• Alexander Melamed, Daniel J Margul, Ling Chen, Nancy L Keating, Marcela G Del Carmen, Junhua Yang, Brandon-Luke L Seagle, Amy Alexander, Emma L Barber, Laurel W Rice, Jason D Wright, Masha Kocherginsky, Shohreh Shahabi, and Rauh-HainJ AlejandroJAFrom the Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School (A.M., M.G.C.), and the Department of Health Care Policy, Harvard Medical School, and .
• From the Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School (A.M., M.G.C.), and the Department of Health Care Policy, Harvard Medical School, and the Division of General Internal Medicine, Brigham and Women's Hospital (N.L.K.) - all in Boston; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prentice Women's Hospital (D.J.M., J.Y., B.-L.L.S., A.A., E.L.B., M.K., S.S.), and the Division of Biostatistics, Department of Preventive Medicine (M.K.), Northwestern University, Feinberg School of Medicine, Chicago; the Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University, and New York Presbyterian Hospital, New York (L.C., J.D.W.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison (L.W.R.); and the Departments of Gynecologic Oncology and Reproductive Medicine and Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston (J.A.R.-H.).
• N. Engl. J. Med. 2018 Nov 15; 379 (20): 190519141905-1914.

BackgroundMinimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer.MethodsWe performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database.ResultsIn the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend).ConclusionsIn an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).

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