Zie ook literatuurlijst niet-toxische middelen, voeding en voedingsstoffen en weinig belastende behandelingen specifiek bij baarmoederhalskanker, samengesteld door arts-bioloog drs. Engelbert Valstar

2 oktober 2020: Linda wees me ook op deze studie: 

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer
Waarin een kijkoperatie - minimale invasieve chirurgie bij baarmoederhalskanker maar liefst het risico op een recidief verdubbelde (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001) en ook de kans op overlijden in vergelijking met open chirurgie 2,42 keer verhoogde (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). 

Patiënten die minimaal invasieve chirurgie ondergingen met behulp van een baarmoedermanipulator hadden een 2,76 keer hoger risico op een recidief (HR, 2,76; 95% BI, 1,75 tot 4,33; P <0,001) en degenen zonder het gebruik van een baarmoedermanipulator hadden een vergelijkbare ziektevrije overleving dan patiënten uit de open chirurgiegroep (HR, 1,58; 95% BI, 0,79 tot 3,15; P = 0,20). Bovendien hadden patiënten die een minimaal invasieve operatie met beschermende vaginale sluiting ondergingen, vergelijkbare recidief percentages als degenen die een open operatie ondergingen (HR 0,63; 95% -BI 0,15 tot 2,59; P <0,52).

Onderaan artikel abstract van deze studie 

5 juli 2020: Bron: JAMA 11 juni 2020

Een minimaal invasieve operatie, ook wel robot gestuurde laporescopie genoemd, bij patiënten met operabele baarmoederhalskanker in beginnend stadium, blijkt een sterk verhoogd risico te geven op een recidief (plus 71 procent) en overlijden (plus 56 procent) in vergelijking met een operatie waarbij open chirurgie wordt toegepast. Dit blijkt uit de meta-analyse van een grote reviewstudie van 15 gerandomiseerde studies met totaal 9499 patiënten met beginnende baarmoederhalskanker. 

71 procent verschil in risico op een recidief en 56 procent verschil in risico op overlijden is toch wel een groot verschil. Al heeft een robotgestuurde laporescopie ook veel voordelen. Van de 9499 patiënten uit de studie kregen er 530 een recidief en overleden uiteindelijk 451 patiënten, dus de percentages zijn alarmerender dan de absolute getallen.

In absolute cijfers uit het abstract gehaald:

Uit de gegevens van 15 gerandomiseerde studies ontdekten de onderzoekers dat van de 9.499 patiënten die een radicale operatie ( hysterectomie ) ondergingen, 49 procent daarvan een minimaal invasieve chirurgie ondergingen. Hiervan kreeg 57 procent (2.675 patiënten) een robotondersteunde laparoscopie.
In totaal waren er 530 recidieven en 451 sterfgevallen, maar het totale risico op recidief of overlijden was 71 procent hoger bij patiënten die een minimaal invasieve radicale operatie ondergingen in vergelijking met degenen die een open operatie ondergingen (hazard ratio, 1,71). Het risico op overlijden was ook hoger (hazard ratio, 1,56). 

Het volledige studierapport: Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer. A systematic Review and meta-analysis is tegen betaling in te zien.

Hier het abstract van de studie: 

Original Investigation
June 11, 2020

Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical CancerA Systematic Review and Meta-analysis

Roni Nitecki, MD1; Pedro T. Ramirez, MD1; Michael Frumovitz, MD, MPH1; et alKate J. Krause, MLIS2; Ana I. Tergas, MD, MPH3; Jason D. Wright, MD3; J. Alejandro Rauh-Hain, MD, MPH1; Alexander Melamed, MD, MPH3
Author Affiliations
JAMA Oncol. Published online June 11, 2020. doi:10.1001/jamaoncol.2020.1694
editorial comment icon 
Editorial
Comment

Key Points

Question  Are the findings of high-quality observational studies consistent with the results of a randomized clinical trial that found that minimally invasive hysterectomy was associated with a higher risk of recurrence and death compared with open surgery?

Findings  In this systematic review and meta-analysis of 15 high-quality studies comprising 9499 patients, minimally invasive radical hysterectomy was associated with shorter overall and disease-free survival among women with operable cervical cancer compared with open surgery.

Meaning  These results provide evidence to support the survival benefit associated with open radical hysterectomy for early-stage cervical cancer; these findings are consistent with a recent randomized clinical trial.

Abstract

Importance  Minimally invasive techniques are increasingly common in cancer surgery. A recent randomized clinical trial has brought into question the safety of minimally invasive radical hysterectomy for cervical cancer.

Objective  To quantify the risk of recurrence and death associated with minimally invasive vs open radical hysterectomy for early-stage cervical cancer reported in observational studies optimized to control for confounding.

Data Sources  Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science (inception to March 26, 2020) performed in an academic medical setting.

Study Selection  In this systematic review and meta-analysis, observational studies were abstracted that used survival analyses to compare outcomes after minimally invasive (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics 2009 stage IA1-IIA) cervical cancer. Study quality was assessed with the Newcastle-Ottawa Scale and included studies with scores of at least 7 points that controlled for confounding by tumor size or stage.

Data Extraction and Synthesis  The Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist was used to abstract data independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between surgical approach and oncologic outcomes.

Main Outcomes and Measures  Risk of recurrence or death and risk of all-cause mortality.

Results  Forty-nine studies were identified, of which 15 were included in the meta-analysis. Of 9499 patients who underwent radical hysterectomy, 49% (n = 4684) received minimally invasive surgery; of these, 57% (n = 2675) received robot-assisted laparoscopy. There were 530 recurrences and 451 deaths reported. The pooled hazard of recurrence or death was 71% higher among patients who underwent minimally invasive radical hysterectomy compared with those who underwent open surgery (hazard ratio , 1.71; 95% CI, 1.36-2.15; P < .001), and the hazard of death was 56% higher (HR, 1.56; 95% CI, 1.16-2.11; P = .004). Heterogeneity of associations was low to moderate. No association was found between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy and hazard of recurrence or death (2.0% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −3.4% to 7.7%]) or all-cause mortality (3.7% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −4.5% to 12.6%]).

Conclusions and Relevance  This systematic review and meta-analysis of observational studies found that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence and death compared with open surgery.

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. F

Original research
SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer
 FREE
  1. Luis Chiva1, 
  2. Vanna Zanagnolo2, 
  3. Denis Querleu3, 
  4. Nerea Martin-Calvo4, 
  5. Juan Arévalo-Serrano5, 
  6. Mihai Emil Căpîlna6, 
  7. Anna Fagotti7, 
  8. Ali Kucukmetin8, 
  9. Constantijne Mom9, 
  10. Galina Chakalova10, 
  11. Shamistan Aliyev11, 
  12. Mario Malzoni12, 
  13. Fabrice Narducci13, 
  14. Octavio Arencibia14, 
  15. Francesco Raspagliesi15, 
  16. Tayfun Toptas16, 
  17. David Cibula17, 
  18. Dilyara Kaidarova18, 
  19. Mehmet Mutlu Meydanli19, 
  20. Mariana Tavares20, 
  21. Dmytro Golub21, 
  22. Anna Myriam Perrone22, 
  23. Robert Poka23, 
  24. Dimitrios Tsolakidis24, 
  25. Goran Vujić25, 
  26. Marcin A Jedryka26, 
  27. Petra L M Zusterzeel27, 
  28. Jogchum Jan Beltman28, 
  29. Frederic Goffin29, 
  30. Dimitrios Haidopoulos30, 
  31. Herman Haller31, 
  32. Robert Jach32, 
  33. Iryna Yezhova33, 
  34. Igor Berlev34, 
  35. Margarida Bernardino35, 
  36. Rasiah Bharathan36, 
  37. Maximilian Lanner37, 
  38. Minna M Maenpaa38, 
  39. Vladyslav Sukhin39, 
  40. Jean-Guillaume Feron40, 
  41. Robert Fruscio41,42, 
  42. Kersti Kukk43, 
  43. Jordi Ponce44, 
  44. Jose Angel Minguez45, 
  45. Daniel Vázquez-Vicente45, 
  46. Teresa Castellanos45, 
  47. Enrique Chacon46, 
  48. Juan Luis Alcazar47, 
  49. On behalf of the SUCCOR study Group

Abstract

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/m2 (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.

View Full Text

http://dx.doi.org/10.1136/ijgc-2020-001506

baarmoederhalskanker, open chirurgie, laparoscopie, risico op recidief, risico op overlijden, overall overleving


Plaats een reactie ...

Reageer op "Operatie: Minimaal invasieve operatie van operabele baarmoederhalskanker geeft groter risico op recidief en overlijden dan open chirurgie blijkt uit grote reviewstudie."


Gerelateerde artikelen