Minimally invasive hysterectomy, a popular procedure for early-stage cervical cancer, turns out to result in worse overall survival for cancer patients than traditional open surgery, reports a new national study from Northwestern Medicine and other institutions.
Among women undergoing minimally invasive surgery, the risk of death within four years was 9.1 percent as compared to 5.3 percent in the open surgery group, a 3.8 percent difference. This equates to patients being about 1.65 times more likely to die over this time frame than if they received open surgery.
The study was published Oct. 31 in the New England Journal of Medicine.
“The results of these studies raise concerns about the safety of minimally invasive radical hysterectomy for cervical cancer,” said Dr. Edward Tanner, III, chief of gynecologic oncology in the department of obstetrics and gynecology and a Northwestern Medicine physician.
“Clearly, we need more research on this issue,” Dr. Tanner said. “It’s possible that some patients with cervical cancer can still undergo minimally invasive surgery safely. Until that time, surgeons offering a minimally invasive approach need to counsel patients about the risks, so they can make an informed decision about their care.”
It is not yet known why minimally invasive surgery is associated with inferior overall survival, noted co-senior author Dr. Shohreh Shahabi, the John and Ruth Brewer Professor of Gynecology and Cancer Research at Feinberg and a Northwestern Medicine physician.
“Possible explanations include the potentially limited extent of tumor removal during minimally invasive surgery, or that tools used during minimally invasive hysterectomy may inadvertently disseminate tumor cells,” Dr. Shahabi said.
Other Northwestern authors on the study include Dr. Masha Kocherginsky, associate professor of preventive medicine in the division of biostatistics and a co-senior author of the study, Dr. Emma Barber, assistant professor of obstetrics and gynecology in the division of gynecologic oncology, and Dr. Amy Alexander, a fellow in gynecologic oncology.