title: Minimally Invasive Radical Hysterectomy for Cervical Cancer Is Associated With Reduced Morbidity and Similar Survival Outcomes Compared With Laparotomy.
abstract: To assess outcomes of women with cervical cancer undergoing upfront radical hysterectomy (RH) via a minimally invasive surgery (MIS) or a traditional laparotomy (XL) approach at 2 large US academic institutions to determine whether the mode of surgery affects patient outcomes.
  
  
  
  Retrospective cohort study (Canadian Task Force classification II-1).
  
  
  
  Two academic medical institutions in the United States.
  
  
  
  Women undergoing upfront RH for cervical cancer between 2000 and 2013.
  
  
  
  Minimally invasive techniques (laparoscopic and robotic) for RH compared with XL.
  
  
  
  A total of 383 women met the eligibility requirements. Of these, 101 underwent an MIS (i.e., traditional laparoscopy, laparoendoscopic single site, or robotic) approach, and 282 underwent an XL approach. Overall survival (median not reached; p = .29) was not different between the 2 groups. Recurrence was rare and equivalent in the 2 groups, affecting 5.0% of patients in the MIS group and 6.4% of those in the XL group (p = .86). Pelvic lymph nodes were dissected in 98% of patients in the MIS group and 97% of those in the XL group (p > .99) and were found to be positive in 10.9% and 8.5% of those patients, respectively (p = .55). The mean number of pelvic lymph nodes retrieved was higher in the MIS group (19.4 vs 16.0; p < .001). There was no between-group difference in the rate of postoperative chemotherapy (p = .32) or radiation therapy (p = .28). Surgical margins were positive in 5.0% of specimens in the MIS group and in 4.6% of specimens in the XL group (p = .54). Although there was no difference in the overall rate of complications (15.1% and 17.2%, respectively; p = .87), laparotomy was associated with a higher median estimated blood loss (EBL) (50 cm3vs 500 cm3) and a higher rate of perioperative blood transfusion (3.0% vs 26.2%; p < .001). Length of perioperative hospital stay was significantly shorter in the MIS group (1.9 days vs 4.9 days; p < .001).
  
  
  
  MIS RH does not compromise patient outcomes, including overall survival, rate of recurrence, and the frequency of pelvic lymph node dissection or positivity. Morbidity was decreased in the MIS group, including decreased EBL, fewer blood transfusions, and shorter hospital stay.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Diver
authors.affiliation: Integrated Residency Program in Obstetrics and Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Emily
authors.initials: E
authors.lastname: Hinchcliff
authors.affiliation: Integrated Residency Program in Obstetrics and Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Allison
authors.initials: A
authors.lastname: Gockley
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Leah
authors.initials: L
authors.lastname: Contrino
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sarah
authors.initials: S
authors.lastname: Feldman
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: wgrowdon@partners.org.
authors.forename: Whitfield
authors.initials: W
authors.lastname: Growdon
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010388:Pelvis / Q000601:surgery; D012189:Retrospective Studies; D012371:Robotics; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; Laparoscopy; Radical hysterectomy; Robotic surgery