番茄社区

SAN DIEGO -- Oncologic surgeons rapidly abandoned minimally invasive surgery (MIS) for early-stage cervical cancer in the wake of a startling 2018 study that warned of the dangers of the approach for this patient population, a National Cancer Database analysis showed.

Comparing 2016-2017 to 2019-2020, the percentage of primary treatments for early-stage cervical cancer performed via MIS fell from 67% to 35%, while open surgery increased from 25% to 56% (P<0.001), Jennifer Wolf, MD, of SUNY Downstate Health Sciences University in New York City, reported here at the Society of Gynecologic Oncology annual meeting.

The findings suggest that surgeons across the U.S. reacted as Wolf's colleagues did in 2018 when the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial were released: "They immediately changed their practice," she told 番茄社区.

The initial LACC findings, released in 2018, found that over a median 2.5 years of follow-up, women who underwent MIS for mostly stage IA2-IB1 cervical tumors were six times more likely to die as those who had open surgery. A final analysis in 2022 showed a disease-free survival rate of 96% with open surgery and 85% with MIS at 4.5 years.

The LACC results were especially surprising in light of the apparent effectiveness of robot-assisted MIS, Wolf said. "We can get really close with the camera and get a nice dissection."

Wolf said the research team launched the new study to understand how the 2018 results affected U.S. practice. An earlier study involving more than 2,400 patients found evidence that MIS procedures quickly fell out of favor following the release of the LACC results, but the new report examines a much larger dataset and suggests the switch in practice may have been even more dramatic.

The current study drew on data from the National Cancer Database, which represents 70% of U.S. institutions, Wolf said. The study focused on the 4,609 women diagnosed with stage IA2-IB1 cervical cancer from 2016-2017 (pre-LACC) and the 3,321 patients diagnosed in 2019-2020 (post-LACC).

Overall, mean age (47-48 years) and racial makeup (79-80% white, 10% Black) were similar in both time periods. There was more stage IA2 disease in the 2019-2020 group (17% vs 13% in the pre-LACC group, P<0.001), suggesting cancer was being caught earlier in the later time period, Wolf said.

There was no difference in the percentage of primary hysterectomies performed between the pre- and post-LACC groups (92% vs 93%, respectively) or in the use of adjuvant radiotherapy. Patients who underwent primary chemoradiation were younger in 2016-2017 versus 2019-2020 (mean age 52 vs 56 years, P=0.005).

From 2016-2017 to 2019-2020, the mean length of post-operative admission increased from 1.98 to 2.77 days, reflecting the extra time needed to recover from open surgery, said Wolf. Rates of 30-day mortality (0.2%) and readmissions (3.2%) were the same for both time periods.

Prior to the LACC results, patients undergoing radical MIS were more likely to be white and have private insurance compared with those selected for open surgery, but no differences in race or insurance type were seen in the 2019-2020 period.

Patients in the pre-LACC period undergoing radical MIS were more likely to have small-volume disease compared with the open-surgery patients (48% vs 41% having tumors of 2 cm or less, respectively, P<0.023), while no significant difference was observed in the post-LACC period.

Post-LACC, patients undergoing MIS were more likely to have stage IA2 tumors than those who underwent open procedures (22% vs 15%, P=0.002).

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