J Minim Invasive Gynecol. 2020 Jul 27:S1553-4650(20)30352-6. doi: 10.1016/j.jmig.2020.07.021. Online ahead of print.
STUDY OBJECTIVE: To compare outcomes after minimally invasive (MIS) versus open radical hysterectomy for early-stage cervical cancer incorporating 2018 FIGO staging.
DESIGN: A retrospective analysis.
SETTING: A single teaching hospital.
PATIENTS: Patients after radical hysterectomy for stage IA1 with LVSI, IA2, or IB1 squamous, adenosquamous, or adenocarcinoma of the cervix between 2007-2018, mirroring the LACC trial criteria.
INTERVENTIONS: The use of minimally invasive surgery for performing radical hysterectomy.
MEASUREMENTS AND MAIN RESULTS: Outcomes were compared between patients undergoing MIS versus open approaches. A total of 126 patients met inclusion criteria. The approach was open in 44 patients (35%) and MIS in 82 patients (65%); 49% were laparoscopic and 51% were robotic. Distribution based on 2009 FIGO staging showed 1 stage IA1 with LVSI, 15 stage IA2, and 110 stage IB1 patients. Although not statistically significant, the 3-year disease-free survival (DFS) was higher in the open compared to the MIS group (95% vs. 87%; P = .17) and the overall survival (OS) was higher in the open compared to the MIS group (97% vs. 92%; P = .25). 14 patients who recurred were Stage IB1 by FIGO 2009 staging; 11/14 were reclassified to a higher stage by 2018 FIGO staging (5/5 open, 6/9 MIS). Of these, adjuvant therapy was recommended in 100% patients based on Sedlis criteria (10/14) or other risk factors (4/14). Despite this, only 1/9 of MIS patients who recurred received adjuvant therapy compared with 3/5 patients who recurred in the open group (P = .05).
CONCLUSION: In a cohort of patients similar to the LACC trial, 2018 FIGO staging may be useful to refine indications for minimally invasive radical hysterectomy in early-stage cervical cancer. However, disparate outcomes between MIS and open approaches may be explained by differences in compliance with NCCN guidelines for adjuvant therapy.