Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study

To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions. Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinom...

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Published in:	Journal of clinical oncology Vol. 38; no. 10; pp. 1030 - 1040
Main Authors:	Uppal, Shitanshu, Gehrig, Paola A, Peng, Katherine, Bixel, Kristin L, Matsuo, Koji, Vetter, Monica H, Davidson, Brittany A, Cisa, M Paige, Lees, Brittany F, Brunette, Laurie L, Tucker, Katherine, Stuart Staley, Allison, Gotlieb, Walter H, Holloway, Robert W, Essel, Kathleen G, Holman, Laura L, Goldfeld, Ester, Olawaiye, Alexander, Rose, Stephen L
Format:	Journal Article
Language:	English
Published:	United States 01-04-2020
Subjects:	Aged Aged, 80 and over Disease-Free Survival Female Humans Hysterectomy - methods Hysterectomy - statistics & numerical data Kaplan-Meier Estimate Middle Aged Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - pathology Neoplasm Staging Retrospective Studies Uterine Cervical Neoplasms - epidemiology Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - surgery
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Summary:	To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions. Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 1, 2010 and December 31, 2017. Of 815 patients, open RH was performed in 255 cases (29.1%) and minimally invasive RH in 560 cases (70.9%). There were 19 (7.5%) recurrences in the open RH and 51 (9.1%) recurrences in the minimally invasive group ( = .43). Risk-adjusted analysis revealed that minimally invasive RH was independently associated with an increased hazard of recurrence (aHR, 1.88; 95% CI, 1.04 to 3.25). Other factors independently associated with an increased hazard of recurrence included tumor size, grade, and adjuvant radiation. Conization before surgery was associated with lower recurrence risk (aHR, 0.4; 95% CI, 0.23 to 0.71). There was no difference in OS in the unadjusted analysis (HR, 1.14; 95% CI, 0.61 to 2.11) or after risk adjustment (aHR, 1.01; 95% CI, 0.5 to 2.2). Of 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor on final pathology), 2/82 (2.4%) recurred in the open RH group and 16/182 (8.8%) in the minimally invasive RH group ( = .058). In propensity score matching analysis, 7/159 (4.4%) recurrences were noted in the open RH group and 18/156 (11.5%) in the minimally invasive RH group ( = .019). Survival analysis revealed an increased risk of recurrence in the minimally invasive group in propensity-matched cohort (HR, 2.83; 95% CI, 1.1 to 7.18). In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior DFS but not overall survival in the entire cohort.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.19.03012