Outcomes of Laparoscopic Radical Hysterectomy in Ia1-Ib1 Cervical Cancer Patients: A Multi-Center Study with 10 Years' Experiences in the Real World

Background: The aim of this retrospective study was to evaluate the outcomes of laparoscopic radical hysterectomy (LRH) for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1 IB1 patients with low-risk cervical cancer (CC), which was defined as tumor ≤ 2cm, less than 1/2 stromal invasion and no lymph node involvement.

Patients and methods: We performed a retrospective analysis of patients with CC who underwent radical hysterectomy across three hospitals between 2010 and 2020. The patients were stratified into low-risk and high-risk groups based on risk factors (tumor size, lymph nodes and stromal invasion depth). Within each group, the survival outcomes of open abdominal radical hysterectomy (OARH) and LRH were compared using the Kaplan-Meier analysis.

Results: In the low-risk group (LRH: N = 320; OARH: N = 525), LRH demonstrated equivalence to OARH regarding 5-year overall survival (OS; 98.6% versus 99.3%, P = 0.571) and 5-year progression-free survival (PFS; 97.6% versus 98.4%, P = 0.418). Subsequently, a stratified analysis based on lymphovascular space invasion (LVSI) status revealed no significant differences in 5-year OS and PFS between LRH and OARH in this group. Conversely, in the high-risk group (LRH: N = 355; OARH: N = 926), LRH exhibited significantly lower 5-year OS and PFS than OARH (91.3% versus 94.8%, P = 0.049; 84.0% versus 88.8%, P = 0.029).

Conclusion: Among FIGO 2018 stage IA1-IB1 patients with low-risk CC, LRH demonstrates survival outcomes comparable to OARH. For patients with early-stage and low-risk CC, the appropriate surgical approach (LRH) can be chosen based on preoperative enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) MRI, which is clinically feasible.