Journal Article

SUCCOR morbidity: complications in minimally invasive versus open radical hysterectomy in early cervical cancer

Martin-Calvo, Nerea, Gilabert, Juan, Querleu, Denis, Sarac, Cosmin-Paul, Povolotskaya, Natalia, Vergote, Ignace, Kovachev, Stefan, Cuadra, Maria, Saaron, Reeli, Abdalla, Nabil, Ferrero, Annamaria, Boria, Felix, Morillas, Bibiana, Mitrovic, Milena, Arencibia, Octavio, Brucker, Cosima, Akbayir, Özgür, Alonso-Espias, Maria, Sousa, Rita, Hernandez-Cortes, Gines, Minguez, Jose Angel, Aliyev, Shamistan, Smrkolj, Špela, Aluloski, Igor, Quesada, Alfonso, Goffin, Frederic, Meili, Gesine, Maenpaa, Minna M, Domingo, Santiago, Chiva, Luis, Yezhova, Iryna, Trum, Hans, Tavares, Mariana, Vorgias, George, Bharathan, Rasiah, Prader, Sonia, Feron, Jean-Guillaume, Chiofalo, Benito, Marina, Tiermes, Gonçalves, Elisabete, Roldan, Fernando, Căpîlna, Mihai Emil, Badzakov, Nikola, Casajuana, Andrea, Díez, Javier, Herrero, Sofía, Tauste, Carmen, Andrade, Claudia, Bonci, Eduard-Aexandru, Fernandez-Gonzalez, Sergi, Redecha, Mikuláš, Beltman, Jogchum Jan, Fidalgo, Soledad, Jedryka, Marcin A, Gomes, Nana, Martín-Salamanca, María Belén, Meydanli, Mehmet Mutlu, Berlev, Igor, Aksahin, Elif, Guijarro, Miriam, Fiol, Gabriel, Bonsang-Kitzi

2024

Overview

ObjectiveThe aim of this study was to compare the incidence of intra-operative and post-operative complications in open and minimally invasive radical hysterectomy for patients with early-stage cervical cancer.MethodsData were collected from the SUCCOR database of 1272 patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO), 2009) who underwent radical hysterectomy in Europe between January 2013 and December 2014. We reviewed the duration of the surgeries, estimated blood loss, length of hospital stay, intra-operative and post-operative complications. The inclusion criteria were age ≥18 years and histologic type (squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma). Pelvic MRI confirming a tumor diameter ≤4 cm with no parametrial invasion and a pre-operative CT scan, MRI, or positron emission tomography CT demonstrating no extra-cervical metastatic disease were mandatory. Outcomes of interest were any grade >3 adverse events, intra-operative adverse events, post-operative adverse events, length of hospital stay, length of operation, and blood loss.ResultsThe study included 1156 patients, 633 (54%) in the open surgery group and 523 (46%) in the minimally invasive surgery group. Median age was 46 years (range 18–82), median body mass index 25 kg/m2 (range 15–68), and 1022 (88.3%) patients were considered to have an optimal performance status (ECOG Performance Status 0). The most common histologic tumor type was squamous carcinoma (n=794, 68.7%) and the most frequent FIGO staging was IB1 (n=510, 44.1%). In the minimally invasive surgery group the median duration of surgery was longer (240 vs 187 min, p<0.01), median estimated blood loss was lower (100 vs 300 mL, p<0.01), and median length of hospital stay was shorter (4 vs 7 days, p<0.01) compared with the abdominal surgery group. There was no difference in the overall incidence of intra-operative and post-operative complications between the two groups. Regarding grade I complications, the incidence of vaginal bleeding (2.9% vs 0.6%, p<0.01) and vaginal cuff dehiscence was higher in the minimally invasive surgery group than in the open group (3.3% vs 0.5%, p<0.01). Regarding grade III post-operative complications, bladder dysfunction (1.3% vs 0.2%, p=0.046) and abdominal wall infection (1.1% vs 0%, p=0.018) were more common in the open surgery group than in the minimally invasive surgery group. Ureteral fistula was more frequent in the minimally invasive group than in the open surgery group (1.7% vs 0.5%, p=0.037).ConclusionOur study showed that there was no significant difference in the overall incidence of intra-operative and post-operative complications between minimally invasive radical hysterectomy and the open approach.

• Publisher: BMJ Publishing Group Ltd,Elsevier Inc,Elsevier Limited,BMJ Publishing Group
• Subject: Abdomen / Adult / Aged / Bladder / Body mass index / Cancer therapies / Cervical Cancer / Chirurgie / Endoscopy / Female / Fistula / Gynecology / Hospitals / Human health sciences / Humans / Hysterectomy / Hysterectomy - adverse effects / Hysterectomy - methods / Infections / Intervention / Intraoperative Complications / Intraoperative Complications - epidemiology / Laparoscopy / Length of Stay / Length of Stay - statistics & numerical data / Lymphatic system / Middle Aged / Minimally invasive surgery / Minimally Invasive Surgical Procedures / Minimally Invasive Surgical Procedures - adverse effects / Minimally Invasive Surgical Procedures - methods / Médecine de la reproduction (Gynécologie, andrologie, obstétrique) / Neoplasm Staging / Obstetrics / Obstetrics and Gynecology / Oncologie / Oncology / Original research / Patients / Postoperative Complications / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Reproductive medicine (gynecology, andrology, obstetrics) / Retrospective Studies / Sciences de la santé humaine / Squamous cell carcinoma / Surgery / Surgical outcomes / Surgical techniques / Uterine Cervical Neoplasms / Uterine Cervical Neoplasms - pathology / Uterine Cervical Neoplasms - surgery / Vagina