Cervical cancer patients may benefit from new surgical technique

Abstract

A new surgical technique may help reduce complications and improve recurrence in patients with early-stage cervical cancer, according to a study published in Lancet Oncology.1 Called a total mesometrial resection (TMMR), the techniqne is a modified traditional radical hysterectomy that is more accurate and anatomically based, allowing there to be less damage to the autonomic nerve system and less surgical trauma, according to lead author Michael Höckel, MD, of the University of Leipzig, Germany. Standard hysterectomy has a relatively high rate of recurrence, and many patients have postoperative bowel and bladder dysfunction. In addition, the standard postoperative radiotherapy that is used has a number of side effects, notes Dr. Höckel. Under current guidelines, the standard hysterectomy involves the removal of pelvic tissue adjacent to the tumor along with the cervix. But some experts believe that localized cancer may only spread to the Müllerian compartment (the fallopian tubes, uterus, proximal, middle vagina, and their embryologically defined mesotissues). As a result, they conclude that removing the complete Müllerian compartment in early-stage disease could reduce recurrence and morbidity. To confirm this theory, Dr. Höckel and his colleagues assessed the effectiveness of TMMR without radiotherapy in 212 patients with early-stage cervical cancer who received treatment at the University of Leipzig between 1999 and 2008. They reported recurrence-free survival of 94% and 5-year survival of 96%. At 41 months, 10 patients had, a recurrence of their cancer. The overall recurrence rate was 5% compared with 28% for patients treated with standard radical hysterectomy. Meanwhile, the 5-year survival for patients with positive lymph nodes was 91% compared with 68% treated with the standard technique. In addition, 63% had no treatment-related complications, while 35% and 20% had grade 1 and 2 complications, respectively. No grade 3 and 4 complications were reported. Dr. Höckel and his colleagues conclude that TMMR without adjuvant radiation may improve survival by 15% but that multi-institutional controlled trials must further assess the technique.