Minimally invasive compared to open surgery in patients with low-risk cervical cancer following simple hysterectomy: An exploratory analysis from the Gynegologic Cancer Intergroup/Canadian Cancer Trials Group CX.5/SHAPE trial. - 2025
Minimally invasive compared to open surgery in patients with low-risk cervical cancer following simple hysterectomy: An exploratory analysis from the Gynegologic Cancer Intergroup/Canadian Cancer Trials Group CX.5/SHAPE trial.
[en] [en] OBJECTIVE: The Laparoscopic Approach to Cervical Cancer trial demonstrated that minimally invasive radical hysterectomy was associated with worse disease-free survival and overall survival among women with early-stage cervical cancer. It is unknown whether this applies to patients with low-risk disease following simple hysterectomy.
METHODS: Among patients who underwent simple hysterectomy in the Simple Hysterectomy And PElvic node assessment trial, univariate and multivariate Cox models were used to assess the association of minimally invasive versus open surgery with clinical outcomes, including pelvic and extra-pelvic recurrence-free survival, overall recurrence-free survival, and overall survival. Other variables included age, race, performance status, body mass index, stage, histologic type and grade, diagnostic procedure, lymphovascular space invasion before surgery and on final pathology, lymph node status, residual disease, and lesions >2 cm on final pathology.
RESULTS: A total of 338 patients underwent simple hysterectomy. Of those, 281 (83%) were performed by minimally invasive surgery and 57 (17%) by open surgery. With a median follow-up of 4.5 years, a total of 12 (4.3%) recurrences were observed in 281 patients having simple hysterectomy by minimally invasive surgery versus 3 in 57 (5.3%) having open surgery (p = .73 from Fisher exact test). Although not randomized, the 2 groups were comparable except for histology and residual disease in the hysterectomy specimen. Patients with minimally invasive surgery had more adenocarcinoma and less adenosquamous compared to open surgery (35.9% versus 22.9% and 3.6% versus 14%, respectively; p = .005). Significantly fewer patients treated by minimally invasive surgery had residual disease in the hysterectomy specimen compared to open surgery (43.1 versus 57.9%; p = .04). No statistically significant difference between minimally invasive and open surgery in pelvic and extra-pelvic recurrence-free survival, overall recurrence-free survival, or overall survival was found.
CONCLUSION: Our data indicate no statistical evidence that minimally invasive surgery is associated with poorer clinical outcomes for patients meeting the SHAPE criteria who underwent simple hysterectomy. Because the surgical approach was not a randomization factor, a large prospective trial is needed to confirm our results before a routine simple hysterectomy by minimally invasive surgery can be recommended.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics) Oncology Surgery
Author, co-author :
Plante, Marie; Centre Hospitalier Universitaire de Québec, Québec City, Canada. Electronic address: marie.plante@crhdq.ulaval.ca
Mahner, Sven; Ludwig Maximilians University Munich, Munich, Germany
Sebastianelli, Alexandra ; Centre Hospitalier Universitaire de Québec de Québec, Québec City, Canada
Bessette, Paul; Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
Lambaudie, Eric; Institut Paoli-Calmettes, Marseilles, France
Guyon, Frederic; Institut Bergonié, Bordeaux, France
Piek, Jurgen; Catharina Hospital and Catharina Cancer Institute, Eindhoven, The Netherlands
Smolders, Ramon; Erasmus MC Cancer Institute, Rotterdam, The Netherlands
Tidy, John ; Sheffield Teaching Hospitals National Health Services Foundation Trust, Sheffield, United Kingdom
Williamson, Karin; Nottingham University Hospitals, National Health Services, Nottingham, United Kingdom
Hanker, Lars; University Hospital Munster, Munster, Germany
Goffin, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie-obstétrique, partim Gynécologie
Tsibulak, Irina ; Medical University of Innsbruck, Innsbruck, Austria
Eyjolfsdottir, Brynhildur; Oslo University Hospital, Radium Hospital, Oslo
Gleeson, Noreen; St James's Hospital University Hospital, Dublin, Ireland
Lee, Jung-Yun; Yonsei University College of Medicine, Seoul, Korea
Ke, Yuwei; Queens' University, Kingston, Canada
Kwon, Janice S; University of British Columbia, Vancouver, Canada
Ferguson, Sarah E; Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
Minimally invasive compared to open surgery in patients with low-risk cervical cancer following simple hysterectomy: An exploratory analysis from the Gynegologic Cancer Intergroup/Canadian Cancer Trials Group CX.5/SHAPE trial.
We would like to acknowledge the support of the Gynecologic Cancer InterGroup which facilitated the participation of the many international cooperative groups that made the SHAPE trial a success.
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