CHICAGO -- Minimally invasive surgery (MIS) for cervical cancer had fewer side effects and cost less than open radical hysterectomy, a researcher said here.
But in some cases where the tumor is >2 cm, such procedures may have an increased risk of death, reported Daniel Margul, MD, of Northwestern University in Chicago, at the American Society of Clinical Oncology (ASCO) annual meeting.
The findings come on the heels of two other studies with much the same results and might be enough to change clinical practice, which has seen an increasing reliance on minimally invasive techniques in recent years.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"We really need to dig into the data to see if we should change practice, but this is the way practice is changed," commented Shannon Westin, MD, of MD Anderson Cancer Center in Houston.
Margul's and colleagues analyzed retrospective data on women with stage 1B1 cervical cancer -- cases in which the tumor is visible to the eye but still <4 cm at its largest diameter -- might or might not have spread to nearby lymph nodes, and has not spread to distant sites.
Such cancers are regarded as early stage but are the most advanced in that category to still be treated with surgery.
In March 2018, two studies -- one prospective and one retrospective -- found significantly greater recurrence and worse survival for minimally invasive surgery, although the absolute numbers were small and the cancer staging was slightly different
"What we are seeing is that the same findings have been repeated now three times," Westin, who was not involved in the study, told 51˶. She suggested that it might be time to take closer look at minimally invasive surgery, which includes laparoscopic procedures as well as robot-assisted surgery.
The advantage of the current study is that it had enough power to tease out the effect of tumor size, and it will be important to see if the data from the other studies can confirm that the risk is confined to the larger tumors, she stated.
Margul's group used the 2010-2013 National Cancer Database to evaluate the 5-year survival of women with stage IB1 cervical squamous cell carcinoma or adenocarcinoma after radical hysterectomy performed open or by minimally invasive surgery.
Then they used the 2010-2015 Premier Healthcare Database to compare complications, length of stay, readmission rates, and hospital costs between the surgical types.
The cancer database showed that 854 women had open surgery and 807 women underwent MIS radical hysterectomy. There were 87 deaths overall.
The key finding from that analysis was that 5-year overall survival was significantly worse for women who had open surgery, with a hazard ratio 1.92 for death.
That was driven by women with a tumor size of ≥2 cm, who had a 5-year survival rate of 81.3%, compared with 90.8% for open surgery. Those numbers yielded an HR 2.39 for death. On the other hand, if tumors were <2 cm, there was no significant difference in survival, he reported.
Both of the earlier studies also showed a marked increase in the risk of death with minimally invasive surgery.
The difference might be a function of the greater experience needed to use minimally invasive surgery safely in patients with larger tumors, commented ASCO discussant Ginger Gardner, MD, of Memorial Sloan Kettering Cancer Center in New York City.
The study is a "very important piece of work," she sad, because it focuses attention on the larger malignancies.
Margul reported that the Premier hospital database had information on 2,830 women who had a radical hysterectomy, including 45.1% with open surgery, 48.9% with robotic surgery, and 6% with laparoscopic surgery.
Open surgery was associated with a median of 3 days in hospital, compared with 1 day for robotic surgery, and no hospital stay with laparoscopic procedures. Total surgical and hospital costs were significantly in favor of minimally invasive procedures, at $12,080 for open surgery, $1,1562 for robotic surgery, and $9,649 for laparoscopic operations.
On the other hand, open surgery had a 44.9% composite complication rate, compared with than 13.9% and 12.4% for robotic and laparoscopic procedures, respectively. Specifically, open surgery had increased bowel injuries, infections, electrolyte or fluid disorders, transfusions, and ileus.
Disclosures
Margul disclosed no relevant relationships with industry.
Primary Source
American Society of Clinical Oncology
Margul DJ, et al "Outcomes and costs of open, robotic, and laparoscopic radical hysterectomy for stage IB1 cervical cancer" ASCO 2018; Abstract 5502.