The following is a summary of “Survival outcomes of laparoscopic versus open radical hysterectomy in early cervical cancer with incidentally identified high-risk factors,” published in the July 2023 issue of Gynecologic Oncology by Kim et al.

Previously, researchers hypothesized that patients with cervical cancer (CC) and lesions measuring less than 2 centimeters on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). This study aims to determine whether LRH worsens the prognosis of patients with incidentally identified high-risk factors, namely lymph node metastasis (LNM) or parametrial invasion (PMI). They identified patients with 2009 FIGO stage IB1 CC at three tertiary institutions who underwent Type C LRH or open radical hysterectomy (ORH) between 2000 and 2019. 

Those with a tumor ≤2 cm on preoperative MRI who did not have a preoperative suspicion of LNM or PMI were included, while those who were indicated to receive adjuvant treatment but did not receive it were excluded. In the overall population, survival outcomes were compared between the LRH and ORH categories, then narrowed to those with LNM and finally to those with PMI. There were 498 patients, 299 in the LRH group and 199 in the ORH group. The 3-year progression-free survival (PFS) and 5-year overall survival (OS) rates were comparable between the LRH and ORH groups (94.0% vs. 93.6%; P = 0.615) and the LRH and ORH groups (97.2% vs. 96.8%; P = 0.439). 

On pathologic examination, 49 (9.8%) and 16 (3.2%) patients, respectively, had LNM and PMI, while 10 (2.0%) patients had both. The 5-year PFS rate did not differ substantially between the LRH and ORH groups in the LNM subgroup (73.2% vs. 91.7%; P = 0.169). In the PMI subgroup, there was no significant difference in PFS between the two groups (P = 0.893). LRH may not worsen recurrence and mortality rates in CC patients with tumors ≤2 cm when adjuvant therapy is administered appropriately, even if pathologic LNM and PMI are identified incidentally.

Source: sciencedirect.com/science/article/abs/pii/S0090825823002512