More deaths seen for less invasive cervical cancer surgery

Henrietta Strickland
November 3, 2018

In August 2018 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals". The news and stories that matter, delivered weekday mornings.

Since available files from the National Cancer Database only go back to 2004, the researchers also analyzed information from the Surveillance, Epidemiology and End Results (SEER) database, which includes data from 18 cancer registries covering 28 percent of the US population.

When a woman is diagnosed with cervical cancer, she often gets her uterus and cervix removed, an operation known as a radical hysterectomy. And now two stunning new studies show that the common wisdom may have been wrong. Understanding how best to prevent recurrences is critical, since most cervical cancer that recurs is hard to treat.

The results were startling and strong enough to change practice in at least one major cancer center, MD Anderson in Texas. It also offers an analysis of the main topographies of the global Minimally Invasive Spine Surgery market.

Two recent reports in the New England Journal of Medicine have found that minimally invasive surgeries are less effective at treating early-stage cervical cancer than open surgeries. It usually leads to less bleeding, fewer infections and fewer complications. "These patients are early stage cancer patients, and the intent of surgical treatment is cure". "Although minimally invasive surgery was associated with higher mortality, some patients may be willing to accept that risk, especially if they have very early cancers". "Personally, I will not offer minimally invasive radical hysterectomy to patients who come to me for cervical cancer treatment until compelling new research demonstrates a minimally invasive approach that does not carry these risks".

A safety board overseeing the experiment called it to a halt before its scheduled completion after it became obvious that women in the minimally invasive group were doing substantially worse.

Researchers "recommend on only using open surgery for cervical cancer" based on the results of the a epidemiologic study published Wednesday in the New England Journal of Medicine.

The study was supported by grants from the National Institutes of Health (P30CA016672, 4P30CA060553-22, R25CA092203, and K12HD050121-12), the American Association of Obstetricians and Gynecologists Foundation, the Foundation for Women's Cancer, the Jean Donovan Estate, and the Phebe Novakovic Fund. You will have inputs regarding company profiling of Minimally Invasive Medical Robotics market leading manufacturers plus their contact information, sales, market share, product picture and specification.

HARRIS: They were also more likely to die in the next four years. Before they could enroll all 740 people in the study, the study was stopped after four months because one group showed dramatically lower survival: the women assigned to receive the minimally invasive hysterectomy. Within 4 years after surgery, 9.1 percent of the minimally invasive surgery group had died versus 5.3 percent in the open-surgery group, translating into a statistically significant 65 percent higher risk of death for the former, when the difference over four years is considered. However, the studies did not show the patients who got the minimally invasive procedure to have more residual tumors than the other group.

Specifically, according to the study, the rate of disease-free survival at 4.5 years was 86% for the minimally invasive surgery group, compared to 96.5% for the open surgery group.

Doctors at MD Anderson Cancer Center wanted to confirm that this was the best option for patients, so they set up a study to compare survival after the two surgical methods. And she was troubled that her follow-up after the surgery had not focused harder on making sure the tumor had not grown back. So Andersson is being treated with radiation and chemotherapy.

Of those, about half had minimally invasive surgery and about half had open surgery.

Although the reasons behind the higher recurrence and death rates are still unclear, it is possible that the laparoscopic cameras that they use during the minimally invasive procedures miss some of the tumors and end up being left behind. "The overall prognosis for women with early cervical cancer after minimally invasive or open hysterectomy is excellent", he adds. Ramirez says carbon dioxide gas used to inflate the abdomen during this surgery could also be playing a role.

The doctors involved agree their findings apply only to cervical cancer. "It is important to note these results are specific to cervical cancer, and minimally invasive surgery is still a great option for other surgeries and cancers", said Dr. Shohreh Shahabi, chief of gynecological oncology atNorthwestern University Feinberg School of Medicine, who worked on one study team.

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