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Boria F, Chiva L, Chacon E, Zanagnolo V, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Zusterzeel PLM, Aluloski I, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Bernardino M, Bharathan R, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Demirkiran F, Vorgias G, Povolotskaya N, Coronado Martín PJ, Marina T, Zapardiel I, Bizzarri N, Gorostidi M, Gutierrez M, Manzour N, Berasaluce A, Martin-Calvo N. SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer. Int J Gynecol Cancer 2022; 32:1236-1243. [PMID: 36583728 DOI: 10.1136/ijgc-2022-003790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. METHODS In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. RESULTS A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy. CONCLUSIONS Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.
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Affiliation(s)
- Felix Boria
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Enrique Chacon
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | | | - Anna Fagotti
- Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Milano, Lombardia, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | | | | | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | - Octavio Arencibia
- Department of Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Las Palmas, Spain
| | | | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Department of Oncogynecology, Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv Region, Ukraine
| | - Anna Myriam Perrone
- Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Igor Aluloski
- Department of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopjeskopje, Macedonia
| | - Frederic Goffin
- Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Margarida Bernardino
- Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Minna M Maenpaa
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine.,Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Fuat Demirkiran
- Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
| | - George Vorgias
- Metaxa Cancer Hospital of Piraeus, Piraeus, Attika, Greece
| | - Natalia Povolotskaya
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
| | - Pluvio J Coronado Martín
- Department of Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
| | - Tiermes Marina
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ignacio Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | | | - Monica Gutierrez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | - Nabil Manzour
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Arantxa Berasaluce
- Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nerea Martin-Calvo
- ,Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
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Chacon E, Manzour N, Zanagnolo V, Querleu D, Núñez-Córdoba JM, Martin-Calvo N, Căpîlna ME, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Gil Moreno A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Tsolakidis D, Vujić G, Jedryka MA, Zusterzeel PLM, Beltman JJ, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Berlev I, Bernardino M, Bharathan R, Lanner M, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Minguez JA, Vázquez-Vicente D, Castellanos T, Boria F, Alcazar JL, Chiva L. SUCCOR cone study: conization before radical hysterectomy. Int J Gynecol Cancer 2022; 32:117-124. [PMID: 35039455 DOI: 10.1136/ijgc-2021-002544] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009). METHODS A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score. RESULTS We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively). CONCLUSIONS In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.
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Affiliation(s)
- Enrique Chacon
- Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Nabil Manzour
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
| | | | | | | | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | - Anna Fagotti
- University Hospital Agostino Gemelli Gynaecological Oncology Complex Operative Unit, Roma, Lazio, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | | | | | - Antonio Gil Moreno
- Gynecology, Vall d'Hebron Hospital, Sant Cugat Del Vallés, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Barcelona, Spain
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | | | | | - Tayfun Toptas
- Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Oncogynecology, Kazahskij Naucno-issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- Department of Surgery, LISOD-Israeli Oncological Hospital, Kyiv, Ukraine
| | - Anna Myriam Perrone
- Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dimitrios Tsolakidis
- General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | | | - Marcin A Jedryka
- Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
| | | | | | - Frederic Goffin
- Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Igor Berlev
- North-Western State Medical University, NN Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
| | - Margarida Bernardino
- Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Maximilian Lanner
- Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
| | - Minna M Maenpaa
- Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | | | | | | | - Felix Boria
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
| | - Juan Luis Alcazar
- Obstetrics and Gynecology, School of Medicine, University of Navarra, Pamplona, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
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Boria F, Chiva L, Zanagnolo V, Querleu D, Martin-Calvo N, Căpîlna ME, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Shamistan A, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Tsolakidis D, Vujić G, Jedryka MA, Zusterzeel PLM, Beltman JJ, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Berlev I, Bernardino M, Bharathan R, Lanner M, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Alonso-Espías M, Minguez JA, Vázquez-Vicente D, Manzour N, Jurado M, Castellanos T, Chacon E, Alcazar JL. Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators. Int J Gynecol Cancer 2021; 31:1212-1219. [PMID: 34321289 DOI: 10.1136/ijgc-2021-002587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/01/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. OBJECTIVE To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. METHODS The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. RESULTS The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. CONCLUSIONS In this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.
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Affiliation(s)
- Felix Boria
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Madrid, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Denis Querleu
- Department of Surgery, Institut Bergonie, Bordeaux, France
| | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | - Anna Fagotti
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Constantijne Mom
- Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | | | | | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | | | - Francesco Raspagliesi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Oncogynecology, Kazahskij Naucno-Issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Mariana Tavares
- Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Dmytro Golub
- Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv region, Ukraine
| | - Anna Myriam Perrone
- Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dimitrios Tsolakidis
- General Hospital of Thessaloniki Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | | | - Marcin A Jedryka
- Department of Oncological Gynecology, Uniwersytet Medyczny im Piastów Śląskich we Wrocławiu (Wroclaw Medical University), Wroclaw, Poland
| | | | | | - Frederic Goffin
- Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Igor Berlev
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Saint-Petersburg, Russian Federation
| | - Margarida Bernardino
- Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisboa, Lisboa, Portugal
| | - Rasiah Bharathan
- University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
| | - Maximilian Lanner
- Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
| | - Minna M Maenpaa
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine.,Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - María Alonso-Espías
- Department of Gynecologíc Oncology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jose Angel Minguez
- Department of Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
| | | | - Nabil Manzour
- Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Navarra, Spain
| | - Matias Jurado
- Department of Gynecology, Clinica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - Teresa Castellanos
- Department of Gynecology, Clinica Universitaria de Navarra, Madrid, Spain
| | - Enrique Chacon
- Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, School of Medicine; University of Navarra, Pamplona, Spain
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4
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Chiva L, Zanagnolo V, Querleu D, Martin-Calvo N, Arévalo-Serrano J, Căpîlna ME, Fagotti A, Kucukmetin A, Mom C, Chakalova G, Aliyev S, Malzoni M, Narducci F, Arencibia O, Raspagliesi F, Toptas T, Cibula D, Kaidarova D, Meydanli MM, Tavares M, Golub D, Perrone AM, Poka R, Tsolakidis D, Vujić G, Jedryka MA, Zusterzeel PLM, Beltman JJ, Goffin F, Haidopoulos D, Haller H, Jach R, Yezhova I, Berlev I, Bernardino M, Bharathan R, Lanner M, Maenpaa MM, Sukhin V, Feron JG, Fruscio R, Kukk K, Ponce J, Minguez JA, Vázquez-Vicente D, Castellanos T, Chacon E, Alcazar JL. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer 2020; 30:1269-1277. [PMID: 32788262 DOI: 10.1136/ijgc-2020-001506] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
| | | | | | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | | | | | - Mario Malzoni
- Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | | | | | | | - Tayfun Toptas
- Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
| | - David Cibula
- Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
| | - Dilyara Kaidarova
- Oncogynecology, Kazahskij Naucno-issledovatel'skij Institut Onkologii i Radiologii, Almaty, Kazakhstan
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | | | - Dmytro Golub
- LISOD - Israeli Oncological Hospital, Kyiv, Ukraine
| | - Anna Myriam Perrone
- Azienda Ospedaliero-Universitaria di Bologna Policlinico SantOrsola-Malpighi, Bologna, Italy
| | - Robert Poka
- Obstetrics and Gynecology; Unit of Gynecologic Oncology; Institute of Obstetrics and Gynecology; Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Marcin A Jedryka
- Oncological Gynecology, Lower Silesian Cancer Center, Wroclaw, Poland
| | | | | | - Frederic Goffin
- Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Dimitrios Haidopoulos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | | | - Igor Berlev
- North-Western State Medical University. N.N. Petrov Research Institute of Oncology, St Petersburg, Russia
| | | | | | | | - Minna M Maenpaa
- Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Vladyslav Sukhin
- Oncogynecology, Grigorev Institute for Radiology, Kharkiv, Ukraine
| | | | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy.,Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
| | - Kersti Kukk
- North Estonia Medical Centre, Tallinn, Estonia
| | - Jordi Ponce
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Jose Angel Minguez
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Teresa Castellanos
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Enrique Chacon
- Obstetrics and Gynecology, Universidad de Navarra, Pamplona, Spain
| | - Juan Luis Alcazar
- Obstetrics and Gynecology, School of Medicine; University of Navarra, Pamplona, Spain
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