KEY TAKEAWAYS
- The study aimed to compare complications in open vs. minimally invasive radical hysterectomy for early-stage cervical cancer.
- The results showed no significant difference in intra-operative and post-operative complications between minimally invasive and open radical hysterectomy.
Daniel Vázquez-Vicente and the team aimed to evaluate and compare intra-operative and post-operative complication rates between open and minimally invasive radical hysterectomy in patients with early-stage cervical cancer.
The study utilized data from the SUCCOR database, comprising 1272 patients diagnosed with stage IB1 cervical cancer (according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification) who underwent radical hysterectomy in Europe from January 2013 to December 2014.
Key parameters assessed included surgery duration, estimated blood loss, hospital stay duration, and incidences of intra-operative and post-operative complications. Inclusion criteria included patients aged ≥18 with histologic types of squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma.
Mandatory prerequisites comprised pelvic MRI confirming tumor diameter ≤4 cm without parametrial invasion and pre-operative CT scan, MRI, or positron emission tomography CT demonstrating the absence of extra-cervical metastatic disease. Primary outcomes included adverse events exceeding grade 3, intra-operative adverse events, postoperative adverse events, hospital stay duration, surgery duration, and blood loss volume.
The study comprised 1156 patients, with 633 (54%) undergoing open surgery and 523 (46%) undergoing minimally invasive surgery. Median age was 46 years (range: 18-82), median body mass index was 25 kg/m2 (range: 15-68), and 1022 (88.3%) patients had optimal performance status (ECOG Performance Status 0). Squamous carcinoma was the most common histologic tumor type (n=794, 68.7%), and FIGO staging IB1 was the most frequent (n=510, 44.1%).
In the minimally invasive surgery group, median surgery duration was longer (240 vs. 187 min, P<0.01), estimated blood loss was lower (100 vs. 300 mL, P<0.01), and hospital stay duration was shorter (4 vs. 7 days, P<0.01) compared to the open surgery group. The two groups showed no significant difference in intra-operative and post-operative complication rates.
Regarding grade I complications, the minimally invasive surgery group had a higher incidence of vaginal bleeding (2.9% vs. 0.6%, P<0.01) and vaginal cuff dehiscence (3.3% vs. 0.5%, P<0.01) compared to the open surgery group.
Regarding grade III post-operative complications, bladder dysfunction (1.3% vs. 0.2%, P=0.046) and abdominal wall infection (1.1% vs. 0%, P=0.018) were more common in the open surgery group than in the minimally invasive surgery group. The ureteral fistula was more frequent in the minimally invasive group than in the open surgery group (1.7% vs. 0.5%, P=0.037).
The study concluded that there was no notable disparity in the overall occurrence of intra-operative and post-operative complications between minimally invasive radical hysterectomy and the open approach.
No funding was received.
Source: https://pubmed.ncbi.nlm.nih.gov/38669163/
Vázquez-Vicente D, Boria F, Castellanos T, et al. (2024) “SUCCOR morbidity: complications in minimally invasive versus open radical hysterectomy in early cervical cancer.” Int J Gynecol Cancer. 2024 Feb 5;34(2):203-208. doi: 10.1136/ijgc-2023-004657. PMID: 38669163.
