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Open vs minimally invasive radical trachelectomy in early-stage cervical cancer: International Radical Trachelectomy Assessment Study
G. Salvo, PT. Ramirez, MM. Leitao, D. Cibula, X. Wu, H. Falconer, J. Persson, M. Perrotta, BJ. Mosgaard, A. Kucukmetin, I. Berlev, G. Rendon, K. Liu, M. Vieira, ME. Capilna, C. Fotopoulou, G. Baiocchi, D. Kaidarova, R. Ribeiro, S. Pedra-Nobre, R....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, Research Support, N.I.H., Extramural
Grantová podpora
P30 CA016672
NCI NIH HHS - United States
- MeSH
- adenokarcinom mortalita chirurgie MeSH
- adenoskvamózní karcinom mortalita chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory děložního čípku mortalita chirurgie MeSH
- přežití bez známek nemoci MeSH
- spinocelulární karcinom mortalita chirurgie MeSH
- trachelektomie MeSH
- zachování plodnosti MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Brazílie MeSH
BACKGROUND: Minimally invasive radical trachelectomy has emerged as an alternative to open radical hysterectomy for patients with early-stage cervical cancer desiring future fertility. Recent data suggest worse oncologic outcomes after minimally invasive radical hysterectomy than after open radical hysterectomy in stage I cervical cancer. OBJECTIVE: We aimed to compare 4.5-year disease-free survival after open vs minimally invasive radical trachelectomy. STUDY DESIGN: This was a collaborative, international retrospective study (International Radical Trachelectomy Assessment Study) of patients treated during 2005-2017 at 18 centers in 12 countries. Eligible patients had squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma; had a preoperative tumor size of ≤2 cm; and underwent open or minimally invasive (robotic or laparoscopic) radical trachelectomy with nodal assessment (pelvic lymphadenectomy and/or sentinel lymph node biopsy). The exclusion criteria included neoadjuvant chemotherapy or preoperative pelvic radiotherapy, previous lymphadenectomy or pelvic retroperitoneal surgery, pregnancy, stage IA1 disease with lymphovascular space invasion, aborted trachelectomy (conversion to radical hysterectomy), or vaginal approach. Surgical approach, indication, and adjuvant therapy regimen were at the discretion of the treating institution. A total of 715 patients were entered into the study database. However, 69 patients were excluded, leaving 646 in the analysis. Endpoints were the 4.5-year disease-free survival rate (primary), 4.5-year overall survival rate (secondary), and recurrence rate (secondary). Kaplan-Meier methods were used to estimate disease-free survival and overall survival. A post hoc weighted analysis was performed, comparing the recurrence rates between surgical approaches, with open surgery being considered as standard and minimally invasive surgery as experimental. RESULTS: Of 646 patients, 358 underwent open surgery, and 288 underwent minimally invasive surgery. The median (range) patient age was 32 (20-42) years for open surgery vs 31 (18-45) years for minimally invasive surgery (P=.11). Median (range) pathologic tumor size was 15 (0-31) mm for open surgery and 12 (0.8-40) mm for minimally invasive surgery (P=.33). The rates of pelvic nodal involvement were 5.3% (19 of 358 patients) for open surgery and 4.9% (14 of 288 patients) for minimally invasive surgery (P=.81). Median (range) follow-up time was 5.5 (0.20-16.70) years for open surgery and 3.1 years (0.02-11.10) years for minimally invasive surgery (P<.001). At 4.5 years, 17 of 358 patients (4.7%) with open surgery and 18 of 288 patients (6.2%) with minimally invasive surgery had recurrence (P=.40). The 4.5-year disease-free survival rates were 94.3% (95% confidence interval, 91.6-97.0) for open surgery and 91.5% (95% confidence interval, 87.6-95.6) for minimally invasive surgery (log-rank P=.37). Post hoc propensity score analysis of recurrence risk showed no difference between surgical approaches (P=.42). At 4.5 years, there were 6 disease-related deaths (open surgery, 3; minimally invasive surgery, 3) (log-rank P=.49). The 4.5-year overall survival rates were 99.2% (95% confidence interval, 97.6-99.7) for open surgery and 99.0% (95% confidence interval, 79.0-99.8) for minimally invasive surgery. CONCLUSION: The 4.5-year disease-free survival rates did not differ between open radical trachelectomy and minimally invasive radical trachelectomy. However, recurrence rates in each group were low. Ongoing prospective studies of conservative management of early-stage cervical cancer may help guide future management.
Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston TX
Department of Clinical Sciences Faculty of Medicine Lund University Lund Sweden
Department of Gynecologic Oncology AC Camargo Cancer Center São Paulo Brazil
Department of Gynecologic Oncology Astorga Clínica de Oncología Medellín Colombia
Department of Gynecologic Oncology Barretos Cancer Hospital Barretos Brazil
Department of Gynecologic Oncology Fudan University Shanghai Cancer Center Shanghai China
Department of Gynecologic Oncology Hospital Erasto Gaertner Curitiba Brazil
Department of Gynecologic Oncology Hospital Israelita Albert Einstein São Paulo Brazil
Department of Gynecologic Oncology Instituto de Cancerología Las Américas Auna Medellín Colombia
Department of Gynecologic Oncology Kazakh Institute of Oncology and Radiology Almaty Kazakhstan
Department of Gynecologic Oncology Pilar Hospital Curitiba Brazil
Department of Gynecology University Hospital Copenhagen Rigshospitalet Copenhagen Denmark
Department of Obstetrics and Gynecology Skåne University Hospital Lund Sweden
Department of Surgery Memorial Sloan Kettering Cancer Center New York NY
Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
Instituto Nacional de Cancerología Bogotá Colombia
Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Gateshead United Kingdom
Servicio de Ginecología Hospital Italiano de Buenos Aires Buenos Aires Argentina
Citace poskytuje Crossref.org
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- $a Salvo, Gloria $u Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: GSalvo@mdandeson.org
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