Long-term impact of surgical route and tumor size on risk of recurrence among early-stage cervical cancer patients in a managed care population.

Abstract

Objective: This study aimed to compare survival outcomes between minimally invasive surgery (MIS) and open surgery for early-stage cervical cancer in a managed care community patient population.

Methods: This retrospective study included adult patients who underwent a hysterectomy or trachelectomy for a pre-operative clinical-pathologic diagnosis of stage IA1 to IIA1 cervical cancer as defined by the International Federation of Gynecology and Obstetrics 2018 cervical cancer staging. Patients were diagnosed with cervical cancer between January 2005 and December 2018 at a Kaiser Permanente Northern California hospital. We compared outcomes between patients with stage IA2 to IIA1 cervical cancer who underwent a radical MIS and those who underwent open surgery. We separately analyzed patients with stage IA1 disease.

Results: A total of 227 patients (55%) with stage IA2 to IIA1 disease underwent MIS and were compared with 187 patients (45%) in the open cohort. In most cases, MIS involved robotic-assisted surgery (77%). The median length of follow-up was 82.6 months (interquartile range; 53.8-106.4) for MIS and 156.6 months (interquartile range; 139.1-168.7) for the open group. There were 27 recurrences in the MIS group (12%) and 8 recurrences in the open group (4%) (p < .01). The 10-year recurrence-free survival was significantly lower in the MIS group (87%, 95% CI 81.0% to 90.7%) than in the open group (97%, 95% CI 92.4% to 98.4%, p < .01). Among patients with tumor size <2 cm, the 10-year recurrence-free survival was significantly lower with MIS (89%, 95% CI 82.7% to 93.5%) than with open surgery (98%, 95% CI 92.3% to 99.5%, p < .01). The 10-year disease-specific survival was also inferior for MIS (96%, 95% CI 92.0% to 98.2%) than for open surgery (100%, 95% CI 100% to 100%, p < .01). None of the 133 patients with stage IA1 disease experienced a cancer recurrence, regardless of surgical approach. Prior cone biopsy was associated with a lower risk of recurrence (adjusted HR 0.48, 95% CI 0.22 to 1.03).

Conclusions: Patients with stage IA2 to IIA1 cervical cancer, including those with tumors <2 cm, had inferior survival outcomes following MIS compared with open surgery. Patients with stage IA1 cervical cancer have a very low risk of recurrence regardless of surgical approach.