer. 2020 May; 30(5):564-571.IJ

Abstract

OBJECTIVE

There is recent evidence that demonstrates worse oncologic outcomes associated with minimally invasive radical hysterectomy when compared with open radical hysterectomy, particularly in patients with tumors >2 cm. The aim of our study was to retrospectively evaluate the oncological outcomes between laparoscopic and open radical hysterectomy in International Federation of Gynecology and Obstetrics(FIGO) 2009 stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm.

METHODS

A retrospective review of medical records was performed to identify patients who underwent either laparoscopic or open radical hysterectomy during January 2010 and December 2018. Inclusion criteria were: (1) histologically confirmed cervical cancer including all histological types; (2) FIGO 2009 stage IB1; (3) tumor size ≤2 cm (determined by pelvic examination, magnetic resonance imaging or transvaginal ultrasound); (4) had undergone radical hysterectomy (type II or III) with pelvic and/or para-aortic lymphadenectomy as primary surgical treatment; (5) had follow-up information. Patients with FIGO 2009 stage IA1 or IA2, tumor size >2 cm, or who received neo-adjuvant chemotherapy before surgery, those with cervical cancer incidentally found after simple hysterectomy, or with insufficient data were excluded. Concurrent comparison between the laparoscopic and open cohorts was made for disease-free survival and overall survival.

RESULTS

A total of 325 cervical cancer patients were included; of these, 129 patients underwent laparoscopic surgery and 196 patients had open surgery. The median follow-up times were 51.8 months (range 2-115) for laparoscopic surgery and 49.5 months (range 3-108) for open surgery. Patients in the laparoscopic group had significantly worse 5 year disease-free survival than those in the open group (90.4% vs 97.7%; p=0.02). There was no significant difference in 5 year overall survival between groups (96.9% vs 99.4%, p=0.33). The Cox proportional hazards regression analysis indicated that laparoscopic surgery was associated with lower disease-free survival compared with open surgery (adjusted hazard ratio 4.64, 95% CI 1.26 to 17.06; p=0.02). In patients with non-squamous cell carcinoma or with grade II-III, laparoscopic surgery had a significantly worse 5 year disease-free survival compared with the open surgery group (74% vs 100%, p=0.01, and 88.8% vs 98.0%, p=0.02, respectively).

CONCLUSION

Laparoscopic radical hysterectomy was associated with worse disease-free survival for stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm compared with open radical hysterectomy. Further studies may shed additional light on the impact of minimally invasive surgery in this low-risk patient population.

Authors+Show Affiliations

Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Gynecology, Wenzhou People's Hospital, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China. Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China. Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China. Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Obstetrics and Gynecology, The First People's Hospital of Foshan, Foshan, Guangdong, China.Department of Gynecology, Taizhou Hospital of Zhejiang Province, Taizhou, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China yxjbetter2016@hotmail.com. Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Wenzhou, Zhejiang, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32276941

Citation

Chen, Xu, et al. "Comparison of Laparoscopic and Open Radical Hysterectomy in Cervical Cancer Patients With Tumor Size ≤2 Cm." International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society, vol. 30, no. 5, 2020, pp. 564-571.
Chen X, Zhao N, Ye P, et al. Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm. Int J Gynecol Cancer. 2020;30(5):564-571.
Chen, X., Zhao, N., Ye, P., Chen, J., Nan, X., Zhao, H., Zhou, K., Zhang, Y., Xue, J., Zhou, H., Shang, H., Zhu, H., Leanne, V. M., & Yan, X. (2020). Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm. International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society, 30(5), 564-571. https://doi.org/10.1136/ijgc-2019-000994
Chen X, et al. Comparison of Laparoscopic and Open Radical Hysterectomy in Cervical Cancer Patients With Tumor Size ≤2 Cm. Int J Gynecol Cancer. 2020;30(5):564-571. PubMed PMID: 32276941.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of laparoscopic and open radical hysterectomy in cervical cancer patients with tumor size ≤2 cm. AU - Chen,Xu, AU - Zhao,Na, AU - Ye,Piaopiao, AU - Chen,Jiahua, AU - Nan,Xingwei, AU - Zhao,Hongqin, AU - Zhou,Kai, AU - Zhang,Yuyang, AU - Xue,Jisen, AU - Zhou,Haihong, AU - Shang,Huiling, AU - Zhu,Hanxiao, AU - Leanne,Van der Merwe, AU - Yan,Xiaojian, Y1 - 2020/04/09/ PY - 2019/10/17/received PY - 2019/12/04/revised PY - 2019/12/19/accepted PY - 2020/4/12/pubmed PY - 2020/4/12/medline PY - 2020/4/12/entrez KW - cervical cancer KW - laparoscopes KW - laparotomy SP - 564 EP - 571 JF - International journal of gynecological cancer : official journal of the International Gynecological Cancer Society JO - Int. J. Gynecol. Cancer VL - 30 IS - 5 N2 - OBJECTIVE: There is recent evidence that demonstrates worse oncologic outcomes associated with minimally invasive radical hysterectomy when compared with open radical hysterectomy, particularly in patients with tumors >2 cm. The aim of our study was to retrospectively evaluate the oncological outcomes between laparoscopic and open radical hysterectomy in International Federation of Gynecology and Obstetrics(FIGO) 2009 stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm. METHODS: A retrospective review of medical records was performed to identify patients who underwent either laparoscopic or open radical hysterectomy during January 2010 and December 2018. Inclusion criteria were: (1) histologically confirmed cervical cancer including all histological types; (2) FIGO 2009 stage IB1; (3) tumor size ≤2 cm (determined by pelvic examination, magnetic resonance imaging or transvaginal ultrasound); (4) had undergone radical hysterectomy (type II or III) with pelvic and/or para-aortic lymphadenectomy as primary surgical treatment; (5) had follow-up information. Patients with FIGO 2009 stage IA1 or IA2, tumor size >2 cm, or who received neo-adjuvant chemotherapy before surgery, those with cervical cancer incidentally found after simple hysterectomy, or with insufficient data were excluded. Concurrent comparison between the laparoscopic and open cohorts was made for disease-free survival and overall survival. RESULTS: A total of 325 cervical cancer patients were included; of these, 129 patients underwent laparoscopic surgery and 196 patients had open surgery. The median follow-up times were 51.8 months (range 2-115) for laparoscopic surgery and 49.5 months (range 3-108) for open surgery. Patients in the laparoscopic group had significantly worse 5 year disease-free survival than those in the open group (90.4% vs 97.7%; p=0.02). There was no significant difference in 5 year overall survival between groups (96.9% vs 99.4%, p=0.33). The Cox proportional hazards regression analysis indicated that laparoscopic surgery was associated with lower disease-free survival compared with open surgery (adjusted hazard ratio 4.64, 95% CI 1.26 to 17.06; p=0.02). In patients with non-squamous cell carcinoma or with grade II-III, laparoscopic surgery had a significantly worse 5 year disease-free survival compared with the open surgery group (74% vs 100%, p=0.01, and 88.8% vs 98.0%, p=0.02, respectively). CONCLUSION: Laparoscopic radical hysterectomy was associated with worse disease-free survival for stage IB1 (FIGO 2009) cervical cancer patients with tumor size ≤2 cm compared with open radical hysterectomy. Further studies may shed additional light on the impact of minimally invasive surgery in this low-risk patient population. SN - 1525-1438 UR - https://www.unboundmedicine.com/medline/citation/32276941/Comparison_of_laparoscopic_and_open_radical_hysterectomy_in_cervical_cancer_patients_with_tumor_size_≤2_cm_ L2 - http://ijgc.bmj.com/cgi/pmidlookup?view=long&pmid=32276941 DB - PRIME DP - Unbound Medicine ER -
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