To the Editor: In the trial reported by Ramirez et al. (Nov. 15 issue),1 the authors observed lower survival rates among women with early-stage cervical cancer who underwent minimally inva-sive surgery than among those who underwent open surgery. These results suggest that factors such as CO2 gas insuff lation might cause early spread of tumor cells, which in turn compromis-es outcomes.
Similar findings were observed in the accompanying retrospective study conducted by Melamed et al.