PMID- 30802438
OWN - NLM
STAT- Publisher
LR  - 20190225
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
DP  - 2019 Feb 22
TI  - Trachelectomy for reproductive-aged women with early-stage cervical cancer:
      minimally-invasive surgery versus laparotomy.
LID - S0002-9378(19)30390-4 [pii]
LID - 10.1016/j.ajog.2019.02.038 [doi]
AB  - BACKGROUND: A recent trial demonstrated decreased survival in women with
      early-stage cervical cancer who underwent radical hysterectomy via
      minimally-invasive surgery (MIS) compared to laparotomy, however outcomes
      following trachelectomy have yet to be studied. OBJECTIVE: To examine trends,
      characteristics, and survival of reproductive-aged women with early-stage
      cervical cancer who underwent MIS trachelectomy. METHODS: This is a retrospective
      study examining the National Cancer Database between 2010-2015. Women aged <50
      years who underwent trachelectomy for stage IA2-IB cervical cancer were grouped
      by mode of surgery. Clinico-pathological characteristics and outcomes were
      compared between MIS and laparotomy groups. RESULTS: A total of 246 women were
      included, 144 (58.5%, 95% confidence interval 52.4-64.7) of which had
      trachelectomy with a MIS approach. Median age was similar between the MIS and
      laparotomy groups (median, 31 versus 29 years, P=0.20). There was a significant
      increase in the use of MIS from 29.3% in 2010 to 75.0% in 2015 (P<0.001).
      Specifically, MIS became the dominant approach for trachelectomy by year 2011
      (54.8%). Hospitals registered in the West (75.0% versus 25.0%) were more likely, 
      whereas those registered in the Midwest (46.9% versus 53.1%) were less likely, to
      perform MIS (P=0.02). Median follow-up was 37 months (interquartile range, 23-51)
      for the MIS group and 40 months (interquartile range, 26-67) for the laparotomy
      group. During follow-up, there were 11 (5.3%) deaths, 4 (3.5%) in the MIS group
      and 7 (7.6%) in the laparotomy group (P=0.25). CONCLUSION: MIS has become the
      dominant modality for trachelectomy in reproductive-aged women with stage IA2-IB 
      cervical cancer after year 2011. Survival of women with stage IA2-IB cervical
      cancer who underwent trachelectomy is generally good regardless of surgical
      modality. While our study showed no difference in survival between the MIS and
      laparotomy approaches, effects of MIS on survival remain unknown and further
      study is warranted.
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Matsuo, Koji
AU  - Matsuo K
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA; Norris Comprehensive
      Cancer Center, University of Southern California, Los Angeles, CA, USA.
FAU - Chen, Ling
AU  - Chen L
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      Columbia University College of Physicians and Surgeons, New York, NY, USA.
FAU - Mandelbaum, Rachel S
AU  - Mandelbaum RS
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA.
FAU - Melamed, Alexander
AU  - Melamed A
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      Columbia University College of Physicians and Surgeons, New York, NY, USA.
FAU - Roman, Lynda D
AU  - Roman LD
AD  - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,
      University of Southern California, Los Angeles, CA, USA; Norris Comprehensive
      Cancer Center, University of Southern California, Los Angeles, CA, USA.
FAU - Wright, Jason D
AU  - Wright JD
AD  - Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard
      Medical School, Boston, MA 02115, USA. Electronic address: jw2459@columbia.edu.
LA  - eng
PT  - Journal Article
DEP - 20190222
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
OTO - NOTNLM
OT  - cervical cancer
OT  - minimally invasive
OT  - survival
OT  - trachelectomy
EDAT- 2019/02/26 06:00
MHDA- 2019/02/26 06:00
CRDT- 2019/02/26 06:00
PHST- 2018/11/21 00:00 [received]
PHST- 2019/01/19 00:00 [revised]
PHST- 2019/02/18 00:00 [accepted]
PHST- 2019/02/26 06:00 [entrez]
PHST- 2019/02/26 06:00 [pubmed]
PHST- 2019/02/26 06:00 [medline]
AID - S0002-9378(19)30390-4 [pii]
AID - 10.1016/j.ajog.2019.02.038 [doi]
PST - aheadofprint
SO  - Am J Obstet Gynecol. 2019 Feb 22. pii: S0002-9378(19)30390-4. doi:
      10.1016/j.ajog.2019.02.038.