Two recent studies suggest that recurrence of cervical cancer after hysterectomy may be linked to minimally invasive surgical techniques, according to a report in the New York Times.

The studies, both published in the New England Journal of Medicine, revealed shocking results showing that minimally invasive surgical techniques may decrease patient mortality and increase the chance of a recurrence of cervical cancer after hysterectomy surgery.

One of the studies included data from 631 women in 33 hospitals across the United States, Columbia, Brazil, Peru, Italy, China, Australia, and Mexico. Patients were recruited for the study between June 2008 and June 2017 and were assigned to have either an open or laparoscopic hysterectomy at random.

An independent safety board monitored the results of the study as it progressed to make sure that patients were not being harmed. During the study, the board determined that too many deaths had affected the minimally invasive hysterectomy group and recommended that researchers stop adding new patients until further analysis could be done. Closer examination of the data confirmed what the initial results showed; laparoscopic hysterectomies were associated with a higher death rate.

After 4.5 years, 96.5 percent of patients who underwent an open surgery were free of cancer, noted study results. Comparatively, 86 percent of patients who underwent the minimally invasive surgery were free of cancer. After three years, 99 percent of open surgery patients were alive compared to 93.8 percent of laparoscopic surgery patients.

In recent years, minimally invasive surgery has become standard for many operations, especially those in the abdomen. The recovery time and fewer complications associated with minimally invasive surgery has made it a popular option for surgeons. A laparoscopic hysterectomy is done entirely through the vagina instead of through the abdomen. The increasing popularity of this method makes the results of the cervical cancer after hysterectomy study more shocking.

Researchers aren’t sure why there was a difference between the two methods and actually expected the methods to be equivalent. However, they have several theories which may explain the recurrence of cervical cancer after hysterectomy surgery done laparoscopically.

According to one theory, the surgical instrument which is passed through the cervix during surgery may spread the cancer cells inadvertently. Another theory argues that carbon dioxide, which is used to inflate the abdomen during laparoscopic surgery, may help with the spread of cancer cells. Further theories claim that laparoscopic hysterectomies simply aren’t effective enough and miss some cancerous tissues.

Dr. Pedro Ramirez, the lead author of one study and a leading expert in minimally invasive gynecological cancer surgery, said that the results of the studies have had an impact on how he treats patients.

“At M.D. Anderson, we have completely stopped performing minimally invasive surgery for cervical cancer,” said Dr. Ramirez, according to the New York Times. “Throughout the gynecologic oncology community, we’re seeing a transition back to the predominance of open surgery.”

However, Ramirez reports that some doctors are reluctant to give up the technique after investing time, energy, and money into learning the approach. Until further research is done, these doctors may continue to use laparoscopic procedures – potentially putting patients at risk for recurrence of cervical cancer after hysterectomy surgery.

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