Outcomes of laparoscopic radical hysterectomy in IA1- IB1 cervical cancer patients with low-risk: A multi-center retrospective study with 10 years’ experience (487)

Abstract

<b>Objectives:</b> More evidence revealed that the oncological outcomes of open abdominal radical hysterectomy (OARH) were superior to those of laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer (CC). However, limited by the number of CC patients with IA and low-risk IB1, some aspects still needed more study to clarify. This retrospective study aimed to estimate the outcomes of LRH for IA1-IB1 cervical cancer patients with low- risk, which was defined as tumor <2cm, less than one-third stromal invasion, no lymphovascular space invasion (LVSI), no lymph node involvement. <b>Methods:</b> By carefully studying the results of the Laparoscopic Approach to Cervical Cancer (LACC) Trial, we were surprised to find that the number of early-stage CC patients with low risk was relatively insufficient. Therefore, we retrospectively reviewed the medical records to identify the low-risk patients with FIGO 2018 stage IA1, IA2, and IB1 cervical cancer and who received laparoscopic or abdominal radical hysterectomy from January 2010 to December 2020 at four hospitals. The Mann-Whitney U test and the Chi-square test were used for the comparison of categorical variables. Progression-free survival and overall survival were compared between matched groups using Kaplan-Meier survival analysis and log-rank tests, along with univariable and multivariable regression analysis. <b>Results:</b> Of 5360 patients selected, 1850 (35%) met the inclusion criteria for this study from January 2010 to December 2020. Of these, 1090 patients underwent open surgery, and 760 patients had laparoscopic surgery. In the entire cohort, the two groups were similar in regard to clinical characteristics, such as age, body mass index (BMI), FIGO stage, histologic type and grade, pelvic lymph nodes, positive margins, stromal invasion, LVSI, and adjuvant therapy. LRH had better outcomes compared with OARH in terms of blood loss, transfusion rates, and the length of hospital stay. And in the subgroup analysis, when it referred to those patients with low-risk factors (tumor <2cm, superficial stromal invasion, negative LVSI, and no lymph node involvement), the LRH group was equivalent to the OARH group with respect to both disease-free survival (DFS) and 5-year overall survival (OS) rates. What's more, when the tumor was >2cm or accompanied by other medium and high-risk factors, the LRH group showed a significantly shorter DFS and OS than OARH, which was consistent with the LACC Trial. <b>Conclusions:</b> Among FIGO 2018 stage IA1-IB1 CC patients with low- risk, tumor <2cm, superficial stromal invasion, negative LVSI, and no lymph node involvement, there was no detrimental effect on survival between LRH and OARH. And it also needed more prospective studies to explore the oncological outcomes of low-risk CC patients with stage IA1-IB1. Besides, LRH was closely associated with worse oncological outcomes than OARH in patients with risk factors.