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. 2023 Feb 6;30(2):1977-1985.
doi: 10.3390/curroncol30020153.

Oncologic Outcomes of Surgically Treated Cervical Cancer with No Residual Disease on Hysterectomy Specimen: A 4C (Canadian Cervical Cancer Collaborative) Working Group Study

Christa Aubrey  1 , Gregory R Pond  2 , Limor Helpman  3 , Danielle Vicus  4 , Laurie Elit  3 , Marie Plante  5 , Susie Lau  6 , Janice S Kwon  7 , Alon D Altman  8 , Karla Willows  9 , Tomer Feigenberg  10 , Jeanelle Sabourin  1 , Vanessa Samouelian  11 , Laurence Bernard  3 , Norah Cockburn  3 , Nora-Beth Saunders  8 , Sabrina Piedimonte  4 , Ly-Ann Teo-Fortin  5 , Soyoun Rachel Kim  4 , Noor Sadeq  9 , Ji-Hyun Jang  7 , Sarah Shamiya  12 , Gregg Nelson  13
Affiliations

Oncologic Outcomes of Surgically Treated Cervical Cancer with No Residual Disease on Hysterectomy Specimen: A 4C (Canadian Cervical Cancer Collaborative) Working Group Study

Christa Aubrey et al. Curr Oncol. .

Abstract

Minimally invasive surgery for the treatment of macroscopic cervical cancer leads to worse oncologic outcomes than with open surgery. Preoperative conization may mitigate the risk of surgical approach. Our objective was to describe the oncologic outcomes in cases of cervical cancer initially treated with conization, and subsequently found to have no residual cervical cancer after hysterectomy performed via open and minimally invasive approaches. This was a retrospective cohort study of surgically treated cervical cancer at 11 Canadian institutions from 2007 to 2017. Cases initially treated with cervical conization and subsequent hysterectomy, with no residual disease on hysterectomy specimen were included. They were subdivided according to minimally invasive (laparoscopic/robotic (MIS) or laparoscopically assisted vaginal/vaginal hysterectomy (LVH)), or abdominal (AH). Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Chi-square and log-rank tests were used to compare between cohorts. Within the total cohort, 238/1696 (14%) had no residual disease on hysterectomy specimen (122 MIS, 103 AH, and 13 VLH). The majority of cases in the cohort were FIGO 2018 stage IB1 (43.7%) and underwent a radical hysterectomy (81.9%). There was no statistical difference between stage, histology, and radical vs simple hysterectomy between the abdominal and minimally invasive groups. There were no significant differences in RFS (5-year: MIS/LVH 97.7%, AH 95.8%, p = 0.23) or OS (5-year: MIS/VLH 98.9%, AH 97.4%, p = 0.10), although event-rates were low. There were only two recurrences. In this large study including only patients with no residual cervical cancer on hysterectomy specimen, no significant differences in survival were seen by surgical approach. This may be due to the small number of events or due to no actual difference between the groups. Further studies are warranted.

Keywords: cervical cancer; minimally invasive surgery.

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Conflict of interest statement

G.N. has received speaker feeds from GSK, Pfizer, 3M, and Medtronic, and serves as the treasurer for the ERAS Society. A.D.A. has received research support from AstraZeneca, Pfizer, Cloivis, CCMB foundation, CCTG, and Merck, and has received speaker fees from AstraZeneca and Merck. Additionally is on the GSK and AstraZeneca advisory board, and on the board of directors for GOC, DocsMB, and University medical group. L.H. has received speaker fees from MSD, and serves on the Advisory board for MSD. She also serves as a board member of the Israeli Society of Gynecologic Oncology. J.S.K. has received research grants to her institution from CIHR, and CCS, and has also received the Michael Smith Foundation for health research Clinician scientist award. She has also received speaker feeds from AstraZeneca, and serves on the editorial board for Gynecologic Oncology, and is the Principle editor for the Journal of Gynecologic Oncology. G.R.P. has received consulting fees from Merck, and Profound medical, as well as honoraria from AstraZeneca. He is also involved in the Takeda Board, and declares a close family member to be an employee at Roche Ltd. None of the these conflicts of interest are felt to be directly relevant to this manuscript, and the remainder of the authors have any relevant conflicts of interest.

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