Introduction/Background We compared survival outcomes of minimally invasive surgery (MIS) and open surgery for radical hysterectomy (RH) in early-stage usual-type adenocarcinoma (UAC) and adenosquamous carcinoma (ASC) of the cervix.
Methodology From the two centers’ cervical cancer cohorts, cervical cancer patients with 2009 FIGO stage IB who underwent Type C RH between 2007 and 2021 were identified. Patients with UAC and ASC were included in the analysis after pathologic review according to the updated WHO Classification of Tumors. Patients’ clinicopathologic characteristics and survival outcomes were compared by surgical approach.
Results A total of 161 patients were included in this analysis: 136 and 25 had UAC and ASC, respectively. No differences in overall survival (OS; P=0.241) and disease-free survival (DFS; P=0.156) were observed between the two histologic subtypes. The MIS RH group (n=99) had significantly smaller tumor size (P<0.001) and less pathologic parametrial invasion (P=0.001) and lymph node metastasis (P<0.001) than the open RH group (n=62). The MIS RH and open RH groups showed similar OS (HR, 0.23; 95% CI, 0.03–2.17; P=0.201) and DFS (3-year DFS rate, 87.9% vs. 75.1%; P=0.184). In multivariate analysis, MIS did not influence DFS (adjusted HR, 1.30; 95% CI, 0.50–3.35; P=0.589), but pathologic parametrial invasion deteriorated DFS (adjusted HR, 3.41; 95% CI, 1.25–9.29; P=0.016). Consistent results were observed among the patients with UAC: MIS was not associated with DFS (adjusted HR, 1.79; 95% CI, 0.62–5.17; P=0.285).
Conclusion Our study suggests equivalent survival outcomes between MIS RH and open RH for early cervical cancer patients with UAC/ASC. While MIS RH was not a prognostic factor, pathologic parametrial invasion significantly deteriorated DFS in these histologic subtypes.
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