Minimally invasive approaches to radical hysterectomy for cervical cancer associated with decreased survival Minimally invasive surgical approaches (MIS; laparoscopy and robotic surgery) have been utilized for radical hysterectomy in women with cervical cancer, with the goal of reducing operative morbidity. However, two new studies found worse oncologic outcomes with MIS procedures. In a randomized trial of women with cervical cancer who underwent radical hysterectomy, MIS compared with laparotomy resulted in a higher rate of death from cervical cancer at 3 years (4.4 versus 0.6 percent) and a lower rate of disease-free survival at 4.5 years (86.0 versus 96.5 percent). Similarly, a cohort study found that MIS radical hysterectomy was associated with a higher four-year mortality rate (9.1 versus 5.3 percent). Both studies were underpowered to detect a difference in outcomes for tumors <2 cm, which is a significant prognostic factor. MIS results in decreased operative morbidity compared with laparotomy and has been adopted for many abdominal procedures, including oncologic surgery. Since the early 2000s, radical hysterectomy for cervical cancer has been performed using conventional laparoscopy and robotic-assisted laparoscopy, but based on new findings of increased risks of recurrence and mortality compared with laparotomy, we now recommend that radical hysterectomy should be performed via laparotomy for most women with cervical cancer. Further study is needed to explore the safety of MIS approaches in women with the lowest-risk disease. Pop
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