More deaths seen for less invasive cervical cancer surgery

When a woman is diagnosed with cervical cancer she often gets her uterus and cervix removed an operation known as a radical hysterectomy

SOURCES: and The New England Journal of Medicine, online October 31, 2018.

Researchers say this applies only to cervical cancer surgery, and minimally invasive surgery can still be a good option for other types of cancers. Doctors estimate that several thousand women in India undergo minimally invasive hysterectomy for early stage cervical cancer or endometrial cancer every year. "Studies had shown that for most cancers, outcomes with less invasive surgery are comparable to open surgery, with the added benefit of fewer short-term postoperative complications".

A second study in the same issue reviewed data on almost 2,500 women and found the risk of death from any cause over up to four years was 65 percent higher with the less-invasive operation.

A hysterectomy was her best option but the 45-year-old orthopedic surgeon had two choices: "Either the traditional, what they call open laparotomy, (in which they) kind of slice you vertically down the front, take everything out, and set you back up and it's a six to eight week recovery", Andersson said. She said Johns Hopkins Hospital in Baltimore has stopped doing less invasive hysterectomies for cervical cancer until there is more data.

"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", agreed Dr. Alexander Melamed of Massachusetts General Hospital and Harvard Medical School, another member of the study team. Schink has been practicing minimally invasive surgeries for the past 15 years.

EMMA BARBER: I think increasingly that's going to be open surgery for many women, but there may still be a role for a minimally invasive surgery in some patients.

The study did not investigate why minimally invasive hysterectomy might result in a higher mortality rate.

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Initial studies appeared to support the use of the minimally invasive techniques. Compared with open surgery, minimally invasive surgery correlated with a lower rate of disease-free survival (three-year rate, 91.2 versus 97.1 percent; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95 percent CI, 1.63 to 8.58) and with a lower rate of overall survival (three-year rate, 93.8 versus 99.0 percent; hazard ratio, 6.00; 95 percent CI, 1.77 to 20.30).

Melamed said patients can still opt for the minimally invasive approach, but only after considering the new data. The rate of disease-free survival at 4.5 years was 86 percent with minimally invasive surgery and 96.5 percent with open surgery. "While we need to learn more about the reasons behind these findings, surgeons who wish to offer minimally invasive radical hysterectomy to cervical cancer patients must ensure they are informed of these risks". He wasn't involved in the studies, but agreed they could change clinical practice.

The researchers tracked the surgical outcomes of 2,461 patients in the US National Cancer Database who had radical hysterectomies for early stage cervical cancer from 2010 to 2013.

The research team - including investigators from Brigham and Women's Hospital, Northwestern University Feinberg School of Medicine, Columbia University/New York Presbyterian Hospital, the University of Wisconsin School of Medicine and Public Health, and the University of Texas M.D. Anderson Cancer Center - analyzed information from the National Cancer Database, which covers around 70 percent of newly diagnosed cancer cases from more than 1,500 US hospitals.

One study team looked at almost 2,500 women with stage 1 cervical cancer in 2010-2013.

Dr. Wright receives consulting fees from Clovis Oncology and Tesaro. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. For new venture, a practicality examination is given. For more information, visit or

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. 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". "It's been an unexpected finding for all of us".



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