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Cervical cancer can be prevented
01:11 - Source: CNN
CNN  — 

The type of surgery a woman has will affect her ability to survive cervical cancer, new research suggests. Among patients with early-stage cervical cancer, women who undergo minimally invasive operations have a greater risk of dying than those who undergo open surgeries, two studies published Wednesday in the New England Journal of Medicine found.

The studies compared the same operation, radical hysterectomy, performed both as open surgery and as a minimally invasive procedure.

Radical hysterectomy, or removal of the uterus, cervix and other parts of the female reproductive system, is a recommended treatment for many patients with early-stage cervical cancer. Introduced in 1992, minimally invasive radical hysterectomy – in which smaller incisions are made with either a laparoscopic or a robot-assisted procedure – increased in popularity over time. Today, about 60% of cervical cancer hysterectomies are minimally invasive, according to the authors of the study.

Small studies of minimally invasive radical hysterectomy had “shown that it was safe,” though most “just focused on what happened in the short term,” explained Dr. Jose Alejandro Rauh-Hain, senior author of one of the new studies and an assistant professor of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center in Houston.

His new analysis of information from the National Cancer Database included “a large sample of patients” and “looked at what happened many years after their diagnosis.”

Survival rate differences by type of surgery

Of 2,461 patients who had a radical hysterectomy for early-stage cervical cancer, about half underwent minimally invasive procedures, and the remaining women had open surgery, Rauh-Hain and his colleagues found. Of the minimally invasive group, 94 women died in the four years after surgery; 70 women in the open surgery group did not survive four years, the study showed.

This translates to a 9.1% risk of death for women in the minimally invasive group and a 5.3% risk of death in the open surgery group, the researchers wrote.

Rauh-Hain and his colleagues also analyzed information from a separate national cancer database and found a stable four-year survival rate for early-stage cervical cancer prior to 2006. However, after that – the time when minimally invasive radical hysterectomies grew more commonplace – survival rates steadily dropped by about 0.8% per year. This trend suggests a cause and effect relationship between minimally invasive procedures and lower survival rates, according to the authors.

Cancer recurrence differences by type of surgery

A second new study also compared minimally invasive and open surgery procedures and found similar results. Here, patients with early-stage cervical cancer were randomly assigned to receive either a minimally invasive radical hysterectomy or an open radical hysterectomy.

“What we found in this study was that patients with early cervical cancer who underwent either laparoscopic or robotic radical hysterectomy had a higher risk of cancer recurrence, or cancer coming back,” said Dr. Pedro Ramirez, lead author of the study and a professor and director of minimally invasive surgical research and education in the Department of Gynecologic Oncology at the University of Texas MD Anderson Cancer Center in Houston.

Overall, women who underwent a minimally invasive radical hysterectomy were four times more likely to experience recurrent cervical cancer than women undergoing open surgery, he said. And minimally invasive surgery was associated with a lower overall survival rate at three years: Nearly 94% survived, versus 99% of the open surgery patients.

So what’s a cervical cancer patient to do if she has undergone a minimally invasive radical hysterectomy?

According to Ramirez, she should have a discussion with her physician about the research results and focus on when she is “at highest risk for recurrence.” He noted that most of the patients in his study who had a cancer recurrence saw their cancer return within two years.

Patients who had minimally invasive surgeries more than two years ago should feel “reassured” because “most likely, they are going to be OK,” he said.

Other patients, those whose minimally invasive operations occurred within the past two years, should discuss the studies with their physicians and be aware of “signs of recurrent disease – signs such as vaginal bleeding, abdominal bloating, unexpected pain and persistent pain,” Ramirez said. These patients should also talk about a plan for closer surveillance with their doctors, he said.

A ‘strong message’ about surgery

Rauh-Hain agrees that patients should discuss the studies and a comprehensive monitoring plan with their physicians.

Because results from both studies are “very, very similar,” they deliver “a strong message that, in fact, minimally invasive surgery is not a safe approach among patients with early-stage cervical cancer,” he said. “We really don’t know at this point why patients with minimally invasive surgery had worse survival.”

Though neither study was designed to answer that question, Ramirez said that having balanced the risk factors between the two groups of patients in his study, the only difference was the actual surgical approach. So what is unique about minimally invasive surgery that could increase the risk of cancer recurrence?