Nishi Jain 21′
(Source: Wikimedia Commons)
Cervical cancer is among the rarer forms of cancer whose rates of diagnoses have dropped farther through the years due to advanced methods of screening. Cervical cancer manifests itself within the cervix, the connection between the uterus and the vagina. And although such a cancer grows slowly, especially if it is detected early and managed properly, it is potentially metastatic. With the potential to metastasize into the liver, lungs, bladder, and vagina, it is imperative to the patient that any cancerous growth is contained to the cervix area only.
One method of containing cervical cancer is surgery. As with many other cancers, if the possibility of containing cancerous growth with surgery is an option, it is often the doctor’s primary choice. Elimination of all cancerous cells from the body altogether warrants a substantially different recovery image than that riddled with radiation and other therapeutic treatments, so it is frequently the primary choice of the patient as well. Within the realm of cervical cancer treatment, there are two predominant surgeries in oncological practice today: laparoscopic or robot-assisted radical hysterectomy (a minimally invasive surgery) and open abdominal radical hysterectomy (an open surgery).
Both the minimally surgery and the open surgery are frequently evaluated side-by-side, and a recent study published in the New England Journal of medicine compared the disease-free survival and overall survival rates of both these treatments. Disease-free survival, as it sounds, follows the percentage of patients that were able to remain cancer free for a certain given period of time, while overall survival measures the percentage of patients who have not died from any cause.
Patients with lymphovascular invasive carcinoma, squamous-cell carcinoma, adenocarcinoma, or adenosquamous caricinoma were followed through the course of the whole clinical trial, and each treatment type was randomly assigned to one patient or another. Patient groups were further normalized for rate of lymphovascular invasion, the rates of lymph node involvement, the rates of parametrial involvement, the size of the tumor, and histologic subtypes. Results showed that minimally invasive surgeries were associated with lower rates of disease-free survival compared to open surgery – a result that persisted despite normalization for patient age, BMI, disease stage, lymphovascular invasion, and rates of lymph node involvement. Minimally invasive surgeries were also associated with lower rates of overall survival as compared to the open surgeries.
Despite these differences, however, rates of cancer recurrence did not differ between these two surgical methods, raising an interesting question about the augmented efficacy of the open surgery over the minimally invasive. This finding is even more curious considering that it directly opposes all of the literature that has already been presented on the subject that reports the minimally invasive surgery as being the more efficacious and powerful solution2 . Given this breakthrough, doctors within this field are beginning to evaluate their decision to move forward with minimally invasive surgery rather than the open surgery, reverting back to the latter instead. And while the reason this old surgical model is more effective is not known, it is certainly an interesting finding that continues to prove the necessity of implementing evidence-based medicine rather than a blind reliance on technology the novel techniques.
References:
[1] Tang, Y., Yin, F., Fu, D. et al. Efficacy and safety of minimal invasive surgery treatment in hypertensive intracerebral hemorrhage: a systematic review and meta-analysis. BMC Neurol 18, 136 (2018). https://doi.org/10.1186/s12883-018-1138-9