SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer
Luis Chiva 1 , Vanna Zanagnolo 2 , Denis Querleu 3 , Nerea Martin-Calvo 4 , Juan Arévalo-Serrano 5 , Mihai Emil Căpîlna 6 , Anna Fagotti 7 , Ali Kucukmetin 8 , Constantijne Mom 9 , Galina Chakalova 10 , Shamistan Aliyev 11 , Mario Malzoni 12 , Fabrice Narducci 13 , Octavio Arencibia 14 , Francesco Raspagliesi 15 , Tayfun Toptas 16 , David Cibula 17 , Dilyara Kaidarova 18 , Mehmet Mutlu Meydanli 19 , Mariana Tavares 20 , Dmytro Golub 21 , Anna Myriam Perrone 22 , Robert Poka 23 , Dimitrios Tsolakidis 24 , Goran Vujić 25 , Marcin A Jedryka 26 , Petra L M Zusterzeel 27 , Jogchum Jan Beltman 28 , Frederic Goffin 29 , Dimitrios Haidopoulos 30 , Herman Haller 31 , Robert Jach 32 , Iryna Yezhova 33 , Igor Berlev 34 , Margarida Bernardino 35 , Rasiah Bharathan 36 , Maximilian Lanner 37 , Minna M Maenpaa 38 , Vladyslav Sukhin 39 , Jean-Guillaume Feron 40 , Robert Fruscio 41 42 , Kersti Kukk 43 , Jordi Ponce 44 , Jose Angel Minguez 45 , Daniel Vázquez-Vicente 45 , Teresa Castellanos 45 , Enrique Chacon 46 , Juan Luis Alcazar 47 , et al, on behalf of the SUCCOR study group
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.
CITATION Int J Gynecol Cancer . 2020 Aug 11;ijgc-2020-001506. doi: 10.1136/ijgc-2020-001506.