Abstract
Study Objective The aim of this study was to compare survival outcomes of open radical hysterectomy and minimally invasive radical hysterectomy in early stage cervical cancer. Design A retrospective analysis. Setting Routine OR setting was done. Patients or Participants 148 patients with stage IB1-IIA2 cervical cancer who underwent primary surgery. Interventions Minimally invasive radical hysterectomy or open radical hysterectomy. Measurements and Main Results Tumor characteristics, recurrence rate, disease-free survival (DFS), and overall survival (OS) were compared according to surgical approach. In total, 110 and 38 patients were assigned to open surgery and MIS groups. After a medical follow-up of 42.1 months, the groups showed similar survival outcomes (recurrence rate, DFS, and OS). However, in patients with tumor size >2 cm, recurrence rate was significantly higher in MIS group (22.5% vs 0%; p=0.008). And MIS group had significantly poorer DFS than open surgery group (p=0.017), although OS was similar between the two groups (p=0.252). Conclusion In patients with tumor size >2 cm, MIS was associated with higher recurrence rates and poorer DFS than open surgery. However, in patients with tumor size ≤2 cm, MIS did not seem to compromise oncologic outcomes.
Highlights
Cervical cancer is the most common gynecologic cancer in developing countries, accounting for 444,500 new cases and 230,200 deaths each year [1]
The rate of patients in stage IB1 was significantly higher in the minimally invasive radical hysterectomy (MIS) group than in the open surgery group (62.7% vs. 26.3%, p
The rate of loop electrosurgical excision procedure (LEEP) conization before surgery was significantly higher in the MIS group (p=0.0013)
Summary
Cervical cancer is the most common gynecologic cancer in developing countries, accounting for 444,500 new cases and 230,200 deaths each year [1]. 13,800 new cases and 4,290 deaths related to cervical cancer are expected to occur in the United States in 2020 [2]. In Korea, the incidence of cervical cancer has been decreasing; it is still the most common gynecologic cancer. It is expected to account for 3,148 new cases and 801 deaths in 2020 [3,4]. In 2018, the prior 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was revised. Stage IB disease is divided into 3 substages and lymph node status is incorporated into stage IIIC disease [5]
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