Minimally Invasive Versus Open Surgery for Radical Hysterectomy Followed By Adjuvant Radiotherapy in Intermediate- or High-Risk Early-Stage Cancer of The Cervix: A Retrospective Study

Abstract Background Postoperative radiotherapy (RT) or chemoradiotherapy (CRT) improves outcomes of cervical cancer patients with risk factors. Minimally invasive surgery (MIS) has an inferior survival than open radical hysterectomy (ORH), however, the impact of MIS on postoperative RT remains uncertain. The study compared the impacts of MIS versus ORH on delivering of adjuvant RT or CRT for intermediate- or high-risk early-stage cervical cancer. Methods Data on stage IB1-IIA2 patients who underwent radical hysterectomy and postoperative RT/CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received postoperative pelvic external beam radiotherapy (50Gy/25f) with platinum-based chemotherapy (0–6 cycles) according to guidelines. Disease-free survival (DFS) and overall survival (OS) were compared in the two surgical groups. Results One hundred and twenty-nine patients eligible for the study (68 in ORH; 61 in MIS groups) had similar clinicopathologic features except for the stage (highest in MIS was IB1; IIA1 in ORH) and presence of lymph vascular space invasion (higher in MIS group). The median time interval from surgery to chemotherapy and to RT was shorter in the MIS group. Three-year DFS and OS were similar in both groups. Further sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size > 4 cm and time interval from surgery to RT beyond seven weeks were adverse independent prognostic factors for DFS. Conclusions In early-stage (IB1-IIA2) cervical cancer patients with intermediate or high-risk factors who received postoperative RT or CRT, no matter they received ORH or MIS as their primary treatment, the DFS and OS had no significant difference, despite TI from surgery to postoperative adjuvant therapy being shorter in the MIS group than ORH.