Robotic Versus Open Radical Hysterectomy in Early-Stage Cervical Cancer: A Comparative Cohort Study

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• The LACC trial raised questions about minimally invasive surgery for early-stage cervical cancer.
• Robotic-assisted surgery offers a potential approach to combine minimally invasive benefits with oncologic safety.
• This study investigates robotic vs. open radical surgery for FIGO 2018 stage IA2-IIA1 cervical cancer.

Purpose of the Study:

• To compare perioperative, pathological, and early oncologic outcomes of robotic and open radical surgery.
• To evaluate the safety and efficacy of robotic-assisted radical hysterectomy in early-stage cervical cancer.

Main Methods:

• Retrospective comparison of 20 patients undergoing robotic surgery (da Vinci Xi) and 22 patients undergoing open abdominal radical hysterectomy.
• Evaluation of perioperative data, histopathological parameters (LVSI, lymph node, margin status), and early oncologic outcomes.
• Exploratory multivariable regression analyses adjusted for age and tumor size.

Main Results:

• Robotic surgery demonstrated significantly lower blood loss and shorter hospital stays compared to open surgery.
• Higher lymph node yield was observed in the robotic cohort; no significant differences in lymph node metastasis, LVSI, or R0 resection rates.
• Tumor size, not surgical approach, was an independent predictor of lymph node metastasis and LVSI.

Conclusions:

• Robotic radical surgery in selected early-stage cervical cancer patients is associated with favorable perioperative outcomes and comparable pathological results to open surgery.
• Tumor size is a key predictor of adverse pathological features, irrespective of surgical approach.
• Findings require confirmation in larger prospective studies due to limitations including sample size and follow-up duration.