New Practice Changing Guideline: Laparotomy is the preferred approach for radical hysterectomy in women with cervical cancer

For women undergoing radical hysterectomy for cervical cancer with tumors ≥2 cm, the new recommendation is laparotomy rather than minimally invasive surgery (MIS).

Patients with smaller tumors (<2 cm) may be candidates for robotic-assisted surgery.

MIS approaches are done with the goal of reducing operative morbidity. However, two new studies reported in the New England Journal of Medicine have found worse oncologic outcomes with these procedures.

In a randomized trial of women with cervical cancer who underwent radical hysterectomy, MIS compared with laparotomy resulted in a higher rate of death from cervical cancer at 3 years (4.4 versus 0.6 percent) and a lower rate of disease-free survival at 4.5 years (86.0 versus 96.5 percent) (1).

Another cohort study found that MIS radical hysterectomy was associated with a higher four-year mortality rate (9.1 versus 5.3 percent) (2).

This is a recent recommendation. Any such new information or recommendation should be discussed with the patient and informed decision should be taken before proceeding ahead with the line of management.

References

1.    Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 2018;379:1895.

2.    Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 2018;379:1905.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA