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Long-Term Oncological Outcomes of Laparoscopic Versus Open Radical Surgery in Early-Stage Cervical Cancer: A Propensity Score–Matched Analysis
by
, , , , and
Rattiya Phianpiset
,
Chayanid Detwongya
,
Sunisa Phookiaw
,
Manatsawee Manopunya
,
Chailert Phongnarisorn
and
Kittipat Charoenkwan
*
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(24), 3960; https://doi.org/10.3390/cancers17243960
Submission received: 17 November 2025
/
Revised: 8 December 2025
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Accepted: 10 December 2025
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Published: 11 December 2025
(This article belongs to the Special Issue Cervical Cancer: Screening and Treatment in 2024-2025)
Simple Summary
Radical hysterectomy is a standard treatment for early-stage cervical cancer and can be performed through open or minimally invasive surgery. After reports suggesting that minimally invasive approaches may worsen survival, their safety has been questioned worldwide. This study compared long-term survival outcomes between laparoscopic and open radical hysterectomy in women with early-stage cervical cancer treated at a high-volume center. Using propensity-score matching and multivariable analyses, we found no significant differences in five-year overall or progression-free survival between the two surgical methods, even after adjusting for tumor size. These results suggest that, when performed by experienced surgeons using refined techniques and careful patient selection, laparoscopic radical hysterectomy can achieve oncologic outcomes equivalent to open surgery. Our findings may help guide future surgical decision-making and support ongoing efforts to optimize minimally invasive approaches for cervical cancer treatment.
Abstract
Objective: To assess the oncological outcomes of laparoscopic versus open radical hysterectomy (RH) in patients with early-stage cervical cancer using propensity score–matched analysis. Methods: We conducted a retrospective cohort study of 1244 patients who underwent RH with pelvic lymphadenectomy at Chiang Mai University Hospital between 2003 and 2019. Of these, 82 patients received a laparoscopic approach (LAP) and 1162 underwent open radical hysterectomy. Propensity-score matching was performed in a 1:4 ratio using a caliper of 0.2 standard deviations to achieve balance between groups. Overall survival (OS) and progression-free survival (PFS) were analyzed with Kaplan–Meier curves and the log-rank test. Subgroup analysis was conducted based on tumor size (≤ 2 cm vs. > 2 cm). In addition, multivariable Cox proportional hazards models incorporating all relevant clinical and pathological variables were applied to the overall cohort to assess independent predictors of OS and PFS. Results: After matching, 72 LAP RH cases were compared with 279 open RH cases, showing well-balanced baseline features. At 5 years, OS was nearly the same between the LAP and the open groups (95.8% vs. 95.5%; p = 0.95), and PFS was also similar (92.3% vs. 93.8%; p = 0.85). Subgroup analyses demonstrated that LAP RH did not result in a survival disadvantage for tumors ≤ 2 cm or > 2 cm. In multivariable Cox analysis, surgical approach was not an independent predictor of (HR 0.83, 95% CI 0.40–1.71, p = 0.61) or PFS (HR 1.12, 95% CI 0.44–2.84, p = 0.82). Conclusions: In our single-center cohort analyzed using propensity score matching, LAP RH showed long-term oncological outcomes comparable to those of open RH. These results support LAP RH as a safe surgical option for selected patients with early-stage cervical cancer within our setting, where procedures were performed by experienced surgeons following standardized techniques. Further evaluation in diverse clinical contexts is still needed.
