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The National Cancer Registration and Analysis Service (NCRAS) has conducted a review of outcomes for women with early stage cervical cancer who underwent radical hysterectomy by either the minimal access (laparoscopic or robotic) or open (laparotomy) route during 2013 - 2016. This review was carried out following two pieces of research from the United States which indicated undergoing open surgery had better survival than women undergoing keyhole surgery.
Following the review, a summary has been produced along with guidance for health professionals, below is a statement regarding the findings.
Robert Music, Chief Executive, Jo’s Cervical Cancer Trust:
“The findings of this analysis are concerning. While outcomes and survival remain high for women with early stage cervical cancer who have been treated by a radical hysterectomy, there is a significant difference in mortality between those who had open versus minimal access surgery. As a matter of urgency we want to see clear guidance regarding whether minimal access surgery should be offered for women and this includes a deeper analysis into additional factors which could be contributing to the different mortality rates, such as tumour size, that were outside of the scope of this analysis.
We do not believe the guidance from BGCS is clear enough. In this instance, It is unreasonable to expect patients to be able to make such a difficult decision about their treatment. The guidance currently relies entirely on the ability of clinicians to fully communicate risks and benefits without any bias and without access to robust research and data outcomes. This will make an already incredibly difficult time for women far more stressful.
Minimal access surgery has previously been favoured over open surgery due to faster recovery and fewer complications or side effects, however this analysis indicates no difference in post-surgical complications for the two. This potentially provides further weight to open surgery having better outcomes in terms of mortality and morbidity, however again further research is needed to better understand this.
The analysis clearly demonstrates the need for careful, ongoing and appropriately timed follow up for women who have had treatment for cervical cancer alongside better awareness of symptoms which could indicate a recurrence.
The gaps in research which this analysis has identified need addressing urgently as we must ensure women having treatment for early stage cervical cancer are receiving the best possible treatment type and that consistency of approach exists across the country.”
While this review may raise concerns or questions, please do remember that overall outcomes for both options remain high. If you have questions or concerns, then please do contact your oncology team who will be able to talk about your treatment pathway. Alternatively, do call our helpline: 0808 802 800