The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes.

Journal: Gynecologic Oncology

Objective: The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy.

Methods: This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used.

Results: We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5).

Conclusions: This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.

Mario Leitao, Qin Zhou, Benny Brandt, Alexia Iasonos, Vasileios Sioulas, Katherine Lavigne Mager, Mark Shahin, Shaina Bruce, Destin Black, Carrie Kay, Meeli Gandhi, Maira Qayyum, Jennifer Scalici, Nathaniel Jones, Rajesh Paladugu, Jubilee Brown, R Naumann, Monica Levine, Alberto Mendivil, Peter Lim, Elizabeth Kang, Leigh Cantrell, Mackenzie Sullivan, Martin Martino, Melissa Kratz, Valentin Kolev, Shannon Tomita, Charles Leath, Teresa K Boitano, David Doo, Colleen Feltmate, Ronan Sugrue, Alexander Olawaiye, Ester Goldfeld, Sarah Ferguson, Jessa Suhner, Nadeem Abu Rustum