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SUCCOR study. An international european cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 (FIGO 2009, <4 cm) cervical cancer operated in 2013–2014
  1. L Chiva1,
  2. V Zanagnolo2,
  3. A Kucukmetin3,
  4. G Chakalova4,
  5. F Raspagliesi5,
  6. F Narducci6,
  7. T Toptas7,
  8. M Meydanli8,
  9. A Fagotti9,
  10. D Cibula10,
  11. D Wydra11,
  12. R Póka12,
  13. R Jach13,
  14. M Tavares14,
  15. K Tamussino15,
  16. D Haidopoulos16,
  17. J Ponce17,
  18. I Berlev18,
  19. F Roldán19,
  20. S Domingo20,
  21. I Zapardiel21,
  22. E Goncalves22,
  23. M Malzoni23,
  24. O Arencibia24,
  25. K Kukk25,
  26. H Haller26,
  27. G Vorgias27,
  28. F Ghezzi28,
  29. F Guyon29,
  30. S Herrero30,
  31. J Haesen31,
  32. JG Feron32,
  33. J Minguez33,
  34. E Chacon33,
  35. D Vazquez34,
  36. T Castellanos34,
  37. J Arevalo35,
  38. N Martin Calvo36 and
  39. JL Alcazar33
  1. 1Clinica Universidad de Navarra, Madrid, Spain
  2. 2European Institute of Oncology, Milano, Italy
  3. 3Northern Gynaecological Oncology Centre, Gateshead, UK
  4. 4University Hospital of Oncology, Sofia, Bulgaria
  5. 5Istituto Nazionale Tumori – Milan, Milan, Italy
  6. 6Centre Oscar Lambret, Lille, France
  7. 7Saglik Bilimleri University Antalya Research and Training Hospital, Antalya
  8. 8Zekai Tahir Burak Women’s Health Training Hospital, Ankara, Turkey
  9. 9Fondazione Policlinico A. Gemelli, Rome, Italy
  10. 10General Faculty Hospital, Prague, Czech Republic
  11. 11MU of Gdansk, Gdansk, Poland
  12. 12Gynecologic Oncology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
  13. 13Jagiellonian University Medical College, Krakow, Poland
  14. 14Instituto Português de Oncologia, Porto, Portugal
  15. 15Medical University of Graz, Graz, Austria
  16. 16Alexandra Hospital, Athens, Greece
  17. 17Hospital del Belvitge, Barcelona, Spain
  18. 18N.N.Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russian Federation
  19. 19Hospital Clínico Universitario Lozano Blesa, Zaragoza
  20. 20University Hospital La Fe, Valencia
  21. 21La Paz University Hospital, Madrid, Spain
  22. 22Chua-HDF, Faro, Portugal
  23. 23Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
  24. 24Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
  25. 25Gynecology, North Estonia Medical Foundation, Tallinn, Estonia
  26. 26Clinical Hospital Center Rijeka, Rijeka, Croatia
  27. 27Metaxa Memorial Cancer Hospital, Piraeus, Greece
  28. 28University of Insubria, Varese, Italy
  29. 29Institut Bergonié, Bordeaux, France
  30. 30Hospital Puerta de Hierro, Madrid, Spain
  31. 31University Hospitals Leuven, Leuven, Belgium
  32. 32Institut Curie, Paris, France
  33. 33Clinica Universidad de Navarra, Pamplona
  34. 34Clinica Universidad de Navarra, MADRID
  35. 35Internal Medicine, Hospital Principe de Asturias
  36. 36Preventive Medicine and Public Health, Clinica Universidad de Navarra, Madrid, Spain


Introduction/Background Minimally invasive surgery (MIS) was adopted as an alternative to laparotomy for radical hysterectomy in patients with early-stage cervical cancer before obtaining solid evidence regarding its effect on survival. We studied what was the outcome of patients that underwent Radical hysterectomy for stage IB1 cervical cancer, depending on the different approaches.

Methodology We performed a cohort study involving women who underwent radical hysterectomy for stage IB1 cervical cancer during the 2013–2014 period in 89 centers belonging to 23 European countries. The study included patients with a histologic subtype of squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma. Either preoperative pelvic MRI or vaginal ultrasound indicating tumor diameter <4 cm and no parametrial invasion was mandatory. The primary outcome was the rate of disease-free survival at 4.5 years between MIS vs. open surgery. Patients with history of previous conization were also analyzed separately. A propensity matching score was applied to balance all the relevant variables that were found significant to modify the rate of relapse. Inverse probability weighting-adjusted disease-free survival evaluated the impact of the use of uterine manipulator in MIS.

Results 624 patients were registered of whom 582 fulfilled all the inclusion criteria.

With a median follow up of 58 months, patients that underwent open surgery showed a DFS at 4,5y of 93% vs. 82% in the group of MIS (p=0,023, HR 3.48; 95% CI: 1.17–9.48). The use of manipulator was associated with a worse DFS in the MIS group (HR 2.38; 95% CI: 1.32–4.29). Overall survival at 4.5y was significantly lower (96% vs.88%) in the group of MIS (p=0,016). Patients with previous conization did not show differences between both approaches.

Conclusion The risk of relapse and death in the group of MIS was significantly higher. The use of manipulator worsened the outcome among MIS patients.

Disclosure Nothing to disclose.

Abstract – Figure 1

DFS in both groups open and MIS after propensity matching score

Abstract – Figure 2

Impact of the use of manipulator in the DFS of the MIS approach

Abstract – Table 1

Characteristics of both groups before the propensity matching score

Abstract – Table 2

Characteristics of both groups after the propensity matching score

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