Comparison of Prognosis between Minimally Invasive and Abdominal Radical Hysterectomy for Patients with Early-Stage Cervical Cancer

Abstract

Minimally invasive surgery (MIS) is performed to treat cervical cancer patients; however, a recent study showed that MIS was associated with higher recurrence and death rate compared with abdominal radical hysterectomy (ARH). In the current study, the prognosis of patients with early-stage cervical cancer who underwent MIS with vaginal closure or ARH was evaluated. One hundred and eighty-two patients underwent radical hysterectomy for cervical cancer with stage of IA2, IB1, and IIA1. MIS was performed by laparoscopy or a robot using the vaginal closure method. Disease-free survival (DFS) and overall survival (OS) were evaluated between the groups. Among the patients, 67 underwent MIS and 115 underwent ARH. The recurrence rate was 4.5% in MIS patients and 3.5% in ARH patients with a median follow-up (interquartile range) of 36 (18-60) and 78 (48-102) months, respectively. DFS and OS were not different between the groups (3y-DFS, 95.3% vs. 96.1%, p = 0.6; 3y-OS, 100% vs. 100%, p = 0.06). In early-stage cervical cancer patients, MIS with vaginal closure did not increase the risk for recurrence or death. Surgical techniques and procedures to avoid spillage of tumor cells could be important for a better prognosis.

Trial registration: ClinicalTrials.gov NCT00614211.

Keywords: minimally invasive surgery; radical hysterectomy; uterine cervical cancer.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1

The port replacement and skin incision. (a) Total laparoscopic radical hysterectomy was performed as a standard five-port technique without intrauterine manipulation in the lithotomy–Trendelenburg position. (b) Robotic radical hysterectomy was performed using the da Vinci Si system in the lithotomy–Trendelenburg position. Four robot ports, one 5-mm trocar, and one 12-mm trocar were placed. (c) Abdominal radical hysterectomy was performed with vertical skin incision.

Figure 2

Vaginal closure for minimally invasive radical hysterectomy for cervical cancer. (a) Several sutures were placed on the cut line of vagina transvaginally. (b) The vaginal mucosa was cut in a circle 3 mm outside the knots with pulling of the sutures. (c) The vaginal cuff of the uterine side was closed with running sutures; the cervical cancer was completely covered with vaginal mucosa. (d) After the circumferential colpotomy was performed under laparoscopy or using a robot, the uterus was removed transvaginally.

Figure 3

Chart of study participants.

Figure 4

Prognosis of cervical cancer patients who underwent minimally invasive surgery and abdominal radical hysterectomy. The DFS and OS were not different between the groups (3y-DFS, 95.3% vs. 96.1%, p = 0.6; 3y-OS, 100% vs. 100%, p = 0.06) with the median follow-up of 33 (16–50) months for the MIS group and 80 (51–108) months for the ARH group.

Figure 5

Prognosis of cervical cancer patients with tumors p = 0.3; 3y-OS, 100% vs. 100%, p = 0.06) with the median follow-up of 33 (16–50) months for the MIS group and 80 (51–108) months for the ARH group.

Figure 6

Prognosis of cervical cancer patients with tumors 2–4 cm in size. The DFS and OS were not different between the groups (3y-PFS, 95.2% vs. 94.8%, p = 0.9; 3y-OS, 100% vs. 100%) with the median follow-up of 51 (28–65) months for the MIS group and 75 (46–96) months for the ARH group.

Figure 7

Prognosis of cervical cancer patients after propensity score-matching analysis. The DFS and OS were not different between the groups (3y-DFS, 93.0% vs. 96.4%, p = 0.3; 3y-OS, 100% vs. 100%, p = 0.3).