Robotic Surgery Heightens Risk of Death for Cervical Cancer Patients

Categories: Winter 2018
Two studies published in the New England Journal of Medicine found that women who underwent minimally invasive surgery for cervical cancer had a greater risk of dying. The issues raised in these studies are similar to those in prostate cancer: minimally invasive robotic surgery has become increasingly popular, despite potential safety concerns and a lack of high-quality studies of outcomes.

Women diagnosed with early stage cervical cancer often have radical hysterectomies to remove the cervix and uterus. Minimally invasive hysterectomies can be performed laparoscopically or using a surgical robot. The other option is open surgery.

Despite limited high-quality evidence supporting minimally- invasive radical hysterectomy for cervical cancer, this approach has been widely adopted since 2006.

One study, a prospective, randomized clinical trial led by researchers at MD Anderson Cancer Center, found that women assigned to minimally-invasive surgery were nearly four times more likely to have cancer recurrence when compared to women who had open surgery.1 Four years after surgery, women were also less likely to be alive if they had minimally invasive surgery. The minimally invasive group included patients who had robotic and laparoscopic surgery.

The other study, including researchers at Harvard, Northwestern, Columbia, and the University of Wisconsin analyzed national cancer data and found that after 4 years, 9% of women died after having minimally invasive surgery, compared to 5% of women who had open surgery.2 They also pointed out that the national trend for early cervical cancer had been improving for years, but in 2006, it started to decline. This timeline correlates to when minimally-invasive surgery started becoming popular.

Minimally invasive vs. open surgery for prostate cancer

In a debate on minimally-invasive versus open radical prostatectomy at the 2018 national American Urological Association, Dr. Catalona pointed out that the 20-year prostate cancer-specific survival rates from Dr. Patrick Walsh’s patients treated in the PSA era with open radical prostatectomy for Gleason 3+4 disease documented that in patients with organ-confined disease, the cancer-specific survival rate was nearly 100%.3 However, long-term cancer outcome results for minimally-invasive prostatectomy are not yet available.


1 NEJM; 2018; DOI: 10.1056/NEJMoa1806395
2 NEM: 2018; DOI: 10.1056/NEJMoa1804923
3 J Urol. 2012;188:2219-24.

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