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Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis
  1. Juliana Rodriguez1,2,
  2. Jose Alejandro Rauh-Hain3,
  3. James Saenz1,
  4. David Ortiz Isla4,
  5. Gabriel Jaime Rendon Pereira5,
  6. Diego Odetto6,
  7. Fabio Martinelli7,
  8. Vladimir Villoslada8,
  9. Ignacio Zapardiel9,
  10. Lina Maria Trujillo1,
  11. Milagros Perez4,
  12. Marcela Hernandez5,
  13. Jose Martin Saadi6,
  14. Francesco Raspagliesi7,
  15. Henry Valdivia8,
  16. Jaime Siegrist9,
  17. Shuangshuang Fu3,
  18. Mindy Hernandez Nava4,
  19. Lina Echeverry5,
  20. Florencia Noll6,
  21. Antonino Ditto7,
  22. Aldo Lopez8,
  23. Alicia Hernandez9 and
  24. Rene Pareja1,10
  1. 1Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
  2. 2Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
  3. 3Departments of Gynecologic Oncology and Reproductive Medicine and Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
  4. 4Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
  5. 5Department of Gynecologic Oncology, Instituto de Cancerologia Las Américas, Medellín, Colombia
  6. 6Gynecology Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  7. 7Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  8. 8Department of Gynecologic Oncology, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
  9. 9Gynecologic Oncology Unit. La Paz University Hospital, La Paz University Hospital—IdiPAZ, Madrid, Spain
  10. 10Gynecologic Oncology, Clinica Astorga, Professor Universidad Pontificia Bolivariana, Medellin, Colombia
  1. Correspondence to Dr Rene Pareja, Gynecologic Oncology, Clinica Astorga, Professor Universidad Pontificia Bolivariana, Medellin, Colombia; ajerapener{at}gmail.com

Abstract

Introduction Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.

Methods We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.

Results A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8–201.2) in the laparoscopic group and 52.6 months (range, 0.4–166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09–2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05–4.37; P=0.03).

Conclusion In this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

  • uterine cervical neoplasms
  • hysterectomy

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Footnotes

  • Twitter @DrFMartinelli, @dramilagrospqGO

  • Contributors Study design: JR, RP, GR, DI, VV, DO, IZ, FM. Data acquisition: JS, MH, MH, AH, JS, VV, FN. Central audit: JS, MH. Data interpretation: JAR, JR, SF, RP. Manuscript writing: JR, JAR, RP. Manuscript review: JR, JAR, JS, DI, GR, DO, VV, IZ, JS, SF, FN, AL, RP.

  • Funding This study was not supported by any person or institution.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval IRB in each participant institution.

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

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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