Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-analysis | Cervical Cancer | JAMA Oncology | JAMA Network
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Sedlis  A, Bundy  BN, Rotman  MZ, Lentz  SS, Muderspach  LI, Zaino  RJ.  A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group study.   Gynecol Oncol. 1999;73(2):177-183. doi:10.1006/gyno.1999.5387 PubMedGoogle ScholarCrossref
Peters  WA  III, Liu  PY, Barrett  RJ  II,  et al.  Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix.   J Clin Oncol. 2000;18(8):1606-1613. doi:10.1200/JCO.2000.18.8.1606 PubMedGoogle ScholarCrossref
Ramirez  PT, Frumovitz  M, Pareja  R,  et al.  Minimally invasive versus abdominal radical hysterectomy for cervical cancer.   N Engl J Med. 2018;379(20):1895-1904. doi:10.1056/NEJMoa1806395 PubMedGoogle ScholarCrossref
Clark  JG.  A more radical method of performing hysterectomy for cancer of the uterus.   Bull Johns Hopkins Hosp. 1895;6:120-124.Google Scholar
Ries  E.  The operative treatment of cancer of the cervix.   JAMA. 1906;XLVII(23):1869-1872. doi:10.1001/jama.1906.25210230005001b Google ScholarCrossref
Nezhat  CR, Burrell  MO, Nezhat  FR, Benigno  BB, Welander  CE.  Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection.   Am J Obstet Gynecol. 1992;166(3):864-865. doi:10.1016/0002-9378(92)91351-A PubMedGoogle ScholarCrossref
Canis  M, Maze  G, Wattiez  A, Pouly  J, Chapron  C, Bruhat  M.  Vaginally assisted laparoscopic radical hysterectomy.   J Gynecol Surg. 1992;8:103-105. doi:10.1089/gyn.1992.8.103 Google ScholarCrossref
Uppal  S, Liu  JR, Reynolds  RK, Rice  LW, Spencer  RJ.  Trends and comparative effectiveness of inpatient radical hysterectomy for cervical cancer in the United States (2012-2015).   Gynecol Oncol. 2019;152(1):133-138. doi:10.1016/j.ygyno.2018.09.027 PubMedGoogle ScholarCrossref
Wright  JD, Herzog  TJ, Neugut  AI,  et al.  Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer.   Gynecol Oncol. 2012;127(1):11-17. doi:10.1016/j.ygyno.2012.06.031 PubMedGoogle ScholarCrossref
Society of Gynecologic Oncology. Notice to SGO members: emerging data on the surgical approach for radical hysterectomy in the treatment of women with cervical cancer. Published November 13, 2018. Accessed April 1, 2020.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer version 1. Accessed April 1, 2020.
Berger  ML, Sox  H, Willke  R,  et al. Duplicate:  recommendations for good procedural practices for real-world data studies of treatment effectiveness and/or comparative effectiveness designed to inform health care decisions: report of the joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making.   Value Health. 2017;7:1033-1039. doi:10.1016/j.jval.2017.07.013 Google Scholar
Wang  YZ, Deng  L, Xu  HC, Zhang  Y, Liang  ZQ.  Laparoscopy versus laparotomy for the management of early stage cervical cancer.   BMC Cancer. 2015;15:928. doi:10.1186/s12885-015-1818-4PubMedGoogle ScholarCrossref
Cao  T, Feng  Y, Huang  Q, Wan  T, Liu  J.  Prognostic and safety roles in laparoscopic versus abdominal radical hysterectomy in cervical cancer: a meta-analysis.   J Laparoendosc Adv Surg Tech A. 2015;25(12):990-998. doi:10.1089/lap.2015.0390 PubMedGoogle ScholarCrossref
Kong  TW, Chang  SJ, Lee  J, Paek  J, Ryu  HS.  Comparison of laparoscopic versus abdominal radical hysterectomy for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater.   Int J Gynecol Cancer. 2014;24(2):280-288. doi:10.1097/IGC.0000000000000052 PubMedGoogle ScholarCrossref
Lee  EJ, Kang  H, Kim  DH.  A comparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for early-stage cervical cancer: a long-term follow-up study.   Eur J Obstet Gynecol Reprod Biol. 2011;156(1):83-86. doi:10.1016/j.ejogrb.2010.12.016 PubMedGoogle ScholarCrossref
Malzoni  M, Tinelli  R, Cosentino  F, Fusco  A, Malzoni  C.  Total laparoscopic radical hysterectomy versus abdominal radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our experience.   Ann Surg Oncol. 2009;16(5):1316-1323. doi:10.1245/s10434-009-0342-7 PubMedGoogle ScholarCrossref
Sobiczewski  P, Bidzinski  M, Derlatka  P,  et al.  Early cervical cancer managed by laparoscopy and conventional surgery: comparison of treatment results.   Int J Gynecol Cancer. 2009;19(8):1390-1395. doi:10.1111/IGC.0b013e3181ba5e88 PubMedGoogle ScholarCrossref
Stroup  DF, Berlin  JA, Morton  SC,  et al.  Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis of Observational Studies in Epidemiology (MOOSE) group.   JAMA. 2000;283(15):2008-2012. doi:10.1001/jama.283.15.2008 PubMedGoogle ScholarCrossref
Wells  GA, O’Connell  D, Peterson  J, Welch  V, Losos  M, Tugwell  P. Newcastle-Ottawa quality assessment scale. Accessed May 5, 2020.
Houghton  JSM, Nickinson  ATO, Morton  AJ,  et al.  Frailty factors and outcomes in vascular surgery patients: a systematic review and meta-analysis.   Ann Surg. Published online October 22, 2019. doi:10.1097/SLA.0000000000003642 PubMedGoogle Scholar
Zhang  T, Sidorchuk  A, Sevilla-Cermeño  L,  et al.  Association of cesarean delivery with risk of neurodevelopmental and psychiatric disorders in the offspring: a systematic review and meta-analysis.   JAMA Netw Open. 2019;2(8):e1910236. doi:10.1001/jamanetworkopen.2019.10236 PubMedGoogle Scholar
Mohammed  SH, Habtewold  TD, Birhanu  MM,  et al.  Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies.   BMJ Open. 2019;9(11):e028238. doi:10.1136/bmjopen-2018-028238 PubMedGoogle Scholar
Gholami  F, Moradi  G, Zareei  B,  et al.  The association between circulating 25-hydroxyvitamin D and cardiovascular diseases: a meta-analysis of prospective cohort studies.   BMC Cardiovasc Disord. 2019;19(1):248. doi:10.1186/s12872-019-1236-7 PubMedGoogle ScholarCrossref
DerSimonian  R, Laird  N.  Meta-analysis in clinical trials.   Control Clin Trials. 1986;7(3):177-188. doi:10.1016/0197-2456(86)90046-2 PubMedGoogle ScholarCrossref
Higgins  JPT, Thompson  SG, Deeks  JJ, Altman  DG.  Measuring inconsistency in meta-analyses.   BMJ. 2003;327(7414):557-560. doi:10.1136/bmj.327.7414.557 PubMedGoogle ScholarCrossref
National Cancer Registration and Analysis Service (NCRAS) From the British Gynaecological Cancer Society. Comparisons of overall survival in women diagnosed with early stage cervical cancer during 2013-2016, treated by radical hysterectomy using minimal access or open approach. Published May 2019. Accessed October 18, 2019.
Wallin  E, Flöter Rådestad  A, Falconer  H.  Introduction of robot-assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome.   Acta Obstet Gynecol Scand. 2017;96(5):536-542. doi:10.1111/aogs.13112 PubMedGoogle ScholarCrossref
Corrado  G, Cutillo  G, Saltari  M,  et al.  Surgical and oncological outcome of robotic surgery compared with laparoscopic and abdominal surgery in the management of locally advanced cervical cancer after neoadjuvant chemotherapy.   Int J Gynecol Cancer. 2016;26(3):539-546. doi:10.1097/IGC.0000000000000646 PubMedGoogle ScholarCrossref
Zanagnolo  V, Minig  L, Rollo  D,  et al.  Clinical and oncologic outcomes of robotic versus abdominal radical hysterectomy for women with cervical cancer: experience at a referral cancer center.   Int J Gynecol Cancer. 2016;26(3):568-574. doi:10.1097/IGC.0000000000000645 PubMedGoogle ScholarCrossref
Mendivil  AA, Rettenmaier  MA, Abaid  LN,  et al.  Survival rate comparisons amongst cervical cancer patients treated with an open, robotic-assisted or laparoscopic radical hysterectomy: a five year experience.   Surg Oncol. 2016;25(1):66-71. doi:10.1016/j.suronc.2015.09.004 PubMedGoogle ScholarCrossref
Sert  BM, Boggess  JF, Ahmad  S,  et al.  Robot-assisted versus open radical hysterectomy: a multi-institutional experience for early-stage cervical cancer.   Eur J Surg Oncol. 2016;42(4):513-522. doi:10.1016/j.ejso.2015.12.014 PubMedGoogle ScholarCrossref
Laterza  RM, Uccella  S, Casarin  J,  et al.  Recurrence of early stage cervical cancer after laparoscopic versus open radical surgery.   Int J Gynecol Cancer. 2016;26(3):547-552. doi:10.1097/IGC.0000000000000627 PubMedGoogle ScholarCrossref
Zhu  T, Chen  X, Zhu  J,  et al.  Surgical and pathological outcomes of laparoscopic versus abdominal radical hysterectomy with pelvic lymphadenectomy and/or para-aortic lymph node sampling for bulky early-stage cervical cancer.   Int J Gynecol Cancer. 2017;27(6):1222-1227. doi:10.1097/IGC.0000000000000716 Google ScholarCrossref
Corrado  G, Vizza  E, Legge  F,  et al.  Comparison of different surgical approaches for stage IB1 cervical cancer patients: a multi-institution study and a review of the literature.   Int J Gynecol Cancer. 2018;28(5):1020-1028. doi:10.1097/IGC.0000000000001254 PubMedGoogle ScholarCrossref
Guo  J, Yang  L, Cai  J,  et al.  Laparoscopic procedure compared with open radical hysterectomy with pelvic lymphadenectomy in early cervical cancer: a retrospective study.   Onco Targets Ther. 2018;11(11):5903-5908. doi:10.2147/OTT.S156064 PubMedGoogle ScholarCrossref
Gil-Moreno  A, Carbonell-Socias  M, Salicrú  S,  et al.  Radical hysterectomy: efficacy and safety in the dawn of minimally invasive techniques.   J Minim Invasive Gynecol. 2019;26(3):492-500. doi:10.1016/j.jmig.2018.06.007 PubMedGoogle ScholarCrossref
Lim  TYK, Lin  KKM, Wong  WL, Aggarwal  IM, Yam  PKL.  Surgical and oncological outcome of total laparoscopic radical hysterectomy versus radical abdominal hysterectomy in early cervical cancer in Singapore.   Gynecol Minim Invasive Ther. 2019;8(2):53-58. doi:10.4103/GMIT.GMIT_43_18 PubMedGoogle ScholarCrossref
Matanes  E, Abitbol  J, Kessous  R,  et al.  Oncologic and surgical outcomes of robotic versus open radical hysterectomy for cervical cancer.   J Obstet Gynaecol Can. 2019;41(4):450-458. doi:10.1016/j.jogc.2018.09.013 PubMedGoogle ScholarCrossref
Li  G, Yan  X, Shang  H, Wang  G, Chen  L, Han  Y.  A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer.   Gynecol Oncol. 2007;105(1):176-180. doi:10.1016/j.ygyno.2006.11.011 PubMedGoogle ScholarCrossref
Magrina  JF, Kho  RM, Weaver  AL, Montero  RP, Magtibay  PM.  Robotic radical hysterectomy: comparison with laparoscopy and laparotomy.   Gynecol Oncol. 2008;109(1):86-91. doi:10.1016/j.ygyno.2008.01.011 PubMedGoogle ScholarCrossref
Sert  MB, Abeler  V.  Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy: one surgeon’s experience at the Norwegian Radium Hospital.   Gynecol Oncol. 2011;121(3):600-604. doi:10.1016/j.ygyno.2011.02.002 PubMedGoogle ScholarCrossref
Park  JY, Kim  DY, Kim  JH, Kim  YM, Kim  YT, Nam  JH.  Laparoscopic versus open radical hysterectomy for elderly patients with early-stage cervical cancer.   Am J Obstet Gynecol. 2012;207(3):195.e1-195.e8. doi:10.1016/j.ajog.2012.06.081 PubMedGoogle ScholarCrossref
Park  JY, Kim  DY, Kim  JH, Kim  YM, Kim  YT, Nam  JH.  Laparoscopic compared with open radical hysterectomy in obese women with early-stage cervical cancer.   Obstet Gynecol. 2012;119(6):1201-1209. doi:10.1097/AOG.0b013e318256ccc5 PubMedGoogle ScholarCrossref
Lim  YK, Chia  YN, Yam  KL.  Total laparoscopic Wertheim’s radical hysterectomy versus Wertheim’s radical abdominal hysterectomy in the management of stage I cervical cancer in Singapore: a pilot study.   Singapore Med J. 2013;54(12):683-688. doi:10.11622/smedj.2013242 PubMedGoogle ScholarCrossref
Park  JY, Kim  DY, Kim  JH, Kim  YM, Kim  YT, Nam  JH.  Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer.   J Surg Oncol. 2013;108(1):63-69. doi:10.1002/jso.23347 PubMedGoogle ScholarCrossref
Eoh  KJ, Lee  JY, Nam  EJ, Kim  S, Kim  SW, Kim  YT.  The institutional learning curve is associated with survival outcomes of robotic radical hysterectomy for early-stage cervical cancer: a retrospective study.   BMC Cancer. 2020;20(1):152. doi:10.1186/s12885-020-6660-7 PubMedGoogle ScholarCrossref
Kim  SI, Lee  M, Lee  S,  et al.  Impact of laparoscopic radical hysterectomy on survival outcome in patients with FIGO stage IB cervical cancer: a matching study of two institutional hospitals in Korea.   Gynecol Oncol. 2019;155(1):75-82. doi:10.1016/j.ygyno.2019.07.019 PubMedGoogle ScholarCrossref
Kim  SI, Cho  JH, Seol  A,  et al.  Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1-IIA2 cervical cancer.   Gynecol Oncol. 2019;153(1):3-12. doi:10.1016/j.ygyno.2019.01.008 PubMedGoogle ScholarCrossref
Chen  B, Ji  M, Li  P,  et al.  Comparison between robot-assisted radical hysterectomy and abdominal radical hysterectomy for cervical cancer: a multicentre retrospective study.   Gynecol Oncol. Published online February 14, 2020. doi:10.1016/j.ygyno.2020.02.019PubMedGoogle Scholar
Chen  C, Liu  P, Ni  Y,  et al.  Laparoscopic versus abdominal radical hysterectomy for stage IB1 cervical cancer patients with tumor size ≤ 2 cm: a case-matched control study.   Int J Clin Oncol. 2020;25(5):937-947. doi:10.1007/s10147-020-01630-z PubMedGoogle ScholarCrossref
Cantrell  LA, Mendivil  A, Gehrig  PA, Boggess  JF.  Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience.   Gynecol Oncol. 2010;117(2):260-265. doi:10.1016/j.ygyno.2010.01.012 PubMedGoogle ScholarCrossref
Toptas  T, Simsek  T.  Total laparoscopic versus open radical hysterectomy in stage IA2-IB1 cervical cancer: disease recurrence and survival comparison.   J Laparoendosc Adv Surg Tech A. 2014;24(6):373-378. doi:10.1089/lap.2013.0514 PubMedGoogle ScholarCrossref
Xiao  M, Zhang  Z.  Total laparoscopic versus laparotomic radical hysterectomy and lymphadenectomy in cervical cancer: an observational study of 13-year experience.   Medicine (Baltimore). 2015;94(30):e1264. doi:10.1097/MD.0000000000001264 PubMedGoogle Scholar
Wang  W, Chu  HJ, Shang  CL,  et al.  Long-term oncological outcomes after laparoscopic versus abdominal radical hysterectomy in stage IA2 to IIA2 cervical cancer.   Int J Gynecol Cancer. 2016;26(7):1264-1273. doi:10.1097/IGC.0000000000000749 PubMedGoogle ScholarCrossref
Diver  E, Hinchcliff  E, Gockley  A,  et al.  Minimally invasive radical hysterectomy for cervical cancer is associated with reduced morbidity and similar survival outcomes compared with laparotomy.   J Minim Invasive Gynecol. 2017;24(3):402-406. doi:10.1016/j.jmig.2016.12.005 PubMedGoogle ScholarCrossref
Kim  JH, Kim  K, Park  SJ,  et al.  Comparative effectiveness of abdominal versus laparoscopic radical hysterectomy for cervical cancer in the postdissemination era.   Cancer Res Treat. 2019;51(2):788-796. doi:10.4143/crt.2018.120 PubMedGoogle ScholarCrossref
Hu  TWY, Ming  X, Yan  HZ, Li  ZY.  Adverse effect of laparoscopic radical hysterectomy depends on tumor size in patients with cervical cancer.   Cancer Manag Res. 2019;11:8249-8255. doi:10.2147/CMAR.S216929 PubMedGoogle ScholarCrossref
Pedone Anchora  L, Turco  LC, Bizzarri  N,  et al.  How to select early-stage cervical cancer patients still suitable for laparoscopic radical hysterectomy: a propensity-matched study.   Ann Surg Oncol. Published online January 2, 2020. doi:10.1245/s10434-019-08162-5 PubMedGoogle Scholar
Brandt  B, Sioulas  V, Basaran  D,  et al.  Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: survival outcomes.   Gynecol Oncol. 2020;156(3):591-597. doi:10.1016/j.ygyno.2019.12.038 PubMedGoogle ScholarCrossref
Cusimano  MC, Baxter  NN, Gien  LT,  et al.  Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer.   Am J Obstet Gynecol. 2019;221(6):619.e1-619.e24. doi:10.1016/j.ajog.2019.07.009 PubMedGoogle ScholarCrossref
Doo  DW, Kirkland  CT, Griswold  LH,  et al.  Comparative outcomes between robotic and abdominal radical hysterectomy for IB1 cervical cancer: results from a single high volume institution.   Gynecol Oncol. 2019;153(2):242-247. doi:10.1016/j.ygyno.2019.03.001PubMedGoogle ScholarCrossref
Paik  ES, Lim  MC, Kim  MH,  et al.  Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment: ancillary analysis of a Korean Gynecologic Oncology Group Study (KGOG 1028).   Gynecol Oncol. 2019;154(3):547-553. doi:10.1016/j.ygyno.2019.06.023 PubMedGoogle ScholarCrossref
Yuan  Z, Cao  D, Yang  J,  et al.  Laparoscopic vs. open abdominal radical hysterectomy for cervical cancer: a single-institution, propensity score matching study in China.   Front Oncol. 2019;9:1107. doi:10.3389/fonc.2019.01107PubMedGoogle ScholarCrossref
Uppal  S, Gehrig  PA, Peng  K,  et al.  Recurrence rates in patients with cervical cancer treated with abdominal versus minimally invasive radical hysterectomy: a multi-institutional retrospective review study.   J Clin Oncol. 2020;38(10):1030-1040. doi:10.1200/JCO.19.03012 PubMedGoogle ScholarCrossref
Nam  JH, Park  JY, Kim  DY, Kim  JH, Kim  YM, Kim  YT.  Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study.   Ann Oncol. 2012;23(4):903-911. doi:10.1093/annonc/mdr360 PubMedGoogle ScholarCrossref
Bogani  G, Cromi  A, Uccella  S,  et al.  Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched analysis.   J Minim Invasive Gynecol. 2014;21(5):857-862. doi:10.1016/j.jmig.2014.03.018 PubMedGoogle ScholarCrossref
Ditto  A, Martinelli  F, Bogani  G,  et al.  Implementation of laparoscopic approach for type B radical hysterectomy: a comparison with open surgical operations.   Eur J Surg Oncol. 2015;41(1):34-39. doi:10.1016/j.ejso.2014.10.058 PubMedGoogle ScholarCrossref
Shah  CA, Beck  T, Liao  JB, Giannakopoulos  NV, Veljovich  D, Paley  P.  Surgical and oncologic outcomes after robotic radical hysterectomy as compared to open radical hysterectomy in the treatment of early cervical cancer.   J Gynecol Oncol. 2017;28(6):e82. doi:10.3802/jgo.2017.28.e82 PubMedGoogle Scholar
Melamed  A, Margul  DJ, Chen  L,  et al.  Survival after minimally invasive radical hysterectomy for early-stage cervical cancer.   N Engl J Med. 2018;379(20):1905-1914. doi:10.1056/NEJMoa1804923 PubMedGoogle ScholarCrossref
Alfonzo  E, Wallin  E, Ekdahl  L,  et al.  No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study.   Eur J Cancer. 2019;116:169-177. doi:10.1016/j.ejca.2019.05.016 PubMedGoogle ScholarCrossref
Moher  D, Liberati  A, Tetzlaff  J, Altman  DG; PRISMA Group.  Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement.   PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097 PubMedGoogle Scholar
Koh  WJ, Greer  BE, Abu-Rustum  NR,  et al.  Cervical cancer, version 2.2015.   J Natl Compr Canc Netw. 2015;13(4):395-404. doi:10.6004/jnccn.2015.0055PubMedGoogle ScholarCrossref
Unger  JM, Cook  E, Tai  E, Bleyer  A.  The role of clinical trial participation in cancer research: barriers, evidence, and strategies.   Am Soc Clin Oncol Educ Book. 2016;35:185-198. doi:10.14694/EDBK_156686PubMedGoogle ScholarCrossref
Hughes  MD, Pocock  SJ.  Stopping rules and estimation problems in clinical trials.   Stat Med. 1988;7(12):1231-1242. doi:10.1002/sim.4780071204 PubMedGoogle ScholarCrossref
Köhler  C, Hertel  H, Herrmann  J,  et al.  Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff: a multicenter analysis.   Int J Gynecol Cancer. 2019;29(5):845-850. doi:10.1136/ijgc-2019-000388 PubMedGoogle ScholarCrossref
Tewari  KS.  Minimally invasive surgery for early-stage cervical carcinoma: interpreting the Laparoscopic Approach to Cervical Cancer trial results.   J Clin Oncol. 2019;37(33):3075-3080. doi:10.1200/JCO.19.02024 PubMedGoogle ScholarCrossref
Melamed  A, Rauh-Hain  JA, Ramirez  PT.  Minimally invasive radical hysterectomy for cervical cancer: when adoption of a novel treatment precedes prospective, randomized evidence.   J Clin Oncol. 2019;37(33):3069-3074. doi:10.1200/JCO.19.01164 PubMedGoogle ScholarCrossref
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    Original Investigation
    June 11, 2020

    Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
    • 2Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston
    • 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
    JAMA Oncol. 2020;6(7):1019-1027. doi:10.1001/jamaoncol.2020.1694
    Key Points

    Question  Are the findings of high-quality observational studies consistent with the results of a randomized clinical trial that found that minimally invasive hysterectomy was associated with a higher risk of recurrence and death compared with open surgery?

    Findings  In this systematic review and meta-analysis of 15 high-quality studies comprising 9499 patients, minimally invasive radical hysterectomy was associated with shorter overall and disease-free survival among women with operable cervical cancer compared with open surgery.

    Meaning  These results provide evidence to support the survival benefit associated with open radical hysterectomy for early-stage cervical cancer; these findings are consistent with a recent randomized clinical trial.


    Importance  Minimally invasive techniques are increasingly common in cancer surgery. A recent randomized clinical trial has brought into question the safety of minimally invasive radical hysterectomy for cervical cancer.

    Objective  To quantify the risk of recurrence and death associated with minimally invasive vs open radical hysterectomy for early-stage cervical cancer reported in observational studies optimized to control for confounding.

    Data Sources  Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science (inception to March 26, 2020) performed in an academic medical setting.

    Study Selection  In this systematic review and meta-analysis, observational studies were abstracted that used survival analyses to compare outcomes after minimally invasive (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics 2009 stage IA1-IIA) cervical cancer. Study quality was assessed with the Newcastle-Ottawa Scale and included studies with scores of at least 7 points that controlled for confounding by tumor size or stage.

    Data Extraction and Synthesis  The Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist was used to abstract data independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between surgical approach and oncologic outcomes.

    Main Outcomes and Measures  Risk of recurrence or death and risk of all-cause mortality.

    Results  Forty-nine studies were identified, of which 15 were included in the meta-analysis. Of 9499 patients who underwent radical hysterectomy, 49% (n = 4684) received minimally invasive surgery; of these, 57% (n = 2675) received robot-assisted laparoscopy. There were 530 recurrences and 451 deaths reported. The pooled hazard of recurrence or death was 71% higher among patients who underwent minimally invasive radical hysterectomy compared with those who underwent open surgery (hazard ratio [HR], 1.71; 95% CI, 1.36-2.15; P < .001), and the hazard of death was 56% higher (HR, 1.56; 95% CI, 1.16-2.11; P = .004). Heterogeneity of associations was low to moderate. No association was found between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy and hazard of recurrence or death (2.0% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −3.4% to 7.7%]) or all-cause mortality (3.7% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −4.5% to 12.6%]).

    Conclusions and Relevance  This systematic review and meta-analysis of observational studies found that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence and death compared with open surgery.