In the early stages of cervical cancer, the main constituent part of therapy, as a rule, is the so-called hysterectomy, an operation during which part of the cervix or the entire uterus is removed. This may be the so-called abdominal hysterectomy, that is, through an incision in the abdominal wall. The alternative is a minimally invasive method in which the uterus is either reduced and removed through small incisions in the abdominal wall (laparoscopy / laparoscopic supracervical hysterectomy), or removed vaginally. In the latter method, there are again two options. To pull the tissues out, to separate the uterus and cervix from the ligamentous apparatus and blood vessels, instruments are inserted either through the vagina (vaginal extirpation of the uterus) or laparoscopically (laparoscopic supracervical hysterectomy).
During recent studies scientists compared the chances of recovery for cervical cancer after laparoscopic surgery with the chances after open abdominal surgery. The scientists from MD Anderson Cancer Centre in Houston have analyzed data from more than 600 women operated on in clinics around the world. In half of the women the uterus was removed minimally invasively, in the second half ‒ through an abdominal incision.
“The patients operated on in the minimally invasive way had four times higher risks of recurrence than those who were operated on by means of the open method,” said the study author Dr. Pedro Ramirez. The safety committee responsible for the study stopped the experiment when it became clear that the women in the minimally invasive group had undoubtedly noticeable complications. Four and a half years after the intervention 94% of the patients in this group are still alive. In the group of the women who underwent open abdominal surgery 99% are alive.
During an independent study, the scientists at Northwestern University in Evanston, Illinois, came to the same conclusion. According to the state database of patients with cervical cancer, four years later 9% of the women operated on in a minimally invasive way died. Only 5% of the patients operated on abdominally died.
Why a minimally invasive intervention reduces the chances of recovery cannot be explained by both studies. The scientists from Houston assume that carbon dioxide injected into the abdominal cavity during laparoscopy to raise the abdominal wall plays some role. There are suppositions that this gas may affect the growth and spread of cancer cells.
Another mystery is the fact that the phenomenon does not seem to concern all types of cancer. According to earlier studies, minimally invasive hysterectomy, for example, is safe for uterine tumours, the authors note. The researchers could not answer the question why the prognosis for patients with a purely vaginal hysterectomy, that is without an abdominal wall incision, is disappointing.