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Studies conclude open surgery a better option for early cervical cancer than less invasive procedures

February 27, 2019 | by CTCA

Robotic-Surgery
Learn why minimally invasive surgeries may not be a good option for patients with early-stage cervical cancer.

For decades, robotic and minimally invasive surgeries have offered doctors and patients a less invasive option compared to radical abdominal operations. Robotic and laparoscopic, or keyhole, surgeries are performed through smaller incisions that are designed to reduce blood loss and post-operative pain. Smaller incisions also may need less time to heal, reduce scarring and require no or shorter hospital stays.

For patients with early-stage cervical cancer, however, recent studies show minimally invasive surgery may not be a good option. A clinical trial and a study by researchers at MD Anderson Cancer Center and Massachusetts General Hospital, respectively, concluded that cervical cancer patients treated with minimally invasive surgery had higher recurrence rates and worse overall survival. “Our research found that compared with open surgery, minimally invasive surgery increased the risk of death among women who underwent radical hysterectomy for early-stage cervical cancer,” J. Alejandro Rauh-Hain, MD, a researcher in one study, says in a statement released by MD Anderson.

The results of the two studies shocked the medical community, including the researchers themselves. “This is the first piece of compelling data that shows one procedure is inferior,” Julian Schink, MD, Chief Medical Officer at Cancer Treatment Centers of America® (CTCA) and Chief of the Division of Gynecologic Oncology at CTCA® told the news website Insider.

A clinical trial conducted by MD Anderson divided a group of 600 patients into two groups assigned to receive either open or minimally invasive surgery for early-stage cervical cancer. The trial was halted in 2017 after women who had received minimally invasive radical hysterectomies experienced higher rates of recurrences. The rate of disease-free survival was 86 percent in patients who had minimally invasive surgery, compared to 96.5 percent in patients who had open surgery. The second study looked at more than 2,400 women who had a radical hysterectomy to treat cervical cancer between 2010 and 2013. “Minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma,” researchers concluded.

  Cancer type      New cases     % of all  
  new cases  
 %  surviving  
  5 years  
Uterine/endometrial
63,230
3.6
81.1
Ovarian
22,240
1.3
47.4
Cervical
13,240
0.8
66.2
Vulvar
6,190
0.4
71

Several theories have been floated as to why cervical cancer may recur at a higher rate in patients treated with minimally invasive surgery. While it’s possible the minimally invasive surgery may leave some cancer behind, Dr. Schink says the way these surgeries are performed may push cancer cells into the patient’s lymphatic system. Before surgery, a patient’s abdomen is inflated with carbon monoxide to create more space for the surgeon to operate. That process creates pressure that may pump cancer cells into the patient’s system, he theorizes. Also, the cervix’s constant movement during the procedure “could be pushing cancer cells out into the lymphatics,” Dr. Schink says. “The issue is that minimally invasive surgery probably pushes cancer out in a way that open surgery doesn’t.”

The two studies covered only cervical cancer and not other gynecologic cancers or prostate cancer, which is often treated with robotic surgery. In fact, a similar study measuring the results of minimally invasive surgery vs. open surgery for endometrial cancer, which is far more common than cervical cancer, showed nearly no difference in the overall survival rates of patients, Dr. Schink says. Minimally invasive surgery is less commonly used to treat ovarian cancer. Dr. Schink also notes that the studies did show that, “the vast majority of patients got effective treatment.”

“These studies emphasize the remarkable progress we’ve made in the treatment of cervical cancer,” Dr. Schink says. “In the one group, the survival was over 95 percent. That’s amazing. And it wasn’t always that way. We’ve come a long way in the treatment of this cancer.”

Learn more about treatments for gynecologic cancers.