Abstract 867P
Background
Recently, the unexpected results of the Laparoscopic Approach to Cervical Cancer (LACC) trial have brought a strong debate into the gynecologic oncology community on the role of minimally invasive surgery (MIS) in patients affected by cervical cancer. These new data suggetsed that MIS correlates with worse outcomes in comparions to open surgery. Here, we aim to identify different patterns of recurrence after MIS and open abdominal radical hysterectomy in order to understand reason supporting worse outcomes following MIS.
Methods
This a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after MIS and open abdominal surgery. In order to reduce possible confounding factors, we applied a propensity-matching algorithm.
Results
Chart of 1,058 cervical cancer patients were retrieved. The study population included 117 (14.2%) and 35 (14.9%) patients with recurrent cervical cancer who had had open abdominal and MIS, respectively. Applying a propensity matched comparison (1:2) we reduced the study population to 105 patients (35 vs. 70 patients having recurrence after MIS and open abdominal radical hysterectomy). The groups had similar baseline characteristics. Patients having radical hysterectomy via MIS experienced shorter progression-free survival than patients having open abdominal procedures (median progression-free survival: 8.0 vs. 15.8 months; HR: 1.98 (95%CI: 1.32 to 2.97); p=0.005). Patients having MIS were more likely to develop intra-pelvic recurrences (74% vs. 34%; p<0.001) and peritoneal carcinomatosis (17% vs. 1%; p=0.005) than patients having open surgery. Site specific progression-free survival for vaginal, lymphatic and distant recurrences was similar between groups. However, patients having MIS are at high risk of developing intra-pelvic recurrences and peritoneal carcinomatosis (HR: 17.9 (95%CI: 3.42 to 93.7); p=0.0006 log-rank test).
Conclusions
Patients having MIS are at high risk of developing intra-pelvic recurrences and peritoneal carcinomatosis, possibly due to a contamination of the pelvic area during colpotomy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Fondazione IRCCS Istituto Nazionale dei Tumori Milano.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.