Introduction Previously, we suggested that patients with cervical cancer with tumors ≤2 cm on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). Here, we aimed to investigate whether LRH deteriorates the prognosis of patients with incidentally identified high-risk factors on pathologic examination.

Methods We identified patients with 2009 FIGO stage IB1 cervical cancer who underwent Type C LRH or open radical hysterectomy (ORH) at three tertiary hospitals between 2007 and 2018. Those with a tumor ≤2 cm on preoperative MRI who adhered to the practice guidelines for adjuvant treatment were included. Survival outcomes were compared between the LRH and ORH groups. Subgroup analyses were conducted according to presence of lymph node metastasis (LNM) and/or parametrial invasion (PMI).

Results In total, 498 patients were included: 299 in the LRH group and 199 in the ORH group. The ORH and LRH groups showed similar 5-year progression-free survival (PFS) (92.9% vs. 91.6%; P=0.615) and 5-year overall survival (OS) rates (96.8% vs. 97.2%; P=0.439). On pathologic examination, 49 (9.8%) and 16 (3.2%) patients had LNM and PMI, respectively, and 10 (2.0%) had both. In the LNM subgroup, 5-year PFS rate was not significantly different between the ORH and LRH groups (91.7% vs. 73.2%; P=0.169). In the PMI subgroup, no difference in PFS was observed between the two groups (P=0.893).

Conclusion/Implications LRH might not deteriorate recurrence and mortality rates in CC patients with a tumor size ≤2 cm when adjuvant treatment is appropriately administered, even if pathologic LNM and PMI are incidentally identified.