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3 November, 2018 00:00 00 AM
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Less-invasive surgery for cervical cancer may bring more risks

Less-invasive surgery 
for cervical cancer may 
bring more risks

Surgeons have long turned to a minimally invasive means of hysterectomy when treating early stage cervical cancer. However, two new studies could change all that. Both found the approach was linked to a higher rate of cancer recurrence, plus worse long-term survival, compared to more "open" surgeries.

"Minimally invasive surgery was adopted as an alternative to open radical hysterectomy before high-quality evidence regarding its impact on survival was available," said Dr. Jose Alejandro Rauh-Hain of the University of Texas MD Anderson Cancer Center in Houston, who helped lead the study. Speaking in a university news release, Rauh-Hain said he was "surprised" to find that the technique "negatively affected oncologic outcomes for women with early stage cervical cancer."

Dr. Alexander Melamed, a gynecologic oncologist at Massachusetts General Hospital (MGH) in Boston, was co-lead researcher on the study with Ruah-Hain. He noted that a second study -- this time an international clinical trial -- has found similar results.

Taken together, the data should change clinical practice, Melamed said in an MGH news release.

"Personally, I will not offer minimally invasive radical hysterectomy to patients who come to me for cervical cancer treatment, until compelling new research demonstrates a minimally invasive approach that does not carry these risks," he said.

Each year, over 13,000 new cases of cervical cancer are diagnosed in the United States, and nearly 4,200 women will die of the disease, according to the American Cancer Society. Radical (complete) hysterectomy is standard treatment. As the researchers explained, oncologic surgeons largely abandoned "open" surgeries for radical hysterectomy years ago with the advent of small-incision, laparoscopic techniques. The use of robot-assisted surgery only accelerated the move away from traditional "open" operations. Initial studies appeared to support the use of the minimally invasive techniques. However, patient follow-up times in those trials were relatively short. The two new studies were different, tracking outcomes for more than four years after surgery.

In the study led by Ruah-Hain and Melamed, researchers assessed outcomes for nearly 2,500 patients in the US National Cancer Database who underwent radical hysterectomy for early stage cervical cancer from 2010 through 2013.

Of those, about half had minimally invasive surgery and about half had open surgery.

In the four years after their procedures, 94 patients in the minimally invasive group died from any cause, compared with 70 patients in the open surgery group. That works out to a 9 per cent risk of death in the minimally invasive group and a 5 per cent risk in the open surgery group -- a significant difference, the study authors said. The investigators also analyzed data from a second US health database, called Surveillance, Epidemiology and End Results (SEER). That analysis showed that four-year post-op survival rates were stable before 2006, when minimally invasive radical hysterectomy began to be widely used to treat early stage cervical cancer. But after 2006, survival rates began to fall by about 0.8 per cent per year, the team reported. That suggests a true cause-and-effect relationship.

"This result is very surprising, since randomized trials have demonstrated the safety of minimally invasive surgery for uterine, gastric and colorectal cancers," Melamed said.

"Our own work using similar methods to investigate minimally invasive surgery for ovarian cancer found no association with increased mortality, so it seems clear that something very different may be going on in cervical cancer," he added.

HealthDay

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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