Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer.
Gynecol Oncol
; 153(1): 3-12, 2019 04.
Article
em En
| MEDLINE
| ID: mdl-30642625
ABSTRACT
OBJECTIVE:
To compare survival outcomes of minimally invasive surgery (MIS) and conventional open surgery for radical hysterectomy (RH) among patients with early-stage cervical cancer (CC).METHODS:
We retrospectively identified stage IB1-IIA2 CC patients who underwent either laparoscopic or open Type C RH between 2000 and 2018. Patients' clinicopathologic characteristics and survival outcomes were compared according to the surgical approach. For a more robust statistical analysis, we narrowed the study population down to the patients with stage IB1 who underwent pre-operative MRI.RESULTS:
In total, 435 and 158 patients were assigned to open surgery and MIS groups, respectively. MIS group had significantly less parametrial invasion (6.3% vs. 15.4%; Pâ¯=â¯0.004). Despite similar proportions of patients received adjuvant treatment, concurrent chemoradiation therapy was performed less frequently in MIS group. After a median follow up of 114.8â¯months, the groups showed similar overall survival; however, MIS group displayed poorer progression-free survival (PFS; 5-year rate, 78.5% vs. 89.7%; Pâ¯<â¯0.001). Multivariate analyses identified MIS as an independent poor prognostic factor for PFS (adjusted HR, 2.883; 95% CI, 1.711-4.859; Pâ¯<â¯0.001). Consistent results were observed among 349 patients with stage IB1 MIS was associated with higher recurrence rates (adjusted HR, 2.276; 95% CI, 1.039-4.986; Pâ¯=â¯0.040). However, MIS did not influence PFS of stage IB1 patients with cervical mass size ≤2â¯cm on pre-operative MRI (adjusted HR, 1.146; 95% CI, 0.278-4.724; Pâ¯=â¯0.850).CONCLUSIONS:
Overall, MIS RH was associated with higher recurrence rates than open RH in patients with early-stage CC. However, MIS was not a poor prognostic factor among those with stage IB1 and cervical mass size ≤2â¯cm on pre-operative MRI.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias do Colo do Útero
/
Procedimentos Cirúrgicos Minimamente Invasivos
/
Histerectomia
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
/
Middle aged
País/Região como assunto:
Asia
Idioma:
En
Revista:
Gynecol Oncol
Ano de publicação:
2019
Tipo de documento:
Article