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EPV062/#354 Comparison of outcomes between abdominal, minimally invasive and combined vaginal- laparoscopic hysterectomy in patients with stage IAI/IA2 cervical cancer: 4C (Canadian cervical cancer collaborative) study
  1. S Piedimonte1,
  2. G Pond2,
  3. M Plante3,
  4. G Nelson4,5,
  5. J Kwon6,
  6. A Altman7,
  7. T Feigenberg8,
  8. L Helpman9,
  9. L Elit2,
  10. S Lau10,
  11. J Sabourin11,
  12. V Samouëlian12,
  13. K Willows13,
  14. C Aubrey5,
  15. RS Kim1,
  16. L-A Teo-Fortin3,
  17. N Cockburn2,
  18. N-B Saunders7,
  19. S Shamiya14 and
  20. D Vicus15
  1. 1University of Toronto, Gynecologic Oncolgoy, Toronto, Canada
  2. 2McMaster University, Juravinski Cancer Center, Hamilton Health Sciences, Gynecologic Oncology, Hamilton, Canada
  3. 3Hotel Dieu de Quebec, Gynecology Oncology, Quebec, Canada
  4. 4Cumming School of Medicine, Obstetrics and Gynecology, Calgary, Canada
  5. 5University of Calgary, Department of Oncology, Division of Gynecologic Oncology, Calgary, Canada
  6. 6Vancouver General Hospital, Gynecologic Oncolgoy, Vancouver, Canada
  7. 7University of Manitoba, Gynecologic Oncology, Winnipeg, Canada
  8. 8Trillium Health Partners, Gynecologic Oncolgoy, missassauga, Canada
  9. 9Juravinski Cancer Center, Gynecologic Oncology, Hamilton, Canada
  10. 10Jewish General Hospital, Gynecologic Oncology, Montréal, Canada
  11. 11Alberta Health Service, Gynecologic Oncology, Edmonton, Canada
  12. 12Gynecologic Oncology Service, CHUM, Université de Montréal, Department of Obstetrics and Gynecology, Montreal, Canada
  13. 13Dalhousie University, Gynecologic Oncology, Halifax, Canada
  14. 14University of Alberta, Gynecologic Oncology, Edmonton, Canada
  15. 15Sunnybrook Health Sciences Centre, Gynecologic Oncology, Toronto, Canada


Objectives Although minimally invasive(MIS) radical hysterectomy has been associated with worse survival compared to abdominal hysterectomy(AH), only 8% of patients in the LACC trial had microinvasive disease(Stage IA1/IA2). We sought to determine differences in outcome among patients undergoing MIS, AH or combined vaginal-laparoscopic hysterectomy(CVLH) for microinvasive cervical cancer.

Methods A retrospective cohort study of all patients undergoing hysterectomy for FIGO 2018, microinvasive cervical cancer across 10 Canadian centers between 2007 and 2019 was performed. Recurrence free survival(RFS) was estimated using Kaplan Meier Survival analysis. Chi-square and log-rank tests were used to compare outcomes.

Results 430 patients with microinvasive cervical cancer were included; 61.9% Stage IA1 and 38.1% IA2. The median age was 44 years(range 24–81). The most frequent histology was squamous(59.5%). Surgical approach was: 49.5% MIS(robotic or laparoscopic), 34.4% AH and 14.7% CVLH. 70.9% underwent radical hysterectomy and 76.5% had pelvic lymph node assessment. There were 5 recurrences (MIS:1, AH:4, CVLH:0). No significant difference in 5-year RFS (96.2% MIS, 93.7% AH, 89.4% CVLH, p=0.36) was found. When limiting to patients with IA1 LVSI+/IA2 (n=194), survival results were similar. Further, there was no significant difference in peri-operative complications(p>0.15). Patients undergoing MIS had a shorter median length of stay(1 day vs 3(AH) vs. 1.5(CVLH), p<0.01), but had more readmissions (13.8% vs 6.5%(AH), 5.2%(CVLH),p=0.036) and ER visits(15.9%, 3.6%(AH), 3.5%(CVLH),p<0.01).

Conclusions In patients with microinvasive cervical cancer, there was no difference in survival by surgical approach, possibly due to low event rate. These patients may benefit from MIS without compromising oncologic outcomes.

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