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SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer
L. Chiva, V. Zanagnolo, D. Querleu, N. Martin-Calvo, J. Arévalo-Serrano, ME. Căpîlna, A. Fagotti, A. Kucukmetin, C. Mom, G. Chakalova, S. Aliyev, M. Malzoni, F. Narducci, O. Arencibia, F. Raspagliesi, T. Toptas, D. Cibula, D. Kaidarova, MM....
Language English Country Great Britain
Document type Journal Article
NLK
ProQuest Central
from 2018-01-01 to 6 months ago
Health & Medicine (ProQuest)
from 2018-01-01 to 6 months ago
- MeSH
- Adult MeSH
- Hysterectomy methods MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures methods MeSH
- Young Adult MeSH
- Uterine Cervical Neoplasms surgery MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Neoplasm Staging MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
BACKGROUND: Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. METHODS: We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. RESULTS: Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m2 (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52). CONCLUSIONS: Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.
Amsterdam University Medical Centre Amsterdam Netherlands
Azienda Ospedaliero Universitaria di Bologna Policlinico SantOrsola Malpighi Bologna Italy
Bellvitge University Hospital L'Hospitalet de Llobregat Catalunya Spain
Center for Advanced Endoscopic Gynecologic Surgery Avellino Italy
Clinic of Obstetrics and Gynecology Hospital San Gerardo Monza Italy
Clinical Hospital Center Rijeka Rijeka Croatia
Clinical Hospital Center Zagreb Croatia
Department of Gynecology and Oncology Jagiellonian University Krakow Poland
Department of Medicine and Surgery University of Milan Bicocca Milano Italy
Department of Obstetrics and Gynecology Clinica Universidad de Navarra Madrid Spain
Department of Obstetrics and Gynecology University of Prague Prague Czech Republic
Department of Preventive Medicine and Public Health Universidad de Navarra Pamplona Spain
Emergency County Hospital Targu Mures Romania
Faculty of Medicine University of Debrecen Debrecen Hungary
Fondazione IRCCS Istituto Nazionale dei Tumori Milano Italy
General Hospital of Thessaloniki Papageorgiou Thessaloniki Greece
Gynaecology LUMC Leiden Netherlands
Gynecological Oncology Radboudumc Nijmegen Netherlands
Gynecology Centre Oscar Lambret Lille France
Institut Curie Paris Île de France France
Institute of Obstetrics and Gynecology
Instituto Português de Oncologia de Lisboa Lisboa Portugal
Istituto Europeo di Oncologia Milano Italy
LISOD Israeli Oncological Hospital Kyiv Ukraine
Lviv Oncology Center Lviv Ukraine
Medical University of Graz Graz Steiermark Austria
National Center of Oncology Baku Azerbaijan
North Estonia Medical Centre Tallinn Estonia
Obstetrics and Gynecology Clinica Universidad de Navarra Pamplona Spain
Obstetrics and Gynecology School of Medicine
Obstetrics and Gynecology Tampere University Hospital Tampere Finland
Obstetrics and Gynecology Universidad de Navarra Pamplona Spain
Obstetrics and Gynecology University of Liege Liege Belgium
Oncogynecology Grigorev Institute for Radiology Kharkiv Ukraine
Oncogynecology Kazahskij Naucno issledovatel'skij Institut Onkologii i Radiologii Almaty Kazakhstan
Oncological Gynecology Lower Silesian Cancer Center Wroclaw Poland
Policlinico A Gemelli Roma Italy
Principe de Asturias University Hospital Alcala de Henares Spain
Queen Elizabeth Hospital Gateshead UK
Saglik Bilimleri University Antalya Research and Training Hospital Antalya Turkey
Surgery Institut Bergonie Bordeaux France
University Hospitals of Leicester NHS Trust Leicester UK
University Maternal Hospital Canary Islands Las Palma Spain
References provided by Crossref.org
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- $a BACKGROUND: Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. METHODS: We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. RESULTS: Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m2 (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52). CONCLUSIONS: Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.
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