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SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

2020; BMJ; Volume: 30; Issue: 9 Linguagem: Inglês

10.1136/ijgc-2020-001506

1525-1438

Luis Chiva, Vanna Zanagnolo, Denis Querleu, Nerea Martín‐Calvo, Juan Arévalo‐Serrano, Mihai Emil Căpîlna, Anna Fagotti, Ali Kucukmetin, Constantijne H. Mom, G Chakalova, Shamistan Aliyev, Mario Malzoni, Fabrice Narducci, Octavio Arencibia, Francesco Raspagliesi, Tayfun Toptaş, David Cibula, Dilyara Kaidarova, Mehmet Mutlu Meydanlı, Mariana Vide Tavares, Dmytro Golub, Anna Myriam Perrone, Ròbert Póka, Dimitrios Tsolakidis, Goran Vujić, Marcin Jędryka, Petra L.M. Zusterzeel, Jogchum Jan Beltman, Frédéric Goffin, Dimitrios Haidopoulos, Herman Haller, Robert Jach, Iryna Yezhova, Igor Berlev, Margarida Bernardino, Rasiah Bharathan, Maximilian Lanner, Minna M Mäenpää, Vladyslav Sukhin, Jean-Guillaume Féron, Robert Fruscio, Kersti Kukk, Jordi Ponce, J. Mínguez, Daniel Vázquez-Vicente, Teresa Castellanos, Enrique Chacón, Juan Luis Alcázar, Nabil Abdalla, Özgür Akbayır, Sedat Akgöl, Elif Akşahin, Shamistan Aliyev, María Alonso-Espías, Игор Алулоски, Cláudia Regina Furquim de Andrade, Nikola Badzakov, Rosa Barrachina, Giorgio Bogani, Eduard-Aexandru Bonci, Hélène Bonsang‐Kitzis, Félix Boria, Cosima Brucker, L. M. Cardenas, Andrea Casajuana, Pere Cavallé, Jorge Cea, Benito Chiofalo, Gloria Cordeiro, Pluvio Coronado, María Cuadra, Javier Dı́ez, Teresa Diniz da Costa, Santiago Domingo, Lukáš Dostálek, Fuat Demirkiran, Diego Erasun, Mathias K. Fehr, Sergi Fernández-Gonzalez, Annamaria Ferrero, Soledad Fidalgo, Gabriel Fiol, Khadra Galaal, José Alenza García, Gerhard Gebauer, Fabio Ghezzi, Juan Gilabert–Estellés, Nana Gomes, Elisabete Gonçalves, Virginia González, Frédéric Grandjean, Miriam Guijarro, Frédéric Guyon, Jolien Haesen, Ginés Hernández-Cortes, Sofía Herrero, Imre Pete, Ioannis Kalogiannidis, Erbil Karaman, Andreas Kavallaris, Łukasz Klasa, Ioannis Kotsopoulos, S Kovachev, Meelis Leht, Arantxa Lekuona, Mathieu Luyckx, Michael R. Mallmann, Gemma Mancebo, Aljoša Mandić, Nabil Manzour, Tiermes Marina, Victor Martín, María Belén Martín-Salamanca, Alejandra Martínez, Gesine Meili, Gustavo Mendinhos, Liliana Mereu, Milena Mitrović, Sara Morales, Enrique Moratalla, Bibiana Morillas, Eva Myriokefalitaki, Maja PakižImre, Stamatios Petousis ImrePete, Laurențiu Pirtea, Natalia Povolotskaya, Sonia Prader, Alfonso Quesada, Mikuláš Redecha, Fernando Alfageme, Philip Rolland, Reeli Saaron, Cosmin-Paul Sarac, Jens-Peter Scharf, Špela Smrkolj, Rita Sousa, Artem Stepanyan, Vladimír Študent, Carmen Tauste, Hans Trum, Taner Turan, Manuela Undurraga, Arno Uppin, Alicia Vázquez, Ignace Vergote, George Vorgias, Ignacio Zapardiel,

Endometriosis Research and Treatment

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/m 2 (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.