Alexander Melamed1, Pedro T Ramirez2. 1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York. 2. Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Abstract
PURPOSE OF REVIEW: The aim of the article is to review recent studies that compare the oncologic efficacy of minimally invasive radical hysterectomy with that of open radical hysterectomy. RECENT FINDINGS: The Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized study design to test the hypothesis that minimally invasive radical hysterectomy is not inferior to open radical hysterectomy, was stopped early by the data and safety monitoring committee after enrolling 631 of a planned 740 patients. The disease-free survival rate at 4.5 years was 86% among women assigned to minimally invasive surgery and 96.5% in those who underwent open surgery (hazard ratio [HR] 3.74; 95% confidence interval [CI] 1.63-8.58). Minimally invasive surgery was also associated with inferior overall survival (HR 6.00; 95% CI 1.44-12.7). Recent well designed, adequately powered observational studies mostly corroborate the findings of the LACC trial. SUMMARY: After a decade of widespread acceptance and increasing popularity, the preponderance of evidence now suggests that minimally invasive radical hysterectomy for cervical cancer confers an excess risk of recurrence and death compared with open abdominal radical hysterectomy.
RCT Entities:
PURPOSE OF REVIEW: The aim of the article is to review recent studies that compare the oncologic efficacy of minimally invasive radical hysterectomy with that of open radical hysterectomy. RECENT FINDINGS: The Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized study design to test the hypothesis that minimally invasive radical hysterectomy is not inferior to open radical hysterectomy, was stopped early by the data and safety monitoring committee after enrolling 631 of a planned 740 patients. The disease-free survival rate at 4.5 years was 86% among women assigned to minimally invasive surgery and 96.5% in those who underwent open surgery (hazard ratio [HR] 3.74; 95% confidence interval [CI] 1.63-8.58). Minimally invasive surgery was also associated with inferior overall survival (HR 6.00; 95% CI 1.44-12.7). Recent well designed, adequately powered observational studies mostly corroborate the findings of the LACC trial. SUMMARY: After a decade of widespread acceptance and increasing popularity, the preponderance of evidence now suggests that minimally invasive radical hysterectomy for cervical cancer confers an excess risk of recurrence and death compared with open abdominal radical hysterectomy.
Authors: Anne Knisely; Charlotte R Gamble; Caryn M St Clair; June Y Hou; Fady Khoury-Collado; Allison A Gockley; Jason D Wright; Alexander Melamed Journal: J Minim Invasive Gynecol Date: 2020-11-14 Impact factor: 4.314