SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer.
[en] [en] BACKGROUND: Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse.
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.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Chiva, Luis ; Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain lchiva@unav.es
Zanagnolo, Vanna; Istituto Europeo di Oncologia, Milano, Italy
Querleu, Denis; Surgery, Institut Bergonie, Bordeaux, France
Martin-Calvo, Nerea; Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
Arévalo-Serrano, Juan; Principe de Asturias University Hospital, Alcala de Henares, Spain
Căpîlna, Mihai Emil; Emergency County Hospital, Targu Mures, Romania
Fagotti, Anna; Policlinico A Gemelli, Roma, Italy
Kucukmetin, Ali; Queen Elizabeth Hospital, Gateshead, UK
Mom, Constantijne; Amsterdam University Medical Centre, Amsterdam, Netherlands
Chakalova, Galina; University Oncologic Hospital, Sofia, Bulgaria
Aliyev, Shamistan; National Center of Oncology, Baku, Azerbaijan
Malzoni, Mario; Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
Narducci, Fabrice ; Gynecology, Centre Oscar Lambret, Lille, France
Arencibia, Octavio; University Maternal Hospital Canary Islands, Las Palma, Spain
Raspagliesi, Francesco; Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Toptas, Tayfun; Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
Cibula, David; Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
Perrone, Anna Myriam ; Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
Poka, Robert; Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Tsolakidis, Dimitrios; General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Greece
Vujić, Goran; Clinical Hospital Center, Zagreb, Croatia
Jedryka, Marcin A ; Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
Zusterzeel, Petra L M; Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Haidopoulos, Dimitrios; Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
Haller, Herman; Clinical Hospital Center Rijeka, Rijeka, Croatia
Jach, Robert; Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
Yezhova, Iryna; Lviv Oncology Center, Lviv, Ukraine
Berlev, Igor; North-Western State Medical University. N.N. Petrov Research Institute of Oncology, St Petersburg, Russia
Bernardino, Margarida; Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
Bharathan, Rasiah; University Hospitals of Leicester NHS Trust, Leicester, UK
Lanner, Maximilian; Medical University of Graz, Graz, Steiermark, Austria
Maenpaa, Minna M; Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
Sukhin, Vladyslav ; Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
Feron, Jean-Guillaume; Institut Curie, Paris, Île-de-France, France
Fruscio, Robert; Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy ; Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
Kukk, Kersti; North Estonia Medical Centre, Tallinn, Estonia
Ponce, Jordi; Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
Minguez, Jose Angel; Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
Vázquez-Vicente, Daniel ; Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
Castellanos, Teresa; Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
Chacon, Enrique; Obstetrics and Gynecology, Universidad de Navarra, Pamplona, Spain
Alcazar, Juan Luis ; Obstetrics and Gynecology, School of Medicine, University of Navarra, Pamplona, Spain
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