Gynaecological oncologists globally are rethinking their approach when it comes to treatment of cervical cancers and, in some cases, are ruling out the use of minimally invasive surgeries.
So said Dr. Troy Gatcliffe, of the Miami Cancer Institute, as he addressed the issue Friday at the Cayman Islands Healthcare Conference.
He said it follows the results of the Laparoscopic Approach to Cervical Cancer study published in the New England Journal of Medicine.
The study, which retroactively looked at both minimally invasive and open surgeries for patients, pointed to a divergence in the numbers of deaths and incidents in the reoccurrence of cervical cancers in patients who have had the minimally invasive surgery or laparoscopic (keyhole) or robotic hysterectomy versus those who had open surgery or abdominal radical hysterectomy.
It suggested a higher rate of deaths and resurgence of cancer in those who underwent minimally invasive surgery.
That study, Gatcliffe said, is incomplete, but its findings were enough to cause global medical associations like the European Society of Gynaecological Oncology to change its position on the use of laparoscopic or robotic hysterectomy versus abdominal radical hysterectomy.
The European Society of Gynaecological Oncology has deemed robotic surgery ‘inferior’ and has urged practitioners to counsel patients on what is the best treatment approach.
However, Gatcliffe remained skeptical of the study.
“I think that the positions that have been taken by the societies like ESGO and the kind of turning on its head by other medical institutions that have stopped completely offering any form of minimally invasive surgery for any type of cervical cancer speaks to the fact that we have embraced data that is incomplete, data that is not robust, data that was not performed in the best randomised way as our surgery,” he argued.
He said the study has medical practitioners in a “really grey area, we are kind of in a way in a no man’s land” when it comes to where to go with surgical cervical cancer treatments.
“So, each of us as practitioners, individually for ourselves and, in some places, whole institutions are choosing to take a stand,” he said.
In some cases, institutions have entirely halted the use of the robotic surgical method.
In his case, Gatcliffe said, he is playing it safe when it comes to his patients.
“I feel like because we are in a grey area. We are starting to see signals that potentially tell us that minimally invasive surgery may be inferior. I certainly do not want to do anything that would potentially put my patient at risk. So, for the time being, until the data is better, I am no longer offering robotic, radical hysterectomy for my patients. That is my personal stance,” he said.
The cause of the divergence, he said, is still unknown.
However, he said, there are schools of thought that it could be the carbon dioxide used in the surgery or the manipulator that is inserted into the patient to move around the uterus.
Health costs will continue to rise
Health costs were also in focus at the healthcare conference.
Visiting presenter Dr. Erick Gryzbowski of Abbott Diagnostics Business shared that global data pointed out healthcare costs will continue to increase.
He said, back in 2007, globally $8 trillion was spent on healthcare.
“[In] 2017, this spending was increased to $10 trillion and the projections [are] that it could be $15 trillion in 2050,” he said.
He said the problem is not only a challenge for first-world countries.
“This problem is up to all of us. Every country is experiencing this increase and the Caribbean and Latin America [are] not special,” he said.