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Abstract
Objectives To compare the long-term oncologic outcomes after minimally invasive surgery (robot assisted/laparoscopic radical hysterectomy) (MIS) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer (CC).
Methods This is a large single center retrospective study. From our institution´s patient registry, we identified a total of 587 early-stage cervical cancer patients who underwent either MIS or ARH between 2000 and 2017. We excluded the following patients from the final analysis: (1) received neo-adjuvant treatment prior to surgery; (2) had histologic types other than squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma; (3) were double primary cancer cases; (4) had stages higher than stageIB1 (FIGO 2009). We included only patients who underwent radical hysterectomy for early-stage cervical cancer and radical parametriectomy for stumph cancer patients in our study population.
Results In total, 230 and 357 patients were assigned to the MIS and ARH groups, retrospectively. There were no significant differences for any demographics including age, stage, histology. Five-year recurrence free survival was 88.6% (95% CI, 83.4%- 92.3%) and 93.5% (95% CI, 90,4%- 95.7%), (p=0.04) respectively in the MIS and ARH group, and the five-year cancer specific survival was 95.4% (95% CI, 90.9%- 97.7%) and 97.4% (95% CI, 95.1%- 98.7%), (p=0.12) in the MIS and ARH group, respectively. MIS group have more peritoneal-combined relapses comparing ARH (p=0.02). The relapse rate tended to be highest for squamous cell carcinoma in MIS group (p=0.09). Disease free survival and cancer specific survival were worse in the MIS group p- value= 0.04 and 0.12 respectively.
Conclusions MIS was associated with a higher recurrence rate and mostly of peritoneal-combined type than ARH. MIS tended to have a higher mortality rate than ARH although not statistically significant in patients with early-stage cervical cancer cases.