Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study.

Abstract

PURPOSE:

To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions.

METHODS:

Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 1, 2010 and December 31, 2017.

RESULTS:

Of 815 patients, open RH was performed in 255 cases (29.1%) and minimally invasive RH in 560 cases (70.9%). There were 19 (7.5%) recurrences in the open RH and 51 (9.1%) recurrences in the minimally invasive group (P = .43). Risk-adjusted analysis revealed that minimally invasive RH was independently associated with an increased hazard of recurrence (aHR, 1.88; 95% CI, 1.04 to 3.25). Other factors independently associated with an increased hazard of recurrence included tumor size, grade, and adjuvant radiation. Conization before surgery was associated with lower recurrence risk (aHR, 0.4; 95% CI, 0.23 to 0.71). There was no difference in OS in the unadjusted analysis (HR, 1.14; 95% CI, 0.61 to 2.11) or after risk adjustment (aHR, 1.01; 95% CI, 0.5 to 2.2). Of 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor on final pathology), 2/82 (2.4%) recurred in the open RH group and 16/182 (8.8%) in the minimally invasive RH group (P = .058). In propensity score matching analysis, 7/159 (4.4%) recurrences were noted in the open RH group and 18/156 (11.5%) in the minimally invasive RH group (P = .019). Survival analysis revealed an increased risk of recurrence in the minimally invasive group in propensity-matched cohort (HR, 2.83; 95% CI, 1.1 to 7.18).

CONCLUSION:

In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior DFS but not overall survival in the entire cohort.

• Authors: Shitanshu Uppal, Paola A Gehrig, Katherine Peng, Kristin L Bixel, Koji Matsuo, Monica H Vetter, Brittany A Davidson, M Paige Cisa, Brittany F Lees, Laurie L Brunette, Katherine Tucker, Allison Stuart Staley, Walter H Gotlieb, Robert W Holloway, Kathleen G Essel, Laura L Holman, Ester Goldfeld, Alexander Olawaiye, Stephen L Rose
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 38 Issue 10 Pg. 1030-1040 (04 01 2020) ISSN: 1527-7755 [Electronic] United States
• PMID: 32031867 (Publication Type: Journal Article, Multicenter Study)

Topics

• Aged
• Aged, 80 and over
• Disease-Free Survival
• Female
• Humans
• Hysterectomy (methods, statistics & numerical data)
• Kaplan-Meier Estimate
• Middle Aged
• Neoplasm Recurrence, Local (epidemiology, pathology)
• Neoplasm Staging
• Retrospective Studies
• Uterine Cervical Neoplasms (epidemiology, pathology, surgery)