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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 cervical cancer
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  1. Luis Chiva1,
  2. Vanna Zanagnolo2,
  3. Denis Querleu3,
  4. Nerea Martin-Calvo4,
  5. Juan Arévalo-Serrano5,
  6. Mihai Emil Căpîlna6,
  7. Anna Fagotti7,
  8. Ali Kucukmetin8,
  9. Constantijne Mom9,
  10. Galina Chakalova10,
  11. Shamistan Aliyev11,
  12. Mario Malzoni12,
  13. Fabrice Narducci13,
  14. Octavio Arencibia14,
  15. Francesco Raspagliesi15,
  16. Tayfun Toptas16,
  17. David Cibula17,
  18. Dilyara Kaidarova18,
  19. Mehmet Mutlu Meydanli19,
  20. Mariana Tavares20,
  21. Dmytro Golub21,
  22. Anna Myriam Perrone22,
  23. Robert Poka23,
  24. Dimitrios Tsolakidis24,
  25. Goran Vujić25,
  26. Marcin A Jedryka26,
  27. Petra L M Zusterzeel27,
  28. Jogchum Jan Beltman28,
  29. Frederic Goffin29,
  30. Dimitrios Haidopoulos30,
  31. Herman Haller31,
  32. Robert Jach32,
  33. Iryna Yezhova33,
  34. Igor Berlev34,
  35. Margarida Bernardino35,
  36. Rasiah Bharathan36,
  37. Maximilian Lanner37,
  38. Minna M Maenpaa38,
  39. Vladyslav Sukhin39,
  40. Jean-Guillaume Feron40,
  41. Robert Fruscio41,42,
  42. Kersti Kukk43,
  43. Jordi Ponce44,
  44. Jose Angel Minguez45,
  45. Daniel Vázquez-Vicente45,
  46. Teresa Castellanos45,
  47. Enrique Chacon46 and
  48. Juan Luis Alcazar47
  49. et al, on behalf of the SUCCOR study group
  1. 1 Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
  2. 2 Istituto Europeo di Oncologia, Milano, Italy
  3. 3 Surgery, Institut Bergonie, Bordeaux, France
  4. 4 Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
  5. 5 Principe de Asturias University Hospital, Alcala de Henares, Spain
  6. 6 Emergency County Hospital, Targu Mures, Romania
  7. 7 Policlinico A Gemelli, Roma, Italy
  8. 8 Queen Elizabeth Hospital, Gateshead, UK
  9. 9 Amsterdam University Medical Centre, Amsterdam, Netherlands
  10. 10 University Oncologic Hospital, Sofia, Bulgaria
  11. 11 National Center of Oncology, Baku, Azerbaijan
  12. 12 Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
  13. 13 Gynecology, Centre Oscar Lambret, Lille, France
  14. 14 University Maternal Hospital Canary Islands, Las Palma, Spain
  15. 15 Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  16. 16 Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
  17. 17 Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
  18. 18 Oncogynecology, Kazahskij Naucno-issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
  19. 19 Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
  20. 20 IPO-PORTO, Porto, Portugal
  21. 21 LISOD - Israeli Oncological Hospital, Kyiv, Ukraine
  22. 22 Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
  23. 23 Obstetrics and Gynecology; Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  24. 24 General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
  25. 25 Clinical Hospital Center, Zagreb, Croatia
  26. 26 Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
  27. 27 Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
  28. 28 Gynaecology, LUMC, Leiden, Netherlands
  29. 29 Obstetrics and Gynecology, University of Liege, Liege, Belgium
  30. 30 Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
  31. 31 Clinical Hospital Center Rijeka, Rijeka, Croatia
  32. 32 Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
  33. 33 Lviv Oncology Center, Lviv, Ukraine
  34. 34 North-Western State Medical University. N.N. Petrov Research Institute of Oncology, St Petersburg, Russia
  35. 35 Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
  36. 36 University Hospitals of Leicester NHS Trust, Leicester, UK
  37. 37 Medical University of Graz, Graz, Steiermark, Austria
  38. 38 Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
  39. 39 Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
  40. 40 Institut Curie, Paris, Île-de-France, France
  41. 41 Department of Medicine and Surgery, University of Milan–Bicocca, Milano, Italy
  42. 42 Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
  43. 43 North Estonia Medical Centre, Tallinn, Estonia
  44. 44 Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
  45. 45 Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
  46. 46 Obstetrics and Gynecology, Universidad de Navarra, Pamplona, Spain
  47. 47 Obstetrics and Gynecology, School of Medicine; University of Navarra, Pamplona, Spain
  1. Correspondence to Dr Luis Chiva, Obstetrics and Gynecology, Clinica Universidad de Navarra, 28027 Madrid, Spain; lchiva{at}unav.es

Abstract

Background Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse.

Methods We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group.

Results Mean age was 48.3 years (range; 23–83) while the mean BMI was 25.7 kg/m2 (range; 15–49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52).

Conclusions Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.

  • cervix uteri
  • surgical oncology
  • laparoscopes
  • neoplasm recurrence, local
  • laparotomy
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Footnotes

  • Twitter @#lchiv4, @r.bolatbekova@gmail.com, @RasiahBharathan, @Juan_L_Alcazar

  • Presented Plenary Session at the 21st European Congress on Gynaecological Oncology on November 2-5, 2019 in Athens, Greece.

  • Collaborators On behalf of the SUCCOR study Group: Nabil Abdalla, Sedat Akgöl, Demirkiran Aksahin, Shamistan Aliyev, Maria Alonso-Espias, Igor Aluloski, Claudia Andrade, Nikola Badzakov, Rosa Barrachina, Giorgio Bogani, Eduard-Aexandru Bonci, Hélène Bonsang-Kitzis, Felix Boria, Cosima Brucker, Laura Cárdenas, Andrea Casajuana, Pere Cavalle, Jorge Cea, Benito Chiofalo, Gloria Cordeiro, Pluvio Coronado, Maria Cuadra, Javier Díez, Teresa Diniz da Costa, Santiago Domingo, Lukas Dostalek, Fuat Elif, Diego Erasun, Mathias Fehr, Sergi Fernandez-Gonzalez, Annamaria Ferrero, Soledad Fidalgo, Gabriel Fiol, Khadra Galaal, José García, Gerhard Gebauer, Fabio Ghezzi, Juan Gilabert, Nana Gomes, Elisabete Gonçalves, Virginia Gonzalez, Frederic Grandjean, Miriam Guijarro, Frédéric Guyon, Jolien Haesen, Gines Hernandez-Cortes, Sofía Herrero, Imre Pete, Ioannis Kalogiannidis, Erbil Karaman, Andreas Kavallaris, Lukasz Klasa, Ioannis Kotsopoulos, Stefan Kovachev, Uppin Arno Leht, Arantxa Lekuona, Mathieu Luyckx, Michael Mallmann, Gemma Mancebo, Aljosa Mandic, Nabil Manzour, Tiermes Marina, Victor Martin, María Belén Martín-Salamanca, Alejandra Martinez, Gesine Meili, Gustavo Mendinhos, Liliana Mereu, Milena Mitrovic, Sara Morales, Enrique Moratalla, Bibiana Morillas, Eva Myriokefalitaki, Maja PakižImre, ImrePete, Stamatios Petousis, Laurentiu Pirtea, Natalia Povolotskaya, Sonia Prader, Alfonso Quesada, Mikuláš Redecha, Fernando Roldan, Philip Rolland, Reeli Saaron, Cosmin-Paul Sarac, Jens-Peter Scharf, Špela Smrkolj, Rita Sousa, Artem Stepanyan, Vladimír Študent, Carmen Tauste, Hans Trum, Taner Turan, Manuela Undurraga, Alicia Vázquez, Ignace Vergote, George Vorgias and Ignacio Zapardiel.

  • Contributors All authors contributed meaningfully to the conception or design of the work or the acquisition, analysis, or interpretation of data for the study. The authors confirm the completeness and accuracy of the data and analyses, the fidelity of the study to the protocol, and the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data will be available upon the requirement of the reviewers at any time.

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