Non-invasive hysterectomy may lead to shorter survival rates

CINCINNATI—A new study co-authored by a University of Cincinnati (UC) resident physician and published in the Oct. 31 online edition of the New England Journal of Medicine shows that a non-invasive radical hysterectomy may lead to shorter survival rates than open surgery in women with early-stage cervical cancer.

The study, co-written and developed by researchers at Massachusetts General Hospital, Northwestern University, MD Anderson Cancer Center and Columbia University, could provide important information to help physicians decide the best course of treatment for patients with early-stage disease.

“Minimally invasive surgery has been the alternative to laparotomy, or open surgery, for radical hysterectomy in patients with early-stage cervical cancer before evidence regarding its effect on survival was available,” says Daniel Margul, MD, PhD, a first-year resident physician in the department of obstetrics and gynecology at UC and UC Medical Center who worked on his portion of the project as a student at Northwestern. “Despite the lack of evidence supporting the use of minimally invasive radical hysterectomy for cervical cancer, the approach has been broadly adopted in the United States and is considered to be a standard approach in national guidelines. In this study, we used data from two large cancer registries to compare the effect of minimally invasive surgery versus open radical hysterectomy on death rates, from all causes. We evaluated whether the use of minimally invasive radical hysterectomy affected national trends in four-year survival rates.”

Radical hysterectomy involves the removal of the uterus and the ligaments (tissue fibers) that hold it in place. The cervix and an inch or two of the vagina around the cervix are also removed.

The epidemiologic study, made up of 2,461 women, looked at patients who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer between 2010 and 2013 at Commission on Cancer (CoC)-accredited hospitals in the United States.

“In our analysis, 1,225 of women (49.8 percent) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured and from ZIP codes with higher socioeconomic attainment; these patients also had smaller, lower-grade tumors when compared with women who underwent open surgery,” Margul says. “Over an average follow-up of 45 months, the four-year death rate was 9.1 percent among women who underwent minimally invasive surgery and 5.3 percent among those who underwent open surgery.

“Before the use of minimally invasive radical hysterectomy, in the 2000 to 2006 period, the four-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable. The use of minimally invasive surgery coincided with a decline in the four-year relative survival rate of 0.8 percent per year after 2006.”

Margul says this data shows that minimally invasive surgery was associated with shorter survival rates, when compared to open surgery, which was more invasive.

“The reasons for this effect on survival are not clear from our work, and more studies are needed to examine this,” he says. “However, this provides important data which could eventually change current guidelines and impact the way physicians decide to treat patients with certain early stage cancers.”

The study was supported by the National Cancer Institute (P30CA016672, 4P30CA060553-22, and R25CA092203), the National Institute of Child Health and Human Development (K12HD050121-12), the American Association of Obstetricians and Gynecologists Foundation, the Foundation for Women’s Cancer, the Jean Donovan Estate and the Phebe Novakovic Fund. Margul cites no conflict of interest.