Recent studies have shown that patients with early‐stage cervical cancer who underwent minimally invasive surgery (MIS) had a worse prognosis than that of laparotomy; However, whether minimally invasive radical hysterectomy is available for relatively low‐risk early patients under the 2018 FIGO guidelines have yet to be studied. A propensity score‐matched cohort study examining patients with stage IB (2018 FIGO) cervical cancer of relatively low‐risk who underwent radical hysterectomy found that the five‐year overall survival and disease‐free survival of MIS respectively reduced by 5.8% and 6.6% compared with laparotomy. The surgical approaches do have a significant difference for survival of patients with early cervical cancer who underwent radical hysterectomy. Even in stage IB1 patients with low‐risk, the oncologic outcomes of laparotomy is better compared with MIS.
Abstract
Objective
To compare the long‐term oncologic outcomes of minimally invasive surgery (MIS) vs laparotomy for patients with stage IB (2018 FIGO) cervical cancer.
Methods
A matched retrospective study of cervical cancer patients who underwent MIS or laparotomy at Sun Yat‐sen University Cancer Center from January 2012 to December 2015 was carried out. Patients were restaged according to the 2018 FIGO staging system for cervical cancer, 700 cases with stage IB cervical cancer were enrolled. Propensity score matching (PSM) was performed by software SPSS version 22.0, and a total of 426 patients were enrolled and analyzed. Oncologic outcomes were compared between patients undergoing MIS vs laparotomy.
Results
After PSM, there were no statistical differences in other baseline characteristics between MIS and laparotomy, except for age (p = 0.008). In all stage IB patients, MIS group had significantly lower disease‐free survival (DFS) rate and overall survival (OS) rate compared with laparotomy group (5‐year DFS rate, 87.5% vs 94.1%, hazard ratio for disease recurrence, 2.403; 95% CI, 1.216‐4.744; 5‐year OS rate, 92.3% vs 98.1%, hazard ratio for death, 3.719; 95% CI, 1.370‐10.093). In stage IB1 patients population, MIS was still associated with worse DFS and OS compared to laparotomy (5‐year DFS rate: 89.5% vs 100%, p = 0.012; 5‐year OS rate: 93.4% vs 100%, p = 0.043). Even in stage IB1 patients without lymph vascular space invasion, worse oncologic outcome could be observed in MIS group (DFS: p = 0.021; OS: p = 0.076).
Conclusion
Our study suggested that laparotomy resulted in better OS and DFS compared with MIS among patients with stage IB cervical cancer. Even in stage IB1 patients without lymph vascular space invasion (2018 FIGO), laparotomy might be still an oncologically safer approach.
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