Boo.

The big buzz coming out of SGO 2018 was that our newer “better” surgical techniques are resulting in newer “worse” survival outcomes for women with early-stage cervical cancer. In case the classic scary movie-watching or trick-or-treaters at the door didn’t give the full-on heebie jeebies this Halloween, NEJM had you covered with the full-length publications of these disturbing results. The first report is an NCDB analysis of nearly 2500 women with stage IA2-IB1 disease. Despite having all the demographics to suggest otherwise, the half undergoing laparoscopic/robotic surgeries had almost double the mortality rate at 4 years: 9% versus 5% with standard open hysterectomy. The second is an actual phase 3 study, the LACC trial, reporting an absolute detriment of 11% in the primary endpoint of progression-free survival among women with IA1-IB1 disease randomized to laparoscopic/robotic versus open resection (86 versus 97% at 4.5 years) and even a significant reduction in overall survival (93 versus 99% at 3 years). If that didn’t terrify you, we’re not sure what will. TBL: There is now high-level evidence that, despite our best intentions, advanced surgical techniques have resulted in a big step backwards in disease outcomes for women with early-stage cervical cancer. | Melamed & Ramirez, N Engl J Med 2018