Lower survival in cervical cancer
The second study was a meta-analysis of 15 studies involving 9,499 women who underwent radical hysterectomy for stage IA1 to IIA cervical cancer.
Nearly half of the cohort (n = 4,684; 49%) underwent MIS. Of those, 57% (n = 2675) underwent robot-assisted laparoscopy.
A total of 530 recurrences and 451 deaths were reported. The pooled hazard of recurrence or death was 71% higher among patients who underwent MIS in comparison with those who underwent open surgery (HR, 1.71; P < .001). The hazard of death was 56% higher in the MIS group than in the open surgery group (HR, 1.56; P = .004).
“The magnitude of the effect, while lower than that reported in the LACC trial, is still notable and likely reflects real-world outcomes,” the editorialists said.
They also noted that the “results of the LACC trial remain controversial but were followed by a global decrease in the use of MIS for treatment of early-stage cervical cancer.”
However, the editorialists also highlighted the advantages of MIS, saying it has “considerable benefits” in the treatment of gynecologic cancer.
They cited an article from the American College of Surgeons National Quality Improvement Program, which reports an analysis of 2076 endometrial cancer cases that found a much lower complication rate after MIS compared with laparotomy (12% vs. 31%).
“Shorter hospital stays and lower complication rates could result in an estimated cost savings of $534 million if MIS was used in 90% of all patients with endometrial cancer in the U.S.A.,” they wrote.
Nevertheless, they added that “the short-term advantages of MIS for gynecologic cancers should be weighed against the risks of potentially worse long-term outcomes.”
These two latest studies should serve as another call to action, they concluded. “We owe it to patients to study any surgical or medical intervention adhering to the highest standards of clinical investigation.”
The ovarian cancer study was supported by grants from the National Cancer Institute Cancer Center and the National Institutes of Health. The cervical cancer meta-analysis study was funded by the National Cancer Institute, the American Cancer Society, and the Frank McGraw Memorial Chair in Cancer Research and Ensign Endowment for Gynecologic Cancer Research. Dr. Wright has received grants from Merck and consultation fees from Clovis Oncology outside the submitted work; several coauthors from both articles report relationships with industry. Dr. Karam has received personal fees from Clovis Oncology, AstraZeneca, GSK, and UpToDate outside the submitted work. Dr. Dorigo has received fees from many pharmaceutical companies and salary for medical legal expert witness testimony.
This article first appeared on Medscape.com.