PURPOSE To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions. METHODS Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 1, 2010 and December 31, 2017. RESULTS Of 815 patients, open RH was performed in 255 cases (29.1%) and minimally invasive RH in 560 cases (70.9%). There were 19 (7.5%) recurrences in the open RH and 51 (9.1%) recurrences in the minimally invasive group (P = .43). Risk-adjusted analysis revealed that minimally invasive RH was independently associated with an increased hazard of recurrence (aHR, 1.88; 95% CI, 1.04 to 3.25). Other factors independently associated with an increased hazard of recurrence included tumor size, grade, and adjuvant radiation. Conization before surgery was associated with lower recurrence risk (aHR, 0.4; 95% CI, 0.23 to 0.71). There was no difference in OS in the unadjusted analysis (HR, 1.14; 95% CI, 0.61 to 2.11) or after risk adjustment (aHR, 1.01; 95% CI, 0.5 to 2.2). Of 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor on final pathology), 2/82 (2.4%) recurred in the open RH group and 16/182 (8.8%) in the minimally invasive RH group (P = .058). In propensity score matching analysis, 7/159 (4.4%) recurrences were noted in the open RH group and 18/156 (11.5%) in the minimally invasive RH group (P = .019). Survival analysis revealed an increased risk of recurrence in the minimally invasive group in propensity-matched cohort (HR, 2.83; 95% CI, 1.1 to 7.18). CONCLUSION In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior DFS but not overall survival in the entire cohort.

中文翻译：

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宫颈癌患者接受腹部与微创根治性子宫切除术的复发率：一项多机构回顾性研究

目的 比较在学术医疗机构进行的开放式和微创根治性子宫切除术 (RH) 的无病生存率 (DFS)。方法 对 2010 年 1 月 1 日至 2017 年 12 月 31 日期间接受 RH 期 IA1（伴有淋巴血管侵犯）、IA2 和 IB1 鳞状癌、腺癌或腺鳞癌的患者进行回顾性多机构审查。 结果 对 815 名患者进行了开放性 RH 255 例（29.1%），微创 RH 560 例（70.9%）。开放 RH 组有 19 例（7.5%）复发，微创组有 51 例（9.1%）复发（P = .43）。风险调整分析显示，微创 RH 与复发风险增加独立相关（aHR，1.88；95% CI，1.04 至 3.25）。与复发风险增加独立相关的其他因素包括肿瘤大小、分级和辅助放疗。术前锥切术与较低的复发风险相关（aHR，0.4；95% CI，0.23 至 0.71）。在未经调整的分析（HR，1.14；95% CI，0.61 至 2.11）或风险调整后（aHR，1.01；95% CI，0.5 至 2.2）中，OS 没有差异。在最终病理学肿瘤≤ 2 cm 的 264 名患者中（不包括最终病理学没有残留肿瘤的患者），开放 RH 组复发率为 2/82（2.4%），微创 RH 组复发率为 16/182（8.8%） (P = .058)。在倾向评分匹配分析中，开放 RH 组有 7/159 (4.4%) 次复发，微创 RH 组有 18/156 (11.5%) 复发（P = .019）。生存分析显示，在倾向匹配的队列中，微创组的复发风险增加（HR，2.83；95% CI，1.1 至 7.18）。结论 在该回顾性系列研究中，接受微创根治性子宫切除术的患者，包括最终病理学上肿瘤大小≤ 2 cm 的患者，在整个队列中的 DFS 较差，但总体生存率并非如此。