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738 Surgical approach, preoperative LEEP/cone biopsy and patterns of recurrence and death in low-risk cervical cancer – analysis of the international CCTG CX.5/SHAPE phase III trial
  1. Sven Mahner1,
  2. Fabian Trillsch1,
  3. Janice Kwon2,
  4. Sarah E Ferguson3,
  5. Paul Bessette4,
  6. Gwenael Ferron5,
  7. Amandine Maulard6,
  8. Cor DDe Kroon7,
  9. Willemien JVan Driel8,
  10. John Tidy9,
  11. Karin Williamson10,
  12. Frederic Goffin11,
  13. Stephan Polterauer12,
  14. Brynhildur Eyjolsdottir13,
  15. Jae-Weon Kim14,
  16. Patrick J Maguire15,
  17. Barbara Schmalfeldt16,
  18. Dongsheng Tu17,
  19. Lois Shepherd17 and
  20. Marie Plante18
  1. 1Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany
  2. 2University of British Columbia, Vancouver, Canada
  3. 3Princess Margaret Hospital, Toronto, Canada
  4. 4Universite de Sherbrooke, Sherbrokee, Canada
  5. 5Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
  6. 6Gustave Roussy Cancer Center, Villejuif, France
  7. 7Department of Gynaecology, Leids University Medical Centre, Leiden, The Netherlands
  8. 8Netherlands Cancer Institute, Amsterdam, The Netherlands
  9. 9Sheffield Teaching Hospitals, Sheffield, UK
  10. 10Nottingham University Hospital, Nottingham, UK
  11. 11CHU de Liege, Liege, Belgium
  12. 12Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
  13. 13Norwegian Radium Hospital, Oslo, Norway
  14. 14Seoul National University College of Medicine, Seoul, South Korea
  15. 15Division of Gynaecological Oncology, St James’s Hospital, Dublin, Ireland
  16. 16University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  17. 17Canadian Cancer Trials Group, Queen’s University, Kingston, Canada
  18. 18Department of Gynecologic Oncology, Québec, Canada


Introduction/Background SHAPE demonstrated that simple hysterectomy was not inferior to radical hysterectomy with respect to 3-year pelvic recurrence rate in patients with low-risk cervical cancer. To further understand the role of preoperative LEEP/cone, clear LEEP/cone margins and surgical approach, analyses were performed regarding patterns of recurrence and death.

Methodology Exploratory analysis to assess outcome (pelvic recurrence, extrapelvic recurrence and death) by surgical approach (minimally invasive surgery [MIS] vs. open), LEEP/cone (yes vs. no) and residual disease in the hysterectomy specimen (yes vs. no) in patients with simple or radical hysterectomy.

Results With a median follow up of 4.5 years, 25 recurrences (pelvic or extrapelvic) were observed from 680 patients who underwent simple (338 patients) or radical (342 patients) hysterectomy. At surgeons’ discretion, MIS was performed in 524 (77%) and open surgery in 156 (23%). The table presents baseline characteristics of patients by surgical approach. Overall, 19 recurrences occurred following MIS (3.6%) and 6 following open surgery (3.8%). Among 174 patients (82%, n=143 MIS; 18%, n=31 open) with clear margins after LEEP/Cone, 2 (1.4%) developed pelvic recurrences after MIS and none after open surgery. Among the entire cohort, 9 patients had extrapelvic recurrence, 7/524 (1.3%) following MIS and 2/156 (1.3%) open surgery. However, no extrapelvic recurrence occurred after either MIS or open surgery among patients who had prior LEEP/cone with clear margins. Among 14 deaths observed, 11 (2.1%) occurred after MIS and 3 (1.9%) after open surgery but none after previous LEEP/cone with clear margins.

Abstract 738 Table 1

Baseline characteristics by surgical approach

Conclusion Exploratory analyses of surgical parameters within the SHAPE trial suggest similar rates of recurrence and death between patients who underwent MIS and open surgery. No extrapelvic recurrences and death occurred in patients with clear margins in prior LEEP/conisation, regardless of surgical approach. These findings could help tailor surgical strategies in patients with low-risk cervical cancer.

Disclosures Nothing to disclose.

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