Minimally invasive surgery is not the best treatment strategy for some gynaecological cancers.

This article is from the NEJM journal watch when the minimally invasive surgical approach isn't necessarily the best strategy in which situations minimally invasive surgery is not necessarily the best strategy. Author: Robert L. Barbieri, MD. in two studies on surgical treatment of gynecologic cancer, minimally invasive surgery (MIS) is associated with poor long-term outcomes.in the past 20 years, MIS has been used more and more in the treatment of early cervical cancer and ovarian cancer, while the application of open surgery is less and less. However, the impact of different surgical methods on the survival of patients with these two types of cancer is still unclear.in a systematic review and meta-analysis, the researchers identified 15 observational studies (9499 patients) on the treatment of early cervical cancer with a median follow-up time of more than 2 years.a total of 451 patients who underwent radical hysterectomy with MIS (49%) or open surgery (51%) died. The mortality risk of MIS was 56% higher than that of open surgery (P = 0.004).and robot assisted MIS did not affect the results.another team conducted an observational study using the U.S. National Cancer Database. They identified 8850 patients (mean age, 57 years) with stage I ovarian cancer who underwent MIS (29%) or open surgery (71%).with MIS, the incidence of ovarian rupture with malignant tumor splashing into peritoneal cavity was higher than that of open surgery (adjusted relative risk, 1.2), and the incidence was also higher when large tumors were removed.tumor rupture (either MIS or open surgery) was associated with an increased risk of death during a 4-year follow-up.with MIS, the above risk increased from 8% (without rupture) to 11% (with rupture).with open surgery, the above risk increased from 9% (without rupture) to 13% (with rupture).comment our gynecological oncology clinic no longer carries out MIS for early cervical cancer.we are waiting for the results of two large clinical trials currently underway to further evaluate the best surgical strategy for these cancers.in the case of stage I ovarian cancer, tumor rupture caused by tumor cells splashing into peritoneal cavity may lead to death, while the risk of rupture of malignant tumor is higher when tumor volume is larger and MIS is used.these observations may help clinicians to make individualized recommendations on the optimal surgical strategy.the reviewed articles [1] niteki R et al. Survival after minimal invasive vs open radical physiology for early stage cancer: a systematic review and meta analysis. JAMA Oncol 2020 Jun 11; [e-pub]. (Matsuo K et al. Minimally invasive surgery and risk of capsule rule for women with early stage ovarian cancer; NEJM journal watch is published by NEJM group. Famous international doctors are invited to comment on important papers in medical field to help doctors understand and apply the latest progress.NEJM medical frontier translated several articles every week, published on app and official website, and selected 2-3 articles to be published on wechat.this article is translated, compiled or invited by the editorial department of NEJM medical frontier. for translation and writing articles originated from English products of NEJM group, the original English version shall prevail. the full text of the Chinese translation and the charts included are exclusively authorized by the NEJM group of the Massachusetts Medical Association. please contact nejmqianyan@nejmqianyan.cn 。 unauthorized translation is an infringement, and the copyright owner reserves the right to investigate the legal liability.