- Two recent reports in the New England Journal of Medicine have found that minimally invasive surgeries are less effective at treating early-stage cervical cancer than open surgeries.
- These results came as a surprise to researchers and members of the gynecological community, as minimally invasive surgeries have been the treatment of choice for the last 15 years.
- In one study, 94.7% of patients who received an open surgery – or laparotomy – were still alive four years after their procedure. Of patients who received a minimally invasive surgery, or laparoscopy, 90.9% were still alive four years later.
- Researchers are unsure what caused the differences in effectiveness, but are taking steps to look into it.
For the last decade, minimally invasive surgeries have been gynecologists’ preferred choice for treating early-stage cervical cancer. After all, they have lead to a lower risk of infection and faster recovery for patients. But two new reports have found that this method, also known as a laparoscopy, is less effective than its more invasive counterpart.
The two studies were both published on October 31 in the New England Journal of Medicine, and reported by TIME. The researchers compared the long-term survival outcome of two kinds of hysterectomy (uterus removal) procedures: minimally invasive surgery and open surgery.
Both analyses found that the minimally invasive procedure had a lower survival rate.
The first study was led by Dr. Pedro Ramirez, a professor at the University of Texas MD Anderson Cancer Center. His team of researchers divided a group of roughly 600 patients in half and assigned them to either get minimally invasive surgery or open surgery. But the study was stopped after four months because the minimally invasive surgery group showed a dramatically lower survival rate.
Specifically, according to the study, the rate of disease-free survival at 4.5 years was 86% for the minimally invasive surgery group, compared to 96.5% for the open surgery group. Furthermore, the minimally invasive surgery group had a lower overall survival rate than the open surgery group (93.8% versus 99%) and a higher rate of death from cervical cancer (4.4% as compared to 0.6%) .
The second study, which was led by Dr. Alexander Melamed, a gynecologic oncologist at Massachusetts General Hospital, found similarly surprising results. The researchers looked at 2,461 women, about half of whom underwent minimally invasive surgery and half did open surgery. Their results showed that the rate of disease-free survival after four years was 90.9% for the minimally invasive surgery group and 94.7% for the open surgery group.
“When you have a cancer like early-stage cervical cancer that has a great prognosis and that most patients should survive, a five per cent difference is pretty significant,” Dr. Alejandro Rauh-Hain, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center who worked on the second study, told INSIDER.
The findings of the study were shocking to many members of the gynecologic oncology community, including Dr. Julian Schink, chief of gynecologic oncology at Cancer Treatment Centres of America. Schink has been practicing minimally invasive surgeries for the past 15 years.
“This is the first piece of compelling data that shows one procedure is inferior,” he told INSIDER. Though Schink said this was shocking and disheartening on a personal level, he is grateful for the information.
“It is our responsibility, as we adopt new technologies, to confirm the changes we made are effective,” he said.
Researchers don’t know why the modern treatment is less effective
It is also important to understand why the less invasive surgery isn’t as effective – a question the researchers of these two studies are still trying to resolve.
But one factor they can rule out is residual tumours. According to Ramirez’s study, there was no evidence that women who underwent the minimally invasive surgery had more residual tumours than those who received the open surgery.
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As a result of these findings, TIME reports, the National Comprehensive Cancer Network (NCCN) is advising women with early-stage cervical cancer to opt for an open hysterectomy. Schink and Rauh-Hain also each told INSIDER that they plan to stop practicing minimally invasive procedures to treat early-stage cervical cancer.
Rauh-Hain added, however, that patients and practitioners should have an open conversation about the findings of these studies.
Additionally, Schink said patients should remember that the study focused solely on cervical cancer, which is just one type of gynecological cancer. In the case of endometrial cancer, he said, all recent research finds both procedures to be equally effective.