SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer.
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Chiva Luis, Zanagnolo Vanna, Querleu Denis, Martin-Calvo Nerea, Arévalo-Serrano Juan, Căpîlna Mihai Emil, Fagotti Anna, Kucukmetin Ali, Mom Constantijne, Chakalova Galina, Aliyev Shamistan, Malzoni Mario, Narducci Fabrice, Arencibia Octavio, Raspagliesi Francesco, Toptas Tayfun, Cibula David, Kaidarova Dilyara, Meydanli Mehmet Mutlu, Tavares Mariana, Golub Dmytro, Perrone Anna Myriam, Poka Robert, Tsolakidis Dimitrios, Vujić Goran, Jedryka Marcin A, Zusterzeel Petra L M, Beltman Jogchum Jan, Goffin Frederic, Haidopoulos Dimitrios, Haller Herman, Jach Robert, Yezhova Iryna, Berlev Igor, Bernardino Margarida, Bharathan Rasiah, Lanner Maximilian, Maenpaa Minna M, Sukhin Vladyslav, Feron Jean-Guillaume, Fruscio Robert, Kukk Kersti, Ponce Jordi, Minguez Jose Angel, Vázquez-Vicente Daniel, Castellanos Teresa, Chacon Enrique, Alcazar Juan Luis, SUCCOR study Group
Аннотация
METHODS: We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group.
RESULTS: Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m2 (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52).
CONCLUSIONS: Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.