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How to Select Early-Stage Cervical Cancer Patients Still Suitable for Laparoscopic Radical Hysterectomy: a Propensity-Matched Study

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recently, it was reported that minimally invasive surgery (MIS) has a negative impact on early-stage cervical cancer (ECC) patient survival. At the same time, advantages of MIS regarding quality of life and low rate of intra- and postoperative complications are well known. Therefore, it is essential to select patients who may benefit from MIS without worsening their oncologic outcomes. The aim of this study is to investigate which pathological factors could guide surgeons’ choice about the best approach in ECC.

Patients and Methods

Patients with 2009 FIGO stage from IA1 with lymphovascular space invasion (LVSI) to IB1/IIA1 treated by open or laparoscopic surgery were judged eligible for the study. Disease-free survivals (DFS) of both approaches were tested in subgroups, defined according to histology, tumor size, grading, LVSI, parametrial involvement, and nodal status.

Results

A total of 423 patients were enrolled (217 in the open and 206 in the laparoscopic group). No difference between open surgery and laparoscopy was found among subgroups defined according to histology, grading, LVSI, parametrial involvement, or nodal status. Among patients with tumor > 20 mm, laparoscopy showed a significantly higher relapse risk [hazard ratio (HR): 2.103, p = 0.030]. Among patients with tumor < 20 mm, laparoscopy showed DFS superimposable to open surgery (HR: 0.560, p = 0.128).

Conclusions

Tumor size of 20 mm appeared as the only independent discrimination criterion in patients whose prognosis is affected by surgical approaches.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy

    Luigi Pedone Anchora MD, Nicolò Bizzarri MD, Andrea Lombisani MD, Valerio Gallotta MD, Anna Fagotti MD, PhD, Gabriella Ferrandina MD, PhD & Giovanni Scambia MD, PhD

  2. Division of Gynecologic Oncology, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy

    Luigi Calrlo Turco MD & Francesco Cosentino MD

  3. Department of Gynecology and Obstetrics, University of Parma, Parma, Italy

    Vito Andrea Capozzi MD

  4. Department of Gynecologic Oncology, University of Palermo, Palermo, Italy

    Vito Chiantera MD

  5. Department of Radiotherapy, Policlinico Umberto I ‘Sapienza’, University of Rome, Rome, Italy

    Francesca De Felice MD

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  1. Luigi Pedone Anchora MD
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  2. Luigi Calrlo Turco MD
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Correspondence to Luigi Pedone Anchora MD.

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Pedone Anchora, L., Turco, L.C., Bizzarri, N. et al. How to Select Early-Stage Cervical Cancer Patients Still Suitable for Laparoscopic Radical Hysterectomy: a Propensity-Matched Study. Ann Surg Oncol 27, 1947–1955 (2020). https://doi.org/10.1245/s10434-019-08162-5

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  • DOI: https://doi.org/10.1245/s10434-019-08162-5

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