Patients with cervical cancer face greater risks with minimally invasive surgery: shots

According to two studies, a treatment for early-stage cervical cancer, which was quickly accepted in the United States, is worse than conventional surgery.

The practice, now called into question, is called minimally invasive surgery. The instruments are threaded into small incisions and the surgeons use them to remove a diseased uterus. This technique has been gaining popularity since 2006 and has been widely adopted.

But it turns out that minimally invasive surgery for early-stage cervical cancer involves unexpected risks. The studies were published online Wednesday in the New England Journal of Medicine.

"Patients who had minimally invasive surgery were four times more likely to [cancer] recurrence only when they have undergone open surgery, "says Dr. Pedro Ramirez at the MD Anderson Cancer Center in Houston.

This is the surprising result of a study that he co-wrote comparing the minimally invasive approach to conventional surgery with a large incision. The study involved more than 600 women recruited from medical centers around the world. Half of their uterus was removed by open abdominal surgery; the other half underwent minimally invasive surgery.

A security office responsible for supervising the experiment ended its activities before the planned end, as it became clear that the women in the at least invasive group were doing much worse.

These women were also less likely to be alive four and a half years after the surgery. About 94% of women were still alive after minimally invasive surgery, compared to 99% of women who had standard surgery for early-stage cancers. (Women with more advanced cervical cancer are usually treated with chemotherapy and radiotherapy rather than surgery.)

According to Ramirez, MD Anderson's surgeons "have decided to stop offering radical mini-invasive hysterectomy and to completely convert to the open approach".

The research team presented preliminary results at a cancer meeting in March. Since then, physicians across the United States have reconsidered their approach to treating early cervical cancer.

What causes this effect is a bit mysterious. According to similar high quality studies, "For uterine cancer, minimally invasive surgery is safe," said Ramirez. This suggests that cancer cells in the cervix could be released more easily during a procedure. According to Ramirez, the carbon dioxide gas used to inflate the abdomen during this operation could also play a role.

The study was funded in part by Medtronic medical device manufacturer. Ramirez said the company had no role in the analysis or publication of the results.

To make the results even more compelling, a second study published alongside this report leads to the same conclusion about minimally invasive surgery for early cervical cancer.

For the second report, a research team led by scientists at Northwestern University reviewed national cancer data and found that after four years, 9% of women who had minimally invasive surgery had died, compared with 5% of women who had open surgery.

"It's a big problem," says Masha Kocherginsky, an epidemiologist and co-author of the study. "These patients are patients with an early stage of cancer and the goal of the surgical treatment is to heal."

In addition, the researchers noted that the national trend in early cervical cancer survival, which had been improving for years, began to decline in 2006, just as minimally invasive surgery began to become popular. .

The news of these results is widespread among physicians and, as a result, national guidelines are already changing to reflect the risks and benefits of both approaches.

Dr. Emma Barber, from the North West, explains that she is now informing her patients about the choice they are facing. "I think more and more, the surgery will be open for many women," she says, "but it may be that minimally invasive surgery still has a role to play in some patients."

You can contact Richard Harris at [email protected].