Introduction Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early stage cervical cancer. The objective of this study was to compare the 4-year disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.

Methods Multicenter, retrospective cohort study of patients diagnosed with cervical cancer stage IA1 with lymph-vascular invasion, IA2 and IB1(FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from 6 countries. In the main patient-level analysis we used inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women who differed only with respect to surgical approach. We estimated the hazard ratio (HR) for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.

Results 1379 patients were included in the analysis, 681 (49.4%) patients operated by laparoscopy, and 698 (50.6%) by laparotomy. Median age was 46 (22–88) years. Median follow-up was 52.1(0.8–201.2) months for laparoscopy, and 52.6 (0.4–166.6) for laparotomy group. Women who underwent laparoscopic radical hysterectomy had inferior 4-year disease-free survival compared with laparotomy group (HR 1.64; 95% Confidence Interval 1.09–2.46). When the outcomes were compared according to preoperative tumor size, there was a higher risk of recurrence only in patients with a tumor size >2 cm operated by laparoscopy (HR= 2.26; 95% CI 1.17–4.37).

Conclusions In this retrospective multicenter study, the laparoscopic approach for early stage cervical cancer was associated with a higher risk of recurrence, compared to laparotomy.