Introduction Accumulating evidence suggested the detrimental effects of adopting minimally invasive surgery in the management of early-stage cervical cancer. However, long-term evidence on the role of minimally invasive radical hysterectomy in ‘low-risk’ patients exists.

Methods This multi-institutional retrospective study compared minimally invasive and open radical hysterectomies in low-risk early-stage cervical cancer patients. A propensity-score matching algorithm (1:2) was used to allocate patients into the study groups. Kaplan-Meir model was used to estimate 10-year progression-free and overall survival.

Results Charts of 224 ‘low-risk’ patients were retrieved. Overall, 50 patients undergoing radical hysterectomy were matched with 100 patients undergoing open radical hysterectomy. Minimally invasive radical hysterectomy was associated with a longer median operative time (224 (range, 100–310) vs. 184 (range, 150–240) minutes; p<0.001), lower estimated blood loss (10 (10–100) vs. 200 (100–1000) ml, p<0.001), and shorter length of hospital stay (3.8 (3–6) vs. 5.1 (4–12); p<0.001). The surgical approach did not influence the risk of having intra-operative (4% vs. 1%; p=0.257) and 90-day severe (grade 3+) postoperative complication rates (4% vs. 8%; p=0.497). Ten-year disease-free survival was similar between groups (94% vs. 95%; p=0.812; HR:1.195; 95%CI:0.275, 5.18). Ten-year overall survival was similar between groups (98% vs. 96%; p=0.995; HR:0.994; 95%CI:0.182, 5.424).

Conclusion/Implications Our study appears to support emerging evidence suggesting that, for low-risk patients, laparoscopic radical hysterectomy does not result in worse 10-year outcomes compared to the open approach. However, further research is needed and open abdominal radical hysterectomy remains the standard treatment for cervical cancer patients.