#abandonmis?

Minimally Invasive Surgeries May Not Be as Beneficial as Assumed

Press Release: January 25, 2019

Gainesville, Fl., January 25, 2019 (swampstrattcomm-sp.19.tumblr.com)- In this week’s MDedge, the topics included new legislation in medicine, price inflations for new and already existing drugs and medication, and new procedural methods in medicine, such as robotic assistance. One of these procedural methods that has been gaining increasing attraction in recent years is minimally invasive surgeries (MIS). MIS is a process that uses small tools for insertion during procedures; and consequently, smaller cuts or incisions, which is perhaps why it is usually the preferred choice for not only patients but for doctors as well. This is especially the case for surgeons in the field of obstetrics and gynecology (Colorado Women’s Health). Today, most hysterectomies and tubal ligations, amongst other procedures are performed by surgeons using MIS technology and robotic surgery such as laparoscopy and hysteroscopy, as opposed to the more traditional open surgery (Med UNC). While MIS undoubtedly has its benefits due to the smaller incisions, smaller scars, and faster recovery rate, a study suggests that the traditional approach of open surgery, specifically for cervical cancer, may be more beneficial.  

Two new studies were published in the New England Journal of Medicine in November of 2018, and another was presented at the American Society of Clinical Oncology (ASCO). Both argued that compared to open surgeries, those who underwent the MIS surgery had a greater probability of the disease reappearing and an overall reduced survival rate for stages IA-IB of cervical cancer. From 2008 to 2017 the Laparoscopic Approach to Cervical Cancer (LAAC) conducted a study comparing the MIS approach to the open surgery approach on 631 patients. The study found that 4.5 years after the MIS procedure, 86% of the patients were still disease free, compared to a 96% disease-free survival for those who did the open surgery.  Furthermore, there were 22 deaths in the MIS group and three deaths in the open surgery group. Another study was conducted by the National Cancer Database that included 2,641 women and focused more on the death rates. From a total of 164 deaths, 94 of those were of MIS patients, while 70 were of open surgery patients (Abandon MIS?). Essentially, mortality rates were higher for those who underwent MIS, and those patients therefore had a shorter overall survival rate. “While we recognize that open surgery is associated with increased morbidity, we do argue that, with the almost-universal implementation of Enhanced Recovery Pathways (ERP) in gynecologic oncology, the disparities between the two groups will be minimized and likely are much smaller than that reported in historical literature,” Mary Mullen, MD.

Although these two studies along with several others depreciates MIS in comparison to open surgery, there are also studies that insinuate the opposite effect, and show research of patients that benefited more from MIS and had fewer drawbacks. Ultimately, more research would need to be conducted in order to adequately compare the two and conclude that it may be a defining factor, but it also may be a case-to-case basis that is dependent on the patient and his or her diagnosis. 

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News