Patients with early-stage cervical cancer undergoing open radical hysterectomy have shown significantly better outcomes than those who opt for minimally invasive radical hysterectomy, according to a comprehensive five-year study conducted by Houston Methodist Hospital researchers. Published in the Journal of Clinical Oncology, this study extends and validates the findings of the Laparoscopic Approaches to Cervical Cancer (LACC) trial, which previously influenced the National Comprehensive Cancer Network to recommend open surgery over laparoscopic radical hysterectomy.
Dr. Pedro T. Ramirez, the study's first author and chair of the Department of Obstetrics and Gynecology at Houston Methodist, emphasized the importance of ensuring that minimally invasive procedures, despite their benefits in reducing perioperative complications and speeding recovery, do not compromise long-term outcomes, especially in cancer treatment. The study's findings clearly indicate that minimally invasive surgery does not match the efficacy of open surgery for early-stage cervical cancer.
The research followed participants to a four-and-a-half-year endpoint, analyzing disease-free survival, overall survival, tumor size, and prior treatments in detail. It confirmed that open surgery offers higher overall survival and disease-free survival rates compared to minimally invasive surgery (MIS). Specifically, the study found that overall survival was 96.2% for open surgery versus 90.6% for MIS, and disease-free survival was 96% for open surgery compared to 85% for MIS.
Participants were four times more likely to relapse and three times more likely to die following minimally invasive techniques than after open radical hysterectomy. Before the LACC trial's publication, nearly 75% of cervical cancer-associated radical hysterectomies were performed minimally invasively, based on studies showing lower perioperative complication rates and equivalent oncologic outcomes for endometrial cancer at the five-year mark.
Dr. Ramirez speculated on potential reasons for the inferior outcomes of minimally invasive surgery in cervical cancer, including the use of gas to expand the abdomen, surgical manipulators, and the necessity of dragging the cervix through the vaginal cavity for removal, all of which could increase the risk of tumor spillage and metastasis. Ongoing studies aim to identify the precise causes and explore safer minimally invasive procedures.
Currently, the best practice recommends against minimally invasive radical hysterectomies for cervical cancer patients unless they are part of an IRB-monitored clinical trial. Dr. Ramirez stressed the importance of disseminating the LACC trial's results to prevent the continued use of minimally invasive techniques in inappropriate cases, which can lead to metastasis of what was once a curable condition.
The LACC trials received partial support from Medtronic and philanthropic donations, with Dr. Ramirez collaborating with a team of researchers to bring these critical findings to light.
