Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses the rationale to conduct a population-based cohort study comparing the efficacy of minimally invasive surgery (MIS) versus open surgery for radical hysterectomy in women with cervical cancer.

The results of the LACC trial, a randomized international trial that compared MIS with open surgery for radical hysterectomy in women with cervical cancer, showed that mortality and recurrence rates were higher in patients who received MIS.

The results of the LACC trial were practice changing and caused a reconsideration of the benefits of MIS versus open surgery for radical hysterectomy. To increase the evidence and provide more real-world data, Ferguson conducted a cohort study in Ontario, Canada, making the same comparison.

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Sarah Ferguson, MD, FRCSC, discusses the rationale to conduct a population-based cohort study comparing the efficacy of minimally invasive surgery versus open surgery for radical hysterectomy in women with cervical cancer.

Dr. Ferguson on Minimally Invasive Vs Open Surgery for Radical Hysterectomy in Cervical Cancer

Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses adverse events (AEs) associated with surgery in cervical cancer.

In the perioperative setting, there is an ongoing study comparing the AEs attributed to simple hysterectomy versus those attributed to radical hysterectomy. The study includes a very small patient population, but it will be the most significant data to date on the perioperative AEs and oncologic outcomes associated with these surgical approaches, Ferguson says.

With hysterectomy in general, there may be an increased risk of certain unique complications like fistulas, although those are highly rare. Bladder dysfunction is also associated with surgery, and whether or not sexual dysfunction is another AE will be confirmed in a future study, Ferguson concludes.

Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses adverse events associated with surgery in cervical cancer.

Dr. Ferguson Discusses AEs Associated With Surgery in Cervical Cancer

Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses treatment options for patients with early-stage cervical cancer.

For this patient population, treatment approaches include external beam radiation with intracavitary brachytherapy. Early-stage patients are not typically treated with single-agent chemotherapy, but it can be added to definitive radiation treatment. With small, early-stage tumors such as stage IbI cancer, surgery is often offered, though radiation can also be part of the discussion with patients, Ferguson says.

In terms of surgery, physicians are now able to offer a minimally invasive radical hysterectomy, but unanswered questions remain with this modality. For example, in a study presented by Ferguson at the 2019 SGO Annual Meeting, there was no clear difference in microscopic tumor samples between patients with early-stage cervical cancer who underwent a minimally invasive surgery versus a traditional open procedure.

Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses treatment options for patients with early-stage cervical cancer.


Dr. Ferguson on Treatment Options for Early-Stage Cervical Cancer

Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses surgical approaches in patients with cervical cancer.

Physicians are currently able to perform a minimally invasive radical hysterectomy. However, it’s unclear if there’s a specific patient population that will benefit from this approach over others, Ferguson says. In a study presented at the 2019 SGO Annual Meeting, there was no clear difference in smaller, microscopic tumor samples between patients who received minimally invasive surgery and those who received a traditional open procedure. However, Ferguson notes, if a patient has a microscopic tumor with no residual disease, it is not unreasonable to think that their subsequent surgical approach will have an impact on their oncologic outcome.

Because the data are not yet well defined, it is important for physicians to have the conversation with patients about which approach they prefer. With open surgery, there is a risk in certain patients for increased hospitalization and adverse events.

Dr. Ferguson on Surgical Approaches in Cervical Cancer

Sarah Ferguson, MD, FRCSC, associate professor of gynecologic oncology, University of Toronto, Princess Margaret Cancer Centre, discusses a population-based study of women with cervical cancer undergoing radical hysterectomy.

This was a population-based study of women in Ontario who underwent radical hysterectomy for cervical cancer. The study spanned a 10-year period and compared surgical approaches and their impact on survival outcomes. Over this period, minimally invasive surgery became more widely adopted, says Ferguson—a trend which was reflected in the study. For the study, investigators tried to control for confounding factors that have been criticized for biasing outcomes in prior randomized trials. These factors included surgeon experience as well as patient factors, says Ferguson.

Results from the analysis showed that patients with stage Ib tumors had similar outcomes to patients who underwent the laparoscopic approach in another cervical cancer study with an increase in all-cause mortality. In patients who received a minimally invasive surgery, 90% were done laparoscopically compared with open surgery.

Sarah Ferguson, MD, FRCSC

Articles

Dr. Ferguson on Minimally Invasive Vs Open Surgery for Radical Hysterectomy in Cervical Cancer

Dr. Ferguson Discusses AEs Associated With Surgery in Cervical Cancer

Dr. Ferguson on Treatment Options for Early-Stage Cervical Cancer

Dr. Ferguson on Surgical Approaches in Cervical Cancer

Dr. Ferguson on a Population-Based Study of Women Undergoing Radical Hysterectomy