Abstract
OBJECTIVE: This study aimed to compare oncologic outcomes between laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in patients with early-stage cervical cancer (FIGO 2018 IA2–IIA1) who underwent cervical conization, and to evaluate independent risk factors influencing their prognosis. METHODS: We retrospectively analyzed clinical data from 397 cervical cancer patients (FIGO 2009 IA2–IIA1) treated with LRH or ORH following conization at Dalian Women and Children’s Medical Center (Group) and Shengjing Hospital, China Medical University, between January 2013 and December 2021. Clinical indicators, including demographics, HPV status, tumor features, and postoperative pathology, were collected. After restaging according to FIGO 2018, 353 patients remained stage IA2–IIA1 (225 ORH, 128 LRH). A 1:1 propensity score matching (PSM) approach balanced clinical variables between groups. Primary endpoints were overall survival (OS) and progression-free survival (PFS). All patients included in the FIGO 2018 IA2–IIA1 cohort were pathologically confirmed to be node-negative, as lymph node metastasis automatically results in classification as stage IIIC1p and such patients were excluded from the primary analysis. Nodal status was assessed through systematic pelvic lymphadenectomy with or without aortic bifurcation lymph node dissection, depending on surgeon preference and guideline recommendations. All lymph nodes were examined by dedicated gynecologic pathologists to ensure accurate staging. Multivariate Cox regression analysis was conducted post-PSM to identify independent prognostic factors. Statistical significance was set at p < 0.05. RESULTS: Of the original 397 patients, 353 retained FIGO 2018 stage IA2–IIA1. After PSM, no significant differences were observed in OS (89.9% ORH vs. 90.3% LRH, p = 0.907) or PFS (87.3% ORH vs. 89.5% LRH, p = 0.907). In the ITT sensitivity analysis that included all FIGO 2018 IIIC1p patients, the survival trends remained consistent with the primary analysis, and no significant differences in OS or PFS were observed between the laparoscopic and open surgery groups, supporting the robustness of our findings. Multivariate analysis identified BMI, tumor size, cervical stromal invasion depth, lymphovascular space invasion (LVSI), and postoperative adjuvant therapy as independent prognostic factors affecting both OS and PFS (all p < 0.05). CONCLUSION: Laparoscopic radical hysterectomy demonstrated comparable oncologic outcomes to open surgery following cervical conization in patients with FIGO 2018 IA2–IIA1 cervical cancer. Prognosis was independently influenced by BMI, tumor size, stromal invasion depth, LVSI, and adjuvant therapy.