Objectives Published results from the LACC trial reported inferior survivals after minimal invasive surgical (MIS) approach in the treatment of early cervical cancer. Spillage of gross tumours and peritoneal contamination had been proposed as possible explanations. We studied oncologic outcomes specifically in patients presenting with no clinical gross cervical cancer treated with minimal invasive versus open radical hysterectomy as this has not been reported.

Methods Retrospective chart reviews of all patients treated with radical surgery for cervical cancer from 2005 to 2018 were performed. Only patients with no gross visible tumour who were diagnosed after a LEEP/cone biopsies were included. Relevant demographics, pathologies and survival outcomes were abstracted. Descriptive and Chi Square statistics were used to summarize clinical variables. Kaplan Meier and Cox regression were used to study survival outcomes. All p<0.05 were considered to be statistically significant.

Results 98 patients were included. Median age was 42. Median tumour size was 10 mm. Most was diagnosed after a cone biopsy (66%). Stage 1B1 was documented in 66% preoperatively. MIS used in 20 patients. Uterine manipulator used in 14 cases. Median follow up was 42 months. One recurrence in MIS group (5%) vs six recurrence in laparotomy group (7.7%), p=0.67.Three death in laparotomy and no death in MIS cohort. MIS is not significant in Cox model for PFS, adjusted for use of adjuvant radiation, and tumour size, p=0.43.

Conclusions MIS radical hysterectomy might be safe in patients with no gross visible tumour at presentation.