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Published on: January 17, 2019
Impact of Prior Conization on Oncological Outcomes of Laparoscopic versus Open Radical Hysterectomy in Early-Stage
Guiyue Shi1, Yunyun Xiao1, Lu Han1
1Department of Gynecology (Shi, Xiao, and Han), Dalian Women and Children's Medical Group, Dalian Medical University, Dalian, Liaoning, China.
Study Objective:
To compare long-term oncological outcomes of laparoscopic (LRH) versus open radical hysterectomy (ORH) in patients with early-stage cervical cancer who underwent prior cervical conization.
Design:
A single-center retrospective observational study using propensity score-based inverse probability of treatment weighting (PS-IPTW) to balance covariates.
Setting:
Shengjing Hospital of China Medical University, a tertiary academic medical center.
Participants:
A total of 241 patients with FIGO 2009 stage IA2, IB1, and IIA1 cervical cancer from January 1, 2014, to December 31, 2018, were included. All patients underwent diagnostic conization followed by radical hysterectomy and were restaged according to the FIGO 2018 classification.
Interventions:
Patients underwent either laparoscopic radical hysterectomy (LRH, n = 42) or open radical hysterectomy (ORH, n = 199).
Measurements And Main Results:
Primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS). Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Median follow-up exceeded 6 years. Remarkably, the LRH group experienced zero deaths or recurrences. The 5-year OS (100% vs 99.5%, p = .646) and PFS (100% vs 98.0%, p = .385) were comparable between LRH and ORH. Post-IPTW adjustment confirmed no statistically significant differences in survival outcomes.
Conclusions:
Contrary to findings in the general population, LRH yields excellent oncological outcomes comparable to ORH in patients with prior conization. Prior cervical conization may reduce the risk of tumor dissemination, suggesting a potentially suitable subgroup for minimally invasive surgery.
