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Abstract
Introduction/Background Over the last years, minimally invasive surgery was advancing as the preferred approach in many cancer centres for the treatment of early-stage cervical cancer, as it offers advantages against open abdominal surgery in in-hospital and short-term outcomes. However, results from a recent randomized trial suggested lower rates of disease-free survival in the follow-up of patients operated with the minimally invasive approach.
The aim of our study was to compare, in our tertiary centre, the rate of disease-free survival at 3.5 years between both surgical techniques.
Methodology Retrospective single-centre study including patients who underwent total laparoscopic radical hysterectomy (LRH) or open radical hysterectomy (ORH) due to early-stage cervical cancer (IA1-IIA1) between 2005–2017.
Results A total of 63 patients were included (39 LRH and 24 ORH). Baseline characteristics are described in table 1. Mean age was similar in both groups 47.5 ±13.3 vs. 48.3 ±12.6 (p=0.8). The prevalence of high-risk HPV was similar in both groups with a higher rate of prior conization in the LRH group 22 (56.4%) vs. 5 (20.8%) (p=0.006). There were no significant differences between both groups in terms of parametrial involvement, histologic subtypes and stage of disease. In almost half of the patients in the LRH group the uterine mobilizer was used during surgery, with 1 case of uterine perforation. There were no significant differences at 3.5 years follow-up in terms of recurrences [LRH 4 (10.3%) vs. ORH 2 (8.3%) (p=0.8)] and overall death (being secondary to their oncological process in all cases), 2 (5.1%) vs. 1 (4.2%) (p=0.87). Kaplan-Meier analysis revealed a similar rate of disease-free survival at 3.5 years in both groups: LRH 87.2% vs. 87.5% (p=0.95) (figure 1). The rate of disease-free survival in patients in which the uterine mobilizer was used was 100%.
We hypothesized that, in experienced hands and with appropriate patient selection, a minimally invasive approach via laparoscopic surgery can be as effective as conventional open surgery. However, the results must be interpreted with caution given the potential risk of bias derived from the relatively small sample size and the single-centre, retrospective nature of the study.
Conclusion In the present study, we did not find statistically significant differences between LRH and ORH for the treatment of early-stage cervical cancer in terms of disease-free survival and overall survival.
Disclosures Nothing to disclosure.