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SGO member update: Emerging data on the surgical approach for radical hysterectomy in the treatment of women with cervical cancer (September 2019)

RecommendationsCervical CancerSurgery
Sep 11, 2019

CHICAGO, IL (Sept. 11, 2019)— Gynecologic oncologists should be aware of the continued emerging data on minimally invasive surgery (MIS) for cervical cancer so that a thorough discussion can be undertaken with patients and shared decision making used when choosing the surgical approach for radical hysterectomy. We provide the following updated statement from the SGO Clinical Practice Committee and approved by the SGO Executive Committee.

The recently published prospective randomized Phase 3 Laparoscopic Approach to Cervical Cancer (LACC) trial and the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database study in the New England Journal of Medicine both noted inferior overall survival outcomes for patients with Stage IA2 and IB1 cervical cancer treated with MIS in early-stage cervical cancer. Since the publication of these important studies, a number of large, population-based and single-institution, retrospective analyses have been performed in several countries, including the United States, Canada, United Kingdom and South Korea (Table). These studies collectively demonstrate similar adverse survival trends for MIS compared to open radical hysterectomy as the LACC trial and the analysis by Melamed et al. Additionally, the National Comprehensive Cancer Network now states that open radical hysterectomy is “the historical and standard approach” to treatment of early-stage cervical cancer.

While the reasons for these outcomes remain unclear, the preponderance of the contemporary published literature suggests poorer survival outcomes for women undergoing radical hysterectomy for cervical cancer treated with MIS compared to open radical hysterectomy. Gynecologic oncologists are encouraged to consider all available data as they counsel individual patients to determine the most appropriate surgical approach.

Table: Contemporary Data Regarding the Survival Impact of Minimally Invasive Compared with Open Radical Hysterectomy

Study # of Pts Type of Study Recurrence Rates PFS* OS**
Ramirez et al LACC Trial 2018

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