Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical...

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Clinical Research

Background:

• Radical hysterectomy (RH) is a cornerstone treatment for early-stage cervical cancer.
• Minimally invasive surgical approaches are increasingly adopted, but their oncologic outcomes require careful evaluation.
• Disease-free survival (DFS) is a critical endpoint for assessing treatment efficacy in cervical cancer.

Purpose of the Study:

• To compare disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH).
• To identify factors associated with recurrence risk following RH in academic medical institutions.

Main Methods:

• Retrospective multi-institutional review of 815 patients undergoing RH for stage IA1-IB1 cervical cancer (2010-2017).
• Comparison of recurrence rates and overall survival (OS) between open RH (255 patients) and minimally invasive RH (560 patients).
• Risk-adjusted and propensity score matching analyses were performed to control for confounding factors.

Main Results:

• Minimally invasive RH was associated with an independently increased hazard of recurrence (aHR, 1.88) in risk-adjusted analysis.
• In propensity-matched analysis, minimally invasive RH showed a significantly increased risk of recurrence (HR, 2.83; P = .019).
• Tumor size, grade, and adjuvant radiation were associated with increased recurrence hazard; conization before surgery was associated with lower risk.

Conclusions:

• Minimally invasive radical hysterectomy was associated with inferior disease-free survival compared to open radical hysterectomy in this retrospective series.
• This finding persisted even in patients with tumors ≤ 2 cm on final pathology.
• Overall survival did not differ significantly between the two surgical approaches.