Objectives Although minimally invasive(MIS) radical hysterectomy has been associated with worse survival compared to abdominal hysterectomy(AH), only 8% of patients in the LACC trial had microinvasive disease(Stage IA1/IA2). We sought to determine differences in outcome among patients undergoing MIS, AH or combined vaginal-laparoscopic hysterectomy(CVLH) for microinvasive cervical cancer.

Methods A retrospective cohort study of all patients undergoing hysterectomy for FIGO 2018, microinvasive cervical cancer across 10 Canadian centers between 2007 and 2019 was performed. Recurrence free survival(RFS) was estimated using Kaplan Meier Survival analysis. Chi-square and log-rank tests were used to compare outcomes.

Results 430 patients with microinvasive cervical cancer were included; 61.9% Stage IA1 and 38.1% IA2. The median age was 44 years(range 24–81). The most frequent histology was squamous(59.5%). Surgical approach was: 49.5% MIS(robotic or laparoscopic), 34.4% AH and 14.7% CVLH. 70.9% underwent radical hysterectomy and 76.5% had pelvic lymph node assessment. There were 5 recurrences (MIS:1, AH:4, CVLH:0). No significant difference in 5-year RFS (96.2% MIS, 93.7% AH, 89.4% CVLH, p=0.36) was found. When limiting to patients with IA1 LVSI+/IA2 (n=194), survival results were similar. Further, there was no significant difference in peri-operative complications(p>0.15). Patients undergoing MIS had a shorter median length of stay(1 day vs 3(AH) vs. 1.5(CVLH), p<0.01), but had more readmissions (13.8% vs 6.5%(AH), 5.2%(CVLH),p=0.036) and ER visits(15.9%, 3.6%(AH), 3.5%(CVLH),p<0.01).

Conclusions In patients with microinvasive cervical cancer, there was no difference in survival by surgical approach, possibly due to low event rate. These patients may benefit from MIS without compromising oncologic outcomes.