By Sara Bondell and Ann Miller Baker
For at least the past decade, patients with cervical cancer requiring surgery faced a choice. They could opt for the traditional, open abdomen operation with its large incision. Or they might choose minimally invasive surgery (MIS), performed through small slits in the abdomen that allowed for a faster recovery. Patients weighed the risks and benefits with their physician.
But two new studies published in the New England Journal of Medicine could tip the scales. The results suggest that MIS is more likely to result in recurrence of the cancer and death.
Physicians have been discussing the issue since preliminary data were presented at the Society of Gynecologic Oncology meeting earlier this year.
One study shows the number of disease recurrences after laparoscopic or robot-assisted surgeries was almost four times higher than the number or recurrences after open surgery. A second study reported an almost 50 percent higher risk of dying within four years of MIS compared to open surgery.
"Given that the two studies had similar findings, we must accept that there may be an advantage of open surgery in terms of recurrence and survival," said Dr. Robert Wenham, chair of the Department of Gynecologic Oncology at Moffitt Cancer Center. "It is important to note that the reasons for these findings are not completely clear. There are many factors that exist that may make one approach safer for a specific patient. In a particular patient, the benefits of MIS may outweigh the risks illustrated in the aggregated data presented."
Wenham says, while these findings were unexpected, he’s not completely shocked. “Without good science until now, I have personally continued to perform almost exclusively open radical hysterectomies for cervical cancer even though I commonly use minimally invasive surgery for other cancers. Intuitively, I have felt that I can do a better surgery for this through the open incision." But he also stresses the benefits of minimally invasive surgery for many patients with a variety of cancers or other diseases.
"This data adds to the discussion between a woman and her doctor," said Wenham. "At Moffitt, we will continue to have all available options and will individualize the approach for women with cervical cancer."