Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: A retrospective database cohort study

Judy Hayek; Mia Mowzoon; Saleshi Demissie; Albert Palileo; Eli Serur; Gary L Goldberg; Ioannis Alagkiozidis

doi:10.1016/j.amsu.2022.103507

Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: A retrospective database cohort study

Ann Med Surg (Lond). 2022 Apr 7:77:103507. doi: 10.1016/j.amsu.2022.103507. eCollection 2022 May.

Authors

Judy Hayek¹, Mia Mowzoon¹, Saleshi Demissie², Albert Palileo³, Eli Serur³, Gary L Goldberg⁴, Ioannis Alagkiozidis⁵

Affiliations

¹ Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, USA.
² Department of Biostatistics, Feinstein Institutes for Medical Research, Staten Island University Hospital, Northwell Health, USA.
³ Department of Gynecologic Oncology, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, USA.
⁴ Department of Obstetrics & Gynecology and Gynecologic Oncology, Zucker School of Medicine at Hofstra/Northwell at Long Island Jewish Medical Center and Feinstein Institutes for Medical Research, USA.
⁵ Department of Gynecologic Oncology, Maimonides Medical Center, USA.

Abstract

Background: 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.

Methods: 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. Using multivariable logistic regression, our primary outcome was to compare overall survival between the open and MIS groups. The data was stratified for simple and radical hysterectomies. Secondary endpoint was comparison of readmission rates and length of stay (LOS).

Results: We identified 6230 patients with stage IA1 and IA2 cervical cancer that underwent hysterectomy as primary treatment. 4054 of these women (65%) underwent MIS. There was no difference in age, lympho-vascular invasion, number of lymph nodes retrieved and histology between the two groups. 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). 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 (p value < 0.0001). No difference was found in the readmission rates (60% for the MIS group vs 55% for the open group; p value 0.14).

Conclusions: 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. Based on this large data set, MIS appears to be a safe and effective surgical approach for women with stage IA1/IA2 cervical cancer.

Keywords: Cervical cancer stage IA; LACC trial; Length of stay; Minimally invasive hysterectomy; Overall survival; Readmission; Surgical outcomes.