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Minimally Invasive Hysterectomy for Cervical Cancer: Less Invasive but Higher Risk

Posted by Sharyn Lewin, M.D., Director of Gynecologic Oncology of Patricia Lynch Cancer Center at Holy Name Medical Center on November 6, 2018

Sharyn Lewin, M.D., director of gynecologic oncology at the medical center

In the years since the turn of the millennium, technology has been the driving force behind countless improvements in healthcare.

Two of the biggest innovations, robot-assisted surgery and laparoscopic surgery, allow doctors to perform many types of complex procedures with more precision, flexibility, and control than with conventional surgery. Gynecologists were pioneers in this field.

"There are so many benefits to both these techniques for the patient, from shorter hospital stays and reduced pain and discomfort, to smaller incisions and reduced blood loss," says Sharyn Lewin, MD, director of gynecologic oncology at the Patricia Lynch Cancer Center at Holy Name Medical Center. "As a result, the field of robotic surgery developed rapidly, and its use for gynecologic conditions has grown tremendously."

But now, two studies published last week in the New England Journal of Medicine found that women who had minimally invasive hysterectomies to treat cervical cancer were more likely to have the cancer return than if they had undergone the more invasive open surgery.

"These results are shocking," says Dr. Lewin, who adds that prior to these two studies a minimally invasive hysterectomy was the standard surgical treatment method.

"I first found out about the results in March at a national conference," says Dr. Lewin. "Since then we have stopped performing minimally invasive procedures on women with cervical cancer at Holy Name Medical Center and made sure to tell all our patients about the newly found risks."

In the first study, researchers compared the two methods in terms of how many women were disease-free four and one-half years after surgery. The result was a 10 percent difference, with 86 percent of women who had the robotic surgery being alive and disease-free after four and one-half years compared with 96.5 percent of women who had open surgery (radical hysterectomy).

In the second study, researchers analyzed 2,461 patients in the National Cancer Database who had radical hysterectomies for early-stage cervical cancer from 2010 through 2013. Half of these were by robotic surgery and half by open surgery. Again, researchers found that the women who underwent the minimally invasive surgery had higher rates of cancer recurrence and death than those who had traditional surgery. There was a 9.1 percent risk of death in the minimally invasive group and a 5.3 percent risk in the open surgery group.

"What we don’t know from this research is why the minimally invasive procedure led to poorer survival rates," says Dr. Lewin, who speculates that perhaps the tumor tissue is not completely removed in some robotic procedures, or that somehow the tools used may help to spread the tumor tissue. "At this point, we recommend only using open surgery to perform a radical hysterectomy for cervical cancer."

Dr. Lewin encourages patients who had or were considering minimally invasive hysterectomy for cervical cancer to speak with their doctors. "We regularly participate in national meetings, and because of this were aware of the study results early. We stopped performing minimally invasive procedures on women with cervical cancer. At Holy Name, we look at this and other evidence-based data and translate it into the best possible outcomes for our patients."

Cervical cancer is the fourth leading cause of cancer death in women worldwide and affects more than 13,000 women in the United States each year. The cervical cancer death rate, though, has dropped significantly with increased use of the Pap smear, a screening procedure that can find changes in the cervix before cancer develops. Dr. Lewin urges women to get tested.

To make an appointment for a screening, please call 201-227-6200.

To learn more about the risks and symptoms of cervical cancer, please visit: www.holyname.org/GynecologicOncology/cervical-cancer.aspx