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November 1 (UPI) – According to two studies published simultaneously, patients with cervical cancer undergoing minimally invasive hysterectomy have poorer survival prospects than an open procedure surgery.
Surgery for cervical cancer "based on the results of an epidemiological study published Wednesday in the New England Journal of Medicine.
Researchers reviewing a published phase 3 trial in the same issue of the New England Journal of Medicine only support open surgery.
Researchers at Harvard Medical School, MD Anderson Cancer Center, Faculty of Medicine and Public Health, University of Wisconsin and the Herbert Irving Comprehensive Cancer Center at Columbia University participated in the studies.
"These studies sound the death knell for minimally invasive radical hysterectomy in the treatment of cervical cancer – not necessarily, but this approach has dealt a blow," said Dr. Amanda N. Fader, professor in the Department of Gynecology. and Obstetrics at the Johns Hopkins School of Medicine, wrote in a newspaper editorial companion. "Although the data is alarming, some subgroups of patients may still benefit from a less invasive approach.
Cervical cancer is due to abnormal growth of cervical cancer cells. The uterus that are able to invade or spread to other parts of the body.
This is the fourth most frequently diagnosed cancer and the fourth leading cause of death About 13,240 women will be diagnosed with cervical cancer this year in the United States, according to the American Society of Clinical Oncology.
Current guidelines from the National Comprehensive Cancer Network and the European Society of Gynecologic Oncology indicate that laparotomy, which is open surgery, or laparoscopy, minimally invasive surgery, is an acceptable approach to Radical hysterectomy in patients with early cervical cancer of the uterus.
A hysterectomy involves the removal of the uterus, uterine cervix and other parts of the female reproductive system
Since 2006, radical hysterectomy at minimal invasion began to become popular. In 2010, just over one-third of radical hysterectomies had been performed with minimally invasive surgery, but by 2013, nearly 60% had been minimally invasive, the researchers noted.
In minimally invasive surgery, the abdomen is inflated with gas and very small incisions are made with the help of a camera and long instruments or a robot. Patients can sometimes return home the same day as the procedure, which is much shorter than open surgery.
In the most invasive surgery, there is a large incision of laparotomy in the middle of the abdomen.
In the epidemiological study, the risk of death within four years was 9.1% in women undergoing minimally invasive surgery, compared with 5.3% in the open surgical group. This means that women who undergo minimally invasive surgery are about 1.65 times more likely to die during this period than if they were undergoing open surgery.
"At this point, we recommend using only open surgery to perform a radical hysterectomy for cervical cancer," Dr. Shohreh Shahabi, co-lead author, Gynecologic Oncology Department Director the Feinberg School of Medicine at Northwestern University and Northwestern medical doctor, said in a press release regarding the study.
She pointed out that the results were specific to cervical cancer. "Minimally invasive surgery remains an excellent option for other surgeries and cancers."
"Although, according to our badyzes, we can not explain why minimally invasive surgery is badociated with lower overall survival, possible explanations include the potentially limited extent of tumor removal during minimal surgery. that tools used during minimally invasive hysterectomy can inadvertently spread tumor cells, "said Shahabi. [19659002] The study examined patient data from the National Cancer Database from 2010 to 2013, which includes 70% of all new cancer diagnoses in the United States.
A total of 2,461 patients with stage IA2 or IB1 cervical cancer were treated. with a radical hysterectomy. About half of these women underwent open surgery and the other half had minimally invasive surgery.
In the other study, 319 patients aged 46 years on average underwent minimally invasive surgery and 312 with open surgery from June 2008 to June 2017 at 33 centers. Of all patients, 91.9% had stage IB1.
Among patients who had minimally invasive surgery, 84.4% had laparoscopy and 15.6% had been operated on by a robot. The disease-free survival rate at 4.5 years was 86% with minimally invasive surgery and 96.5% with open surgery.
"Among the strengths of our trial is that it is a prospective randomized trial evaluating the oncological findings of the minimally invasive form of radical hysterectomy," wrote Dr. Pedro T. Ramirez. , director of the study at the Department of Gynecologic Oncology and Reproductive Medicine at the Mzd Anderson Cancer Center. "It included a large number of centers around the world and all centers had to demonstrate their skills in minimally invasive surgery.
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