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 Gynecologic Oncology Zekai Tahir Burak Women's Health Education and Research Hospital Ankara Turkey

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

Division of Gynecologic Oncology 1st Department of Obstetrics and Gynecology Alexandra Hospital National and Kapodistrian University of Athens Athens Greece

Emergency County Hospital Targu Mures Romania

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

Instituto Português de Oncologia de Lisboa Lisboa Portugal

IPO PORTO Porto 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

North Western State Medical University N N Petrov Research Institute of Oncology St Petersburg Russia

Obstetrics and Gynecology Clinica Universidad de Navarra Pamplona Spain

Obstetrics and Gynecology School of Medicine; University of Navarra Pamplona Spain

Obstetrics and Gynecology Tampere University Hospital Tampere Finland

Obstetrics and Gynecology Universidad de Navarra Pamplona Spain

Obstetrics and Gynecology University of Liege Liege Belgium

Obstetrics and Gynecology; Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine University of Debrecen Debrecen Hungary

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

University Oncologic Hospital Sofia Bulgaria

Int J Gynecol Cancer. 2020 Sep;30(9):1278-1279. doi: 10.1136/ijgc-2020-001870. PubMed

References provided by Crossref.org

Assessing minimally invasive simple hysterectomy in low risk cervical cancer: set up for the LASH trial

MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial?