Minimally Invasive Sx May Up Mortality in Early Cervical Cancer

Leslie Hanson
November 3, 2018

NewYork-Presbyterian Hospitalis ranked #1 in the NY metropolitan area by U.S. News and World Report and repeatedly named to the Honor Roll of "America's Best Hospitals".

NewYork-Presbyterian is one of the nation's most comprehensive, integrated academic healthcare delivery systems, whose organizations are dedicated to providing the highest quality, most compassionate care and service to patients in the NY metropolitan area, nationally, and throughout the globe.

Keyhole surgery seemed like a no-brainer to Jeanine Andersson when she was diagnosed with cervical cancer a year ago.

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 USA population.

Global Minimally Invasive Market Report provides data about manufacturers, including: shipment, price, revenue, gross profit, interview record, business distribution CAGR etc. "I chose minimally invasive thinking it was the best, latest and greatest and best thing to do", Andersson said.

But a year and a half later, her cancer was back.

However, two new studies could change all that.

Keyhole surgery, which has become the standard for many different kinds of operations, may be more risky for women with cervical cancer.

New evidence about a cancer operation in women finds a higher death rate for the less invasive version, challenging standard practice and the "less is more" approach to treating cervical cancer.

"We suspected that there might be a difference in survival between the two approaches, but the extent of the difference was surprising", says co-principal investigator Jason D. Wright, MD, associate professor of obstetrics and gynecology atColumbia University Vagelos College of Physicians and Surgeons and chief of gynecologic oncology at NewYork-Presbyterian/Columbia University Irving Medical Center. That works out to a 9 percent risk of death in the minimally invasive group and a 5 percent risk in the open surgery group - a significant difference, the study authors said.

Since 2006, minimally invasive radical hysterectomy first started to become popular. It usually leads to less bleeding, fewer infections and fewer complications.

Other studies have shown that these keyhole techniques are just as effective for early stage colorectal cancer, stomach cancer or cancer of the uterus.

Making the outcome even stronger, a second study published alongside this report comes to the same conclusion about minimally invasive surgery for early cervical cancer.

The unexpected findings are prompting changes at some hospitals that perform radical hysterectomies for early-stage cervical cancer.

The researchers then analyzed data from the National Cancer Databaseof 2,461 women with early cervical cancer who underwent radical hysterectomy between 2010 and 2013.

Melamed said one possible explanation for the findings is that there is "something technical about minimally invasive radical hysterectomy that is different from the open procedure and makes a difference in long-term survival". The two new studies were different, tracking outcomes for more than four years after surgery.

SEER database information - which reflects cancer-related deaths - showed a stable four-year survival rate prior to 2006, when minimally invasive radical hysterectomy began to be broadly adopted for treatment of early-stage cervical cancer.

While some patients with small tumors might do as well with minimally invasive surgery, "surgeons should proceed cautiously" and discuss the new information with patients, Fader wrote in an accompanying editorial.

Evidently, those who had the minimally invasive procedure are four times likelier of having a recurrence and of dying compared to those who had the open surgery.

Ramirez says surgeons at MD Anderson "decided to stop offering the minimally invasive radical hysterectomy and completely convert to the open approach". Some women with early-stage cervical cancer are choosing fertility-sparing techniques, treatments not included in the new research. So Andersson is being treated with radiation and chemotherapy.

The researchers don't know why the risks are higher with the minimally invasive 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.

RAMIREZ: We chose to stop offering the minimally invasive radical hysterectomy and completely convert to the open approach.

PEDRO RAMIREZ: It will be performed through very small incisions in the abdomen where instruments are introduced in through the abdomen through those small incisions. Ramirez says carbon dioxide gas used to inflate the abdomen during this surgery could also be playing a role.

Surgical skill may also be a factor, said Melamed.

The doctors involved agree their findings apply only to cervical cancer.

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