Laparotomy Superior to Minimally Invasive Radical Hysterectomies

Final analysis of the first prospective randomized clinical trial comparing overall survival between open and minimally invasive radical hysterectomy for treating early-stage cervical cancer revealed that an open approach should be the standard of care. The clinical trial update, published in the Journal of Clinical Oncology, reaffirmed conclusions drawn from the initial 2018 publication that analyzed results at 84% power. At the time of the initial publication, both laparotomy and minimally invasive techniques were acceptable radical hysterectomy approaches–despite limited retrospective study data evaluating survival rates of the robot-assisted surgery. While researchers hypothesized that minimally invasive radical hysterectomy would not be inferior to laparotomy, results suggested otherwise. Of the 289 patients undergoing minimally invasive surgery and 274 undergoing open surgery, disease-free survival was 85% in the minimally invasive group and 96% in the open group at follow-up (4.5 years). Overall survival was also higher in the open surgery group (96.2% vs. 90.6%), revealing a 2.5 times higher risk of death from cervical cancer in the minimally invasive group. Further, rates of recurrence as carcinomatosis were 9% in the open group versus 23% in the minimally invasive group.