2019 ASCO Annual Meeting!
Session: Gynecologic Cancer
Type: Oral Abstract Session
Time: Monday June 3, 1:15 PM to 4:15 PM
Recurrence rates in cervical cancer patients treated with abdominal versus minimally invasive radical hysterectomy: A multi-institutional analysis of 700 cases.
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr 5504)
Author(s): Shitanshu Uppal, Paola Gehrig, Monica Hagan Vetter, Brittany Anne Davidson, Brittany F Lees, Laurie Leigh Brunette, Katherine Tucker, Koji Matsuo, Kristin Leigh Bixel, Allison Stuart Staley, Walter H. Gotlieb, Robert W. Holloway, Kathleen N. Moore, Stephen L. Rose; University of Michigan, Ann Arbor, MI; University of North Carolina, Chapel Hill, NC; The Ohio State University, Columbus, OH; Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC; University of Wisconsin, Madison, WI; Los Angeles County Hospital/ University of Southern California, Los Angeles, CA; University of North Carolina, Division of Gynecologic Oncology, Chapel Hill, NC; Los Angeles County Hospital-University of Southern California, Los Angeles, CA; Ohio State Univ, Columbus, OH; Surgical Oncology McGill University - SMBD Jewish General Hospital, Montreal, QC, Canada; AdventHealth Cancer Institute, Orlando, FL; Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK
Background: Compare outcomes between open and minimally invasive radical hysterectomy. Methods: Retrospective multi-institutional review of patients undergoing radical hysterectomy for stage IA1, IA2 and IB1 squamous, adeno- or adeno-squamous carcinoma between 01/01/2010 - 12/31/2017. Results: From 704 cases that met the inclusion criteria, 185 (26.3%) underwent open and 519 (73.7%) underwent minimally invasive surgery (MIS). Women treated with open surgery were older, had larger tumors on preoperative assessment as well as on final pathology assessment, had higher proportion of patients with IB1 stage and adjuvant therapy. Patients undergoing open surgery had longer median follow-up compared to MIS (44 vs. 30.3 months, p < 0.001). The two groups were similar in regard to race distribution, body mass index, comorbidities and preoperative histology. There were 13/185 (7%) recurrences and 10/185 (5.4%) deaths in the open compared to 42/519 (8.1%) recurrences and 26/519 (5%) deaths in MIS (p = n.s for both). However, on multivariate analysis, after controlling for race, comorbidities, preoperative tumor size, histology, grade and smoking status, MIS had higher odds of recurrence (OR 2.24, 95% CI 1.04 - 4.87, p = 0.04). On a second model, in addition to prior mentioned factors, we included lymphovascular space invasion, receipt of adjuvant therapy and vaginal margin status. Undergoing MIS remained associated with higher odds of recurrence (OR 2.37, 95% CI 1.1 - 5.1, p = 0.031). On sub-group analysis of cases with preoperative tumor size less than equal to 2 cm, there were 5/121 (4.1%) recurrence in open and 25/415 (6%) recurrences in MIS group (p = 0.34). Multivariate analysis did not show a higher rate of recurrence in MIS arm in this subgroup. In 26 cases of MIS where no vaginal manipulator was used, no recurrences were noted. In comparison 19/270 (7%) recurrences were noted in intra-uterine manipulator (V-care/Zumi/Rumi) and 22/210 (11%) in vaginal manipulators (EEA sizer/Colpo Probe) groups (p = 0.119). Conclusions: In this large retrospective analysis, patients undergoing MIS for early stage cervical cancer had higher odds of recurrence. In patients with 2 cm or less tumor on preoperative assessment, recurrence rates were similar between the two groups. Role of manipulator in increasing recurrence should be further studied in this patient population.