Study: Non-Invasive Hysterectomy May Not Be The Right Choice

Oct 31, 2018

Some surprising findings could alter the way doctors treat cervical cancer.

A study co-authored by a first-year medical resident at the University of Cincinnati suggests women who have non-invasive radical hysterectomies have shorter survival rates than those who undergo traditional open surgery.

The findings are published in the Oct. 31 online edition of the New England Journal of Medicine.

"Despite the lack of evidence supporting the use of minimally invasive radical hysterectomy for cervical cancer, the approach has been broadly adopted in the United States and is considered to be a standard approach in national guidelines," says Daniel Margul, MD, the co-author on the study.

Margul and researchers from Massachusetts General Hospital, Northwestern University, MD Anderson Cancer Center and Columbia University studied data from patients with certain types of cervical cancer who had one of the two procedures.

"Over an average follow-up of 45 months, the four-year death rate was 9.1 percent among women who underwent minimally invasive surgery and 5.3 percent among those who underwent open surgery," Margul says.

He adds, "Before the use of minimally invasive radical hysterectomy, in the 2000 to 2006 period, the four-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable. The use of minimally invasive surgery coincided with a decline in the four-year relative survival rate of 0.8 percent per year after 2006."

Dr. Daniel Margul is a first-year resident physician in the department of obstetrics and gynecology at UC and UC Medical Center who worked on his portion of the project as a student at Northwestern.
Credit Colleen Kelley / University of Cincinnati

Changing The Treatment Standard

Deputy Director of the UC Cancer Institute Tom Herzog, MD, says the results could lead to a big change in women's healthcare. The trend has been to move away from open surgery to the non-invasive procedure, which patients also preferred.

"I know there are other centers looking at studies now that are really flummoxed by this data who can't believe it either," he says. "But now there's really three data sets done in different ways that all show the same thing, so certainly there's something going on here that's real. The question is if there's a sub group we can tease out and still save minimally invasive surgery for them."

The study results also raise questions about why open surgery has a higher survival rate.

"Is the immune system, for example, more stimulated with an open procedure and is that why we're seeing better results in terms of outcomes? Or is the resection not as thorough as it would be for those that have an open procedure?" wonders Herzog.

Dr. Tom Herzog is deputy director of the University of Cincinnati Cancer Institute.
Credit Colleen Kelley / University of Cincinnati