Abstract
Objectives: This study aimed to compare the 5-year disease-free survival (DFS) and overall survival (OS) of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for IA1 with lymphovascular space invasion (LVSI)-IIA2 cervical cancer and to analyze the Cox proportional hazard ratio (HR) of LRH among the total study population and different subgroups.Methods: This was a multicenter retrospective cohort study. The oncological outcomes of LRH (n = 4,236) and ARH (n = 9,177) were compared. The HRs and 95% confidence intervals for the effect of LRH on 5-year OS and DFS were estimated by Cox proportional hazards models.Results: Overall, there was no difference in DFS between LRH and ARH in the unadjusted analysis (HR 1.11, 95% CI: 0.99–1.25, p = 0.075). The risk-adjusted analysis revealed that LRH was independently associated with inferior DFS (HR 1.25, 95% CI: 1.11–1.40, p < 0.001). There was no difference in OS between the two groups in the unadjusted analysis (HR 1.00, 95% CI: 0.85–1.17, p = 0.997) or risk-adjusted analysis (HR 1.15, 95% CI: 0.98–1.35, p = 0.091). For patients with FIGO stage IB1 and tumor size <2 cm, LRH was not associated with lower DFS or OS (p = 0.637 or p = 0.107, respectively) in risk-adjusted analysis. For patients with FIGO stage IB1 and tumor size ≥2 cm, LRH was associated with lower 5-year DFS (HR 1.42, 95% CI: 1.19–1.69, p < 0.001) in risk-adjusted analysis, but it was not associated with lower 5-year OS (p = 0.107). For patients with FIGO stage IIA1 and tumor size <2 cm, LRH was not associated with lower 5-year DFS or OS (p = 0.954 or p = 0.873, respectively) in risk-adjusted analysis. For patients with FIGO stage IIA1 and tumor size ≥2 cm, LRH was associated with lower DFS (HR 1.48, 95% CI: 1.16–1.90, p = 0.002) and 5-year OS (HR 1.69, 95% CI: 1.22–2.33, p = 0.002) in risk-adjusted analysis.Conclusion: The 5-year DFS of LRH was worse than that of ARH for FIGO stage IA1 with LVSI-IIA2. LRH is not an appropriate option for FIGO stage IB1 or IIA1 and tumor size ≥ 2 cm compared with ARH.
Highlights
Cervical cancer is the fourth most common cancer among women worldwide; 85% of new cases and 90% of deaths are from low-resource regions or from people who live in socioeconomically weaker sections of society, and the disease seriously threatens women’s health [1,2,3]
A phase III randomized clinical trial demonstrated that minimally invasive radical hysterectomy was associated with lower rates of 4.5-year disease-free survival (DFS) and overall survival (OS) compared with abdominal radical hysterectomy (ARH) [12]
Among the 46,313 patients described in the database, 13,413 were included in this study (4,236 patients in the laparoscopic radical hysterectomy (LRH) group and 9,177 patients in the ARH group)
Summary
Cervical cancer is the fourth most common cancer among women worldwide; 85% of new cases and 90% of deaths are from low-resource regions or from people who live in socioeconomically weaker sections of society, and the disease seriously threatens women’s health [1,2,3]. Laparoscopic radical hysterectomy (LRH) appears to provide equivalent or better intraoperative and short-term postoperative outcomes [11]. These findings have led to widespread use of LRH for cervical cancer. Several recent retrospective studies demonstrated that minimally invasive radical hysterectomy was associated with shorter survival compared with ARH [13,14,15]. Based on this evidence, an open abdominal approach is recommended as the only standard approach for radical hysterectomy starting with Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology [16]
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