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Women with early cervical cancer who opt for minimally-invasive surgery are more likely to have their tumors reappeared than those who have a conventional hysterectomy, according to which studies could dramatically change treatment for the deadly malignancy.
Minimally-invasive laparoscopic surgery involves just three or four small incisions in the abdomen to remove the uterus. Recovery time is much faster than traditional "open" surgery, which involves a single large incision.
"You have a four-fold greater likelihood of recurrence" with the less-invasive technique, said Dr. Pedro Ramirez of the University of Texas at the Anderson Cancer Center in Houston, who said Randomized comparison of the procedures published in the New England Journal of Medicine.
A second study in nearly 2,500 women and men was found to be 65 percent higher with the less-invasive operation.
The reason less-invasive surgery is less safe remains a mystery.
The Ramirez study "was never designed to determine the cause of this inferiority," Ramirez told Reuters Health in a phone interview.
Similar less-invasive surgery is used to treat endometrial, ovarian and uterine cancers, but for those malignancies, studies have shown that minimally-invasive surgery does not pose a higher risk of complications, death or tumor recurrence, noted Dr. Jason Wright, chief University of New York City, University of New York, and the University of New York City.
So with cervical cancer, Wright said in a phone interview, "this is definitely not what we expected to find."
Cervical cancer strikes about 13,200 women in the US each year and nearly 4,200 die from it annually, according to the American Cancer Society.
The new findings could not be reduced to minimally invasive surgery for this type of cancer, even though it has become more popular since 2006, the doctors said.
Dr. Anderson has discontinued using it for early-stage disease since the new study uncovered the higher recurrence rate, Ramirez noted. So have other medical centers that learned of the results, beginning at a medical meeting in March.
Before minimally-invasive treatment became widely adopted, survival times for women with cervical cancer were improving. A minimally-invasive embryo surgery that reverses the pace of survival in the four-year survival of 0.8 percent per year between 2006 and 2010, "Wright's team reports in their paper.
In an interesting twist, Wright's team found that women were not white, and they were not white, and they were more likely to have undergone "open" surgery, blood loss and other drawbacks. Yet those women were more likely to survive. Socioeconomic factors are often tied to treatment success.
If anything, "we should have expected the patients who had opened surgery to do worse, and that was not the case," Wright said. "The bias should have been other way in this study, which was another surprising factor."
However, Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that he suspected that middle-and upper-class women might be more likely to push for less-invasive surgery. less comfortable with it.
If you find the doctor who is comfortable doing the laparoscopic procedure, I think the results would be just as good with open surgery, "he said.
The women in the two studies had stages of IA2 and IB1 cervical cancer, meaning their tumors were small – and possibly microscopic.
Ramirez and his colleagues found that the disease was 4.5 years old, 96.5 percent with open surgery and 86 percent with minimally-invasive surgery. Even after adjusting for issues such as age, weight, the stage of the tumor, and the fact that it had spread to the lymph nodes, minimally invasive surgery was not good for survival.
In the retrospective database study, four-year death rates were 5.3 percent with open surgery and 9.1 percent with minimally-invasive surgery.
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