Patterns of Recurrence after Laparoscopic and Open Abdominal Radical Hysterectomy for Cervical Cancer: A Propensity-Matched Analysis

Abstract

Study Objective To identify different patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer. Design This a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery. In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Setting Two oncologic referral centers. Patients or Participants Consecutive cervical cancer patients who developed recurrence after surgical treatments. Interventions Laparoscopic and open abdominal radical hysterectomy. Measurements and Main Results Chart of 1,058 cervical cancer patients were retrieved. The study population included 117 (14.2%) and 35 (14.9%) patients with recurrent cervical cancer who had had open abdominal and laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2) we reduced the study population to 105 patients (35 vs. 70 patients having recurrence after laparoscopic and open abdominal radical hysterectomy). The groups had similar baseline characteristics. Patients having laparoscopic radical hysterectomy experienced shorter progression-free survival than patients having open abdominal procedures (median progression-free survival: 8.0 vs. 15.8 months; HR: 1.98 (95%CI: 1.32 to 2.97); p=0.005). Site specific progression-free survival for vaginal, lymphatic and distant recurrences was similar between groups. However, patients having laparoscopy are at high risk of developing intra-pelvic recurrences and peritoneal carcinomatosis (HR: 17.9 (95%CI: 3.42 to 93.7); p=0.0006 log-rank test). Conclusion Patients having laparoscopy are at high risk of developing intra-pelvic recurrences and peritoneal carcinomatosis, due to unknown reasons (possibly due to a contamination of the pelvic area during colpotomy). Further evidence is needed in order to identify the best surgical treatment modality for cervical cancer patients.