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Outcomes of minimally invasive versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging.
J Minim Invasive Gynecol. 2020 Jul 27 [Online ahead of print]JM

Abstract

STUDY OBJECTIVE

To compare outcomes after minimally invasive (MIS) versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging.

DESIGN

A retrospective analysis.

SETTING

A single teaching hospital.

PATIENTS

Patients after radical hysterectomy for stage IA1 with LVSI, IA2, or IB1 squamous, adenosquamous, or adenocarcinoma of the cervix between 2007-2018, mirroring the LACC trial criteria.

INTERVENTIONS

The use of minimally invasive surgery for performing radical hysterectomy.

MEASUREMENTS AND MAIN RESULTS

Outcomes were compared between patients undergoing MIS versus open approaches. A total of 126 patients met inclusion criteria. The approach was open in 44 patients (35%) and MIS in 82 patients (65%); 49% were laparoscopic and 51% were robotic. Distribution based on 2009 FIGO staging showed 1 stage IA1 with LVSI, 15 stage IA2, and 110 stage IB1 patients. Although not statistically significant, the 3-year disease-free survival (DFS) was higher in the open compared to the MIS group (95% vs. 87%; P = .17) and the overall survival (OS) was higher in the open compared to the MIS group (97% vs. 92%; P = .25). 14 patients who recurred were Stage IB1 by FIGO 2009 staging; 11/14 were reclassified to a higher stage by 2018 FIGO staging (5/5 open, 6/9 MIS). Of these, adjuvant therapy was recommended in 100% patients based on Sedlis criteria (10/14) or other risk factors (4/14). Despite this, only 1/9 of MIS patients who recurred received adjuvant therapy compared with 3/5 patients who recurred in the open group (P = .05).

CONCLUSION

In a cohort of patients similar to the LACC trial, 2018 FIGO staging may be useful to refine indications for minimally invasive radical hysterectomy in early-stage cervical cancer. However, disparate outcomes between MIS and open approaches may be explained by differences in compliance with NCCN guidelines for adjuvant therapy.

Authors+Show Affiliations

Levine Cancer Institute, Atrium Health, Department of Gynecologic Oncology. 1021 Morehead Medical Dr., Charlotte NC 28204.Levine Cancer Institute, Atrium Health, Department of Gynecologic Oncology. 1021 Morehead Medical Dr., Charlotte NC 28204. Electronic address: jubilee.brown@atriumhealth.org.Levine Cancer Institute, Atrium Health, Department of Gynecologic Oncology. 1021 Morehead Medical Dr., Charlotte NC 28204.Levine Cancer Institute, Atrium Health, Department of Gynecologic Oncology. 1021 Morehead Medical Dr., Charlotte NC 28204.Levine Cancer Institute, Atrium Health, Department of Gynecologic Oncology. 1021 Morehead Medical Dr., Charlotte NC 28204.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32730990

Citation

Levine, Monica D., et al. "Outcomes of Minimally Invasive Versus Open Radical Hysterectomy for Early-stage Cervical Cancer Incorporating 2018 FIGO Staging." Journal of Minimally Invasive Gynecology, 2020.
Levine MD, Brown J, Crane EK, et al. Outcomes of minimally invasive versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging. J Minim Invasive Gynecol. 2020.
Levine, M. D., Brown, J., Crane, E. K., Tait, D. L., & Naumann, R. W. (2020). Outcomes of minimally invasive versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2020.07.021
Levine MD, et al. Outcomes of Minimally Invasive Versus Open Radical Hysterectomy for Early-stage Cervical Cancer Incorporating 2018 FIGO Staging. J Minim Invasive Gynecol. 2020 Jul 27; PubMed PMID: 32730990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of minimally invasive versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging. AU - Levine,Monica D, AU - Brown,Jubilee, AU - Crane,Erin K, AU - Tait,David L, AU - Naumann,R Wendel, Y1 - 2020/07/27/ PY - 2020/05/26/received PY - 2020/07/14/revised PY - 2020/07/16/accepted PY - 2020/7/31/entrez PY - 2020/7/31/pubmed PY - 2020/7/31/medline KW - early-stage cervical cancer KW - radical hysterectomy KW - staging JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol N2 - STUDY OBJECTIVE: To compare outcomes after minimally invasive (MIS) versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging. DESIGN: A retrospective analysis. SETTING: A single teaching hospital. PATIENTS: Patients after radical hysterectomy for stage IA1 with LVSI, IA2, or IB1 squamous, adenosquamous, or adenocarcinoma of the cervix between 2007-2018, mirroring the LACC trial criteria. INTERVENTIONS: The use of minimally invasive surgery for performing radical hysterectomy. MEASUREMENTS AND MAIN RESULTS: Outcomes were compared between patients undergoing MIS versus open approaches. A total of 126 patients met inclusion criteria. The approach was open in 44 patients (35%) and MIS in 82 patients (65%); 49% were laparoscopic and 51% were robotic. Distribution based on 2009 FIGO staging showed 1 stage IA1 with LVSI, 15 stage IA2, and 110 stage IB1 patients. Although not statistically significant, the 3-year disease-free survival (DFS) was higher in the open compared to the MIS group (95% vs. 87%; P = .17) and the overall survival (OS) was higher in the open compared to the MIS group (97% vs. 92%; P = .25). 14 patients who recurred were Stage IB1 by FIGO 2009 staging; 11/14 were reclassified to a higher stage by 2018 FIGO staging (5/5 open, 6/9 MIS). Of these, adjuvant therapy was recommended in 100% patients based on Sedlis criteria (10/14) or other risk factors (4/14). Despite this, only 1/9 of MIS patients who recurred received adjuvant therapy compared with 3/5 patients who recurred in the open group (P = .05). CONCLUSION: In a cohort of patients similar to the LACC trial, 2018 FIGO staging may be useful to refine indications for minimally invasive radical hysterectomy in early-stage cervical cancer. However, disparate outcomes between MIS and open approaches may be explained by differences in compliance with NCCN guidelines for adjuvant therapy. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/32730990/Outcomes_of_minimally_invasive_versus_open_radical_hysterectomy_for_early_stage_cervical_cancer_incorporating_2018_FIGO_staging_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(20)30352-6 DB - PRIME DP - Unbound Medicine ER -
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