Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes Journal Article


Authors: Brandt, B.; Sioulas, V.; Basaran, D.; Kuhn, T.; LaVigne, K.; Gardner, G. J.; Sonoda, Y.; Chi, D. S.; Long Roche, K. C.; Mueller, J. J.; Jewell, E. L.; Broach, V. A.; Zivanovic, O.; Abu-Rustum, N. R.; Leitao, M. M. Jr
Article Title: Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes
Abstract: Objective: To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma. Methods: We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007–12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders. Results: We identified 196 evaluable cases—117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (53.2% vs. 33.3%, P = 0.006). Median follow-up was ~4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04). Conclusions: MIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma. © 2020 Elsevier Inc.
Keywords: adult; cancer survival; aged; survival rate; major clinical study; overall survival; clinical feature; histopathology; cancer recurrence; cancer adjuvant therapy; disease free survival; cancer staging; follow up; lymph node dissection; laparoscopy; laparoscopic surgery; laparotomy; tumor volume; cohort analysis; surgical approach; retrospective study; cancer mortality; postoperative complication; early cancer; uterine cervix cancer; intermethod comparison; minimally invasive surgery; perioperative period; minimal invasive surgery; radical hysterectomy; uterine cervix carcinoma; cervical cancer; clinical outcome; robotic surgery; lymph vessel metastasis; conversion to open surgery; human; female; priority journal; article; robot assisted surgery; all cause mortality
Journal Title: Gynecologic Oncology
Volume: 156
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2020-03-01
Start Page: 591
End Page: 597
Language: English
DOI: 10.1016/j.ygyno.2019.12.038
PUBMED: 31918996
PROVIDER: scopus
PMCID: PMC7056548
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    203 Gardner
  2. Elizabeth Jewell
    95 Jewell
  3. Dennis S Chi
    588 Chi
  4. Yukio Sonoda
    364 Sonoda
  5. Mario Leitao
    433 Leitao
  6. Oliver Zivanovic
    206 Zivanovic
  7. Kara Christine Long
    137 Long
  8. Katherine Anne Lavigne
    10 Lavigne
  9. Jennifer Jean Mueller
    94 Mueller
  10. Vance Andrew Broach
    49 Broach
  11. Benny Brandt
    4 Brandt
  12. Theresa Kuhn
    4 Kuhn
  13. Derman Basaran
    11 Basaran