Is minimally invasive surgery safe for cervical cancer patients with a diameter of less than 2 cm? (565)

Abstract

<b>Objectives:</b> Several authors have suggested that minimally invasive surgery was not a poor prognostic factor among those with 2018 FIGO stage IB1. However, it is necessary to accurately analyze risk factors related to pelvic recurrence in this patient group. This study aimed to identify the clinical-pathologic prognostic factors associated with pelvic recurrence for patients with 2018 FIGO stage IA2 and IB1 cervical cancer treated with laparoscopic/robotic radical hysterectomy. <b>Methods:</b> A total of 117 FIGO stage IA2 and IB1 cervical cancer patients were identified between April 2006 and January 2021. One patient with lung metastasis was excluded. Sites of disease recurrence and all possible clinical-pathologic factors related to the risk of pelvic recurrence were analyzed. Disease-free survival (DFS) was estimated using the Kaplan-Meier method, and groups were compared by univariate analysis, employing the log-rank test. The Cox proportional hazard regression model with a backward elimination method was used to determine prognostic factors for DFS. <b>Results:</b> Of the 116 patients, eight (6.9 %) showed disease recurrence (four vaginal stumps, two pelvic lymph nodes, two peritonea). Five- year DFS rates were 92.9%. In multivariate analysis, the risk factors associated with pelvic recurrence during and after surgery were intracorporeal colpotomy (p < 0.044, odds ratio [OR]: 5.281, 95% CI: 1.046-26.665), the size of residual tumor (p < 0.003, OR: 4.081, 95% CI: 1.611-10.340), deep stromal invasion of the outer third of the cervix (p < 0.015, OR: 9.852, 95% CI: 1.563-62.093), and the positivity of the vaginal cuff margin (p < 0.001, OR: 64.912, 95% CI: 6.193-680.414). Conversely preoperative conization reduced the risk of pelvic recurrence (p < 0.044, OR: 0.092, 95% CI: 0.009-0.943). Four patients with vaginal stump recurrence responded to additional chemoradiation and are still alive. However, two patients with peritoneal recurrences showed disease progression with peritoneal carcinomatosis despite additional chemoradiation and died. <b>Conclusions:</b> There is no guarantee that minimally invasive surgery is safe in FIGO stage IB1 patients with tumors less than 2 cm in size. Surgical techniques to prevent tumor spillage during colpotomy should be performed even in patients with tumors less than 2 cm in diameter. In addition, preoperative conization and the absence of residual tumor at the time of surgery might have a preventive effect on the recurrence of minimally invasive radical hysterectomy.