Minimally invasive versus open surgery for stage 1A1 and 1A2 cervical cancer

Abstract

<h3>Objectives:</h3> Recent studies comparing minimally invasive versus open radical hysterectomy in patients with early stage cervical cancer have reported a worse overall survival with minimally invasive surgery (MIS). However, in the patients with microscopic disease, there was no survival difference and the optimal surgical approach for microscopic cervical cancer remains unclear. Our aim was to compare the overall survival and surgical outcomes between open and MIS in a large cohort of women with stage IA1/IA2 cervical cancer. <h3>Methods:</h3> Using the National Cancer Database, we identified a cohort of women who underwent hysterectomy as the primary treatment for stage IA1/IA2 cervical cancer between January 2010 and December 2016. Outcomes were compared between the cohorts using the Mann-Whitney U test, the chi- squared test or Fisher's exact test. Multivariable logistic regression was used to determine clinical characteristics that were statistically significant predictors of outcome. P values <0.05 were significant. The data was stratified for radical and simple hysterectomy. We also compared the readmission rates and length of stay (LOS) among the groups. <h3>Results:</h3> We identified 6230 patients with stage IA1 and IA2 cervical cancer that underwent hysterectomy as primary treatment. 4054 of these women (65%) underwent MIS and 1931 women had a radical hysterectomy. In this group, 1152 had a minimally invasive radical hysterectomy. In the overall cohort, there was no difference in survival between the open and the MIS group (Hazard ratio for the open group 1.23; CI 0.92-1.63). When stratified, the data showed no difference in overall survival for stage IA1 cases (HR 1.15; CI 0.77-1.73). For women with stage IA2, there was a trend towards decreased overall survival in the open group that did not reach statistical significance (HR 1.64; CI 0.84-3.23). Of note, post-operative radiation therapy was more common in the open group (5.24% vs 4.09%, p value <0.02). The mean LOS (1.35 days vs 3.08 days) was shorter in MIS group (pvalue <0.0001). No statistical significance was found in the readmission rates (60% for the MIS group vs 55% for the open group; p value 0.14). For the women who underwent a radical hysterectomy, there was no difference in survival between the open and the MIS cohort (p value 0.31) and as expected, the MIS group was associated with a decreased length of stay. <h3>Conclusions:</h3> Our data suggest that MIS is associated with similar overall survival and shorter length of hospital stay compared to the open hysterectomy in women with stage IA cervical cancer. When the data was stratified to simple and radical hysterectomy, the results were the same. Those women having open surgery were more likely to get post-operative radiation therapy. Based on this large data set, MIS appears to be a safe and effective surgical approach for women with stage IA1/IA2 cervical cancer.