Q&A with Jason Wright, MD: Examining the safety of minimally invasive surgery for cervical cancer
Jason D. Wright, MD, Chief of Gynecologic Oncology at Columbia University Irving Medical Center, recently co-authored a study published in the New England Journal of Medicine examining the safety of minimally invasive surgery for cervical cancer. We sat down with Dr. Wright to learn more about the surprising results that are already changing medical practices around the world.
What were the benefits to the minimally invasive surgery approach for cervical cancer compared to the open abdominal procedure?
Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. Because the minimally invasive procedure is performed through small slits in the abdomen, rather than a large incision, it has allowed for shorter patient recovery times. For many cancer surgeries, the long term outcomes of minimally invasive surgery and open surgery have been found to be equivalent with shorter recovery times for minimally invasive surgery.
What did you expect to conclude from this study?
We expected to find that survival was similar for open and minimally invasive radical hysterectomy for cervical cancer. Prior studies have found that for many cancer surgeries the long term outcomes of minimally invasive and open surgery are similar and that recovery times are shorter for minimally invasive surgery. Therefore, our findings were unexpected.
What were your results?
In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery. Thus, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. Further, when the US population was examined we also found that around the time that minimally invasive hysterectomy began to be used in practice the average survival of women with cervical cancer began to decline.
Because of the findings, have you stopped performing minimally invasive surgery for cervical cancer at NYP/Columbia?
For the majority of women with early stage cervical cancer who require radical hysterectomy, we have stopped performing minimally invasive surgery. There may be some women with very early cancers who may still consider minimally invasive surgery, but most women should probably have an open radical hysterectomy.