Skip to main content

Advertisement

SpringerLink
Log in

Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of the study was to compare recurrence-free survival (RFS) and overall survival (OS) of patients with early stage cervical cancer in dependence of surgical approach and treatment center.

Patients and methods

A population-based cohort study including women with early stage IA1-IIB2 cervical cancer treated by radical hysterectomy between January 2010 and December 2015 was performed.

Results

The median follow-up time was 5.6 years. After exclusions, 413 patients were eligible for analysis: 111 (26.9%) underwent minimal-invasive surgery (MIS) and 302 (73.1%) open surgery. Both treatment groups were well balanced regarding the clinical and pathological characteristics. The mean age of the patients was 51.0 years. MIS was associated with improved RFS and OS compared with the open surgery. The 5-year RFS rates were 89.2% in the MIS group and 73.4% in the open surgery group (p = 0.004). The 5-year OS rates were 93.7% in the MIS group and 81.8% in the open surgery group (p = 0.016). After adjustment for other prognostic covariates, the MIS was further associated with improved RFS (HR = 0.45, 95% CI 0.24–0.86; p = 0.015) but not with OS. Nevertheless, after adjustment for treatment center, the surgical approach was not associated with significant difference in RFS (HR = 0.61, 95% CI 0.31–1.19; p = 0.143). Overall survival of patients treated in university cancer centers was significantly increased compared to patients treated in non-university cancer centers. The treatment center remains a strong prognostic factor regarding RFS (HR = 0.49, 95% CI 0.28–0.83; p = 0.009) and OS (HR = 0.50, 95% CI 0.26–0.94; p = 0.031).

Conclusions

The treatment center but not the surgical approach was associated with the survival of patients treated with radical hysterectomy for early stage cervical cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Alfonzo E, Wallin E, Ekdahl L et al (2019) No survival difference between robotic and open radical hysterectomy for women with early stage cervical cancer: results from a nationwide population-based cohort study. Eur J Cancer 116:169–177

    Article  Google Scholar 

  2. Bogani G, Cromi A, Uccella S et al (2014) Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched analysis. J Minim Invasive Gynecol 21:857–862

    Article  Google Scholar 

  3. Bogani G, Leone Roberti Maggiore U, Rossetti D et al (2019) Advances in laparoscopic surgery for cervical cancer. Crit Rev Oncol Hematol 143:76–80

    Article  Google Scholar 

  4. Casarin J, Buda A, Bogani G et al (2020) Predictors of recurrence following laparoscopic radical hysterectomy for early stage cervical cancer: a multi-institutional study. Gynecol Oncol 159(1):164–170

    Article  CAS  Google Scholar 

  5. Colombo N, Carinelli S, Colombo A et al (2012) Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii27-32

    Article  Google Scholar 

  6. Conrad LB, Ramirez PT, Burke W et al (2015) Role of minimally invasive surgery in gynecologic oncology: an updated survey of members of the society of gynecologic oncology. Int J Gynecol Cancer 25:1121–1127

    Article  Google Scholar 

  7. Cusimano MC, Baxter NN, Gien LT et al (2019) Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. Am J Obstet Gynecol 221:619

    Article  Google Scholar 

  8. Diver E, Hinchcliff E, Gockley A et al (2017) Minimally Invasive Radical Hysterectomy for Cervical Cancer Is Associated With Reduced Morbidity and Similar Survival Outcomes Compared With Laparotomy. J Minim Invasive Gynecol 24:402–406

    Article  Google Scholar 

  9. Eggemann H, Ignatov T, Geyken CH et al (2018) Management of elderly women with cervical cancer. J Cancer Res Clin Oncol 144:961–967

    Article  Google Scholar 

  10. Falconer H, Palsdottir K, Stalberg K et al (2019) Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. Int J Gynecol Cancer 29:1072–1076

    Article  Google Scholar 

  11. Hillemanns P, Brucker S, Holthaus B et al (2019) Updated Opinion of the Uterus Commission of the Gynecological Oncology Working Group (AGO) and the Gynecological Endoscopy Working Group (AGE) of the German Society of Gynecology and Obstetrics (DGGG) on the randomized study comparing minimally invasive with abdominal radical hysterectomy for early stage cervical cancer (LACC). Geburtshilfe Frauenheilkd 79:145–147

    Article  Google Scholar 

  12. Hwang JH, Yoo HJ, Joo J et al (2012) Learning curve analysis of laparoscopic radical hysterectomy and lymph node dissection in early cervical cancer. Eur J Obstet Gynecol Reprod Biol 163:219–223

    Article  Google Scholar 

  13. Kim SI, Lee M, Lee S et al (2019) Impact of laparoscopic radical hysterectomy on survival outcome in patients with FIGO stage IB cervical cancer: a matching study of two institutional hospitals in Korea. Gynecol Oncol 155:75–82

    Article  Google Scholar 

  14. Kimmig R, Ind T (2018) Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study. J Gynecol Oncol 29:e75

    Article  Google Scholar 

  15. Lee B, Kim K, Park Y et al (2018) Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer: a systematic review and meta-analysis. Medicine (Baltimore) 97:e13445

    Article  Google Scholar 

  16. Melamed A, Margul DJ, Chen L et al (2018) Survival after Minimally Invasive Radical Hysterectomy for Early stage Cervical Cancer. N Engl J Med 379:1905–1914

    Article  Google Scholar 

  17. Nam JH, Park JY, Kim DY et al (2012) Laparoscopic versus open radical hysterectomy in early stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol 23:903–911

    Article  Google Scholar 

  18. Nie JC, Yan AQ, Liu XS (2017) Robotic-assisted radical hysterectomy results in better surgical outcomes compared with the traditional laparoscopic radical hysterectomy for the treatment of cervical cancer. Int J Gynecol Cancer 27:1990–1999

    Article  Google Scholar 

  19. Nitecki R, Ramirez PT, Frumovitz M et al. (2020) Survival After Minimally Invasive vs Open Radical Hysterectomy for Early stage Cervical Cancer: A Systematic Review and Meta-analysis. JAMA Oncol

  20. Papathemelis T, Knobloch S, Gerken M et al (2019) Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer. J Cancer Res Clin Oncol 145:1369–1376

    Article  Google Scholar 

  21. Pergialiotis V, Rodolakis A, Christakis D et al (2013) Laparoscopically assisted vaginal radical hysterectomy: systematic review of the literature. J Minim Invasive Gynecol 20:745–753

    Article  Google Scholar 

  22. Ramirez PT, Frumovitz M, Pareja R et al (2018) Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 379:1895–1904

    Article  Google Scholar 

  23. Reade C, Hauspy J, Schmuck ML et al (2011) Characterizing the learning curve for laparoscopic radical hysterectomy: buddy operating as a technique for accelerating skill acquisition. Int J Gynecol Cancer 21:930–935

    Article  Google Scholar 

  24. Shah CA, Beck T, Liao JB et al (2017) Surgical and oncologic outcomes after robotic radical hysterectomy as compared to open radical hysterectomy in the treatment of early cervical cancer. J Gynecol Oncol 28:e82

    Article  Google Scholar 

  25. Uppal S, Gehrig PA, Peng K et al (2020) Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study. J Clin Oncol 38:1030–1040

    Article  Google Scholar 

  26. Wang W, Chu HJ, Shang CL et al (2016) Long-term oncological outcomes after laparoscopic versus abdominal radical hysterectomy in stage IA2 to IIA2 cervical cancer: a matched cohort study. Int J Gynecol Cancer 26:1264–1273

    Article  Google Scholar 

Download references

Funding

This study was not funded.

Author information

Author notes

  1. Holm Eggemann and Atanas Ignatov have contributed equally to this work as senior authors.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany

    Paolo Gennari, József Mészáros, Olaf Ortmann & Atanas Ignatov

  2. Tumor Center, University of Regensburg, Regensburg, Germany

    Michael Gerken & Monika Klinkhammer-Schalke

  3. Department of Gynecology and Obstetrics, Klinikum Magdeburg, Magdeburg, Germany

    Holm Eggemann

Authors
  1. Paolo Gennari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Gerken
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. József Mészáros
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monika Klinkhammer-Schalke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olaf Ortmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Holm Eggemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Atanas Ignatov
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PG: data collection, data analysis, manuscript writing/editing. MG: data collection, data analysis, manuscript writing/editing. JM: data collection, data analysis, manuscript writing/editing. MK-S: data analysis, manuscript writing/editing. OO: data analysis, manuscript writing/editing. HE: protocol/project development, data collection, data analysis, manuscript writing/editing. AI: protocol/project development, data collection, data analysis, manuscript writing/editing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Atanas Ignatov.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Patients gave written informed consent for data transfer to the tumor registry before treatment. Additional individual consent for this analysis was not needed. According to the statement of the responsible Ethical Committees, an additional individual consent was not required for this analysis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gennari, P., Gerken, M., Mészáros, J. et al. Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters. Arch Gynecol Obstet 304, 503–510 (2021). https://doi.org/10.1007/s00404-020-05947-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05947-y

Keywords

Search

Navigation