Objective. Accumulating evidence suggested the detrimental effects of adopting minimally invasive surgery in the management of early-stage cervical cancer. However, long-term evidence on the role of minimally invasive radical hysterectomy in "low-risk" patients exists. Methods. This is multi-institutional retrospective study comparing minimally invasive and open radical hys-terectomy in low-risk early-stage cervical cancer patients. A propensity-score matching algorithm (1:2) was used to allocate patients into the study groups. Kaplan-Meir model was used to estimate 10-year progression -free and overall survival.Results. Charts of 224 "low-risk" patients were retrieved. Overall, 50 patients undergoing radical hysterec-tomy were matched with 100 patients undergoing open radical hysterectomy. Minimally invasive radical hyster-ectomy was associated with a longer median operative time (224 (range, 100-310) vs. 184 (range, 150-240) minutes; p < 0.001), lower estimated blood loss (10 (10-100) vs. 200 (100-1000) ml, p < 0.001), and shorter length of hospital stay (3.8 (3-6) vs. 5.1 (4-12); p < 0.001). Surgical approach did not influence the risk of having intra-operative (4% vs. 1%; p = 0.257) and 90-day severe (grade 3+) postoperative complication rates (4% vs. 8%; p = 0.497). Ten-year disease-free survival was similar between groups (94% vs. 95%; p = 0.812; HR:1.195; 95% CI:0.275, 5.18). Ten-year overall survival was similar between groups (98% vs. 96%; p = 0.995; HR:0.994; 95% CI:0.182, 5.424).Conclusions. Our study appears to support emerging evidence suggesting that, for low-risk patients, laparo-scopic radical hysterectomy does not result in worse 10-year outcomes compared to the open approach. However, further research is needed and open abdominal radical hysterectomy remains the standard treatment for cervical cancer patients.(c) 2023 Elsevier Inc. All rights reserved.
Ten-year outcomes following laparoscopic and open abdominal radical hysterectomy for “low-risk” early-stage cervical cancer: A propensity-score based analysis / Di Donato, V.; Bogani, G.; Casarin, J.; Ghezzi, F.; Malzoni, M.; Falcone, F.; Petrillo, M.; Capobianco, G.; Calo, F.; D'Auge, T. G.; Muzii, L.; Benedetti Panici, P.; Ervas, E.; Ditto, A.; Raspagliesi, F.; Sopracordevole, F.; Vizza, E.; Giannini, A.. - In: GYNECOLOGIC ONCOLOGY. - ISSN 1095-6859. - 174:(2023), pp. 49-54. [10.1016/j.ygyno.2023.04.030]
Ten-year outcomes following laparoscopic and open abdominal radical hysterectomy for “low-risk” early-stage cervical cancer: A propensity-score based analysis
Petrillo M.Writing – Review & Editing
;Capobianco G.Writing – Review & Editing
;
2023-01-01
Abstract
Objective. Accumulating evidence suggested the detrimental effects of adopting minimally invasive surgery in the management of early-stage cervical cancer. However, long-term evidence on the role of minimally invasive radical hysterectomy in "low-risk" patients exists. Methods. This is multi-institutional retrospective study comparing minimally invasive and open radical hys-terectomy in low-risk early-stage cervical cancer patients. A propensity-score matching algorithm (1:2) was used to allocate patients into the study groups. Kaplan-Meir model was used to estimate 10-year progression -free and overall survival.Results. Charts of 224 "low-risk" patients were retrieved. Overall, 50 patients undergoing radical hysterec-tomy were matched with 100 patients undergoing open radical hysterectomy. Minimally invasive radical hyster-ectomy was associated with a longer median operative time (224 (range, 100-310) vs. 184 (range, 150-240) minutes; p < 0.001), lower estimated blood loss (10 (10-100) vs. 200 (100-1000) ml, p < 0.001), and shorter length of hospital stay (3.8 (3-6) vs. 5.1 (4-12); p < 0.001). Surgical approach did not influence the risk of having intra-operative (4% vs. 1%; p = 0.257) and 90-day severe (grade 3+) postoperative complication rates (4% vs. 8%; p = 0.497). Ten-year disease-free survival was similar between groups (94% vs. 95%; p = 0.812; HR:1.195; 95% CI:0.275, 5.18). Ten-year overall survival was similar between groups (98% vs. 96%; p = 0.995; HR:0.994; 95% CI:0.182, 5.424).Conclusions. Our study appears to support emerging evidence suggesting that, for low-risk patients, laparo-scopic radical hysterectomy does not result in worse 10-year outcomes compared to the open approach. However, further research is needed and open abdominal radical hysterectomy remains the standard treatment for cervical cancer patients.(c) 2023 Elsevier Inc. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
