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Comparative Study
. 2019 May;220(5):469.e1-469.e13.
doi: 10.1016/j.ajog.2019.02.038. Epub 2019 Feb 22.

Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy

Koji Matsuo  1 , Ling Chen  2 , Rachel S Mandelbaum  3 , Alexander Melamed  2 , Lynda D Roman  1 , Jason D Wright  4
Affiliations
Comparative Study

Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy

Koji Matsuo et al. Am J Obstet Gynecol. 2019 May.

Abstract

Background: A recent trial demonstrated decreased survival in women with early-stage cervical cancer who underwent radical hysterectomy via minimally invasive surgery compared with laparotomy; however, outcomes following trachelectomy have yet to be studied.

Objective: To examine trends, characteristics, and survival of reproductive-aged women with early-stage cervical cancer who underwent minimally invasive trachelectomy.

Study design: This is a retrospective study examining the National Cancer Database between 2010 and 2015. Women aged <50 years who underwent trachelectomy for stage IA2-IB cervical cancer were grouped by mode of surgery. Clinicopathologic characteristics and outcomes were compared between minimally invasive surgery and laparotomy groups.

Results: A total of 246 women were included, 144 (58.5%, 95% confidence interval, 52.4%-64.7%) of whom had trachelectomy with a minimally invasive surgery approach. Median age was similar between the minimally invasive surgery and laparotomy groups (median, 31 vs 29 years, P = .20). There was a significant increase in the use of minimally invasive surgery from 29.3% in 2010 to 75.0% in 2015 (P < .001). Specifically, minimally invasive surgery became the dominant approach for trachelectomy by year 2011 (54.8%). Hospitals registered in the West (75.0% vs 25.0%) were more likely, whereas those registered in the Midwest (46.9% vs 53.1%) were less likely, to perform minimally invasive surgery (P = .02). Median follow-up was 37 months (interquartile range, 23-51) for the minimally invasive surgery group and 40 months (interquartile range, 26-67) for the laparotomy group. During follow-up, there were 11 (5.3%) deaths, 4 (3.5%) in the minimally invasive surgery group and 7 (7.6%) in the laparotomy group (P = .25).

Conclusion: Minimally invasive surgery has become the dominant modality for trachelectomy in reproductive-aged women with stage IA2-IB cervical cancer after year 2011. Survival of women with stage IA2-IB cervical cancer who underwent trachelectomy is generally good regardless of surgical modality. Although our study showed no difference in survival between the minimally invasive surgery and laparotomy approaches, effects of MIS on survival remain unknown and further study is warranted.

Keywords: cervical cancer; minimally invasive; survival; trachelectomy.

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Conflict of interest statement

Consultant, Tesaro and Clovis Oncology (J.W.); consultant, Tempus Lab (L.D.R.); and honorarium, Chugai (K.M.). The other authors report no conflict of interest.

Figures

FIGURE 1
FIGURE 1. Study schema
Cohort selection criteria from the National Cancer Database.
FIGURE 2
FIGURE 2. Trend of trachelectomy use between 2010 and 2015
Cochran–Armitage trend test for P-value. Dots represent observed value and bars represent 95% confidence interval for minimally invasive trachelectomy.
FIGURE 3
FIGURE 3. Overall survival based on treatment modality
Colored areas represent 95% confidence intervals. MIS, minimally invasive surgery.
See this image and copyright information in PMC

Comment in

References

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