Introduction
Cervical cancer (CC) is one of the most important malignant tumors that
threaten women’s lives and health worldwide. There were approximately
570,000 new cases of CC worldwide in 2018 and 311,000 patients dying of
the disease.1, 2 About 90% of CC deaths occur in low-
and middle-income countries, and the mortality rate is estimated 18
times that of developed countries.3 The incidence of
CC is 9.9/100,000 in developed countries, ranking 11th in the incidence
of cancer, and the mortality is 3.3/100,000, ranking 9th in
cancer-related mortality, while the incidence of CC is 15.7/100,000 in
developing countries, ranking second in cancer incidence, with a
mortality of 8.3/100,000, ranking third in cancer-related
mortality.4 Early-stage cervical cancer is usually
asymptomatic and can be detected by screening on physical examination.
Most outpatient patients have combined contact bleeding or abnormal
vaginal bleeding and/or drainage.5 Surgery and
radiation therapy are preferred treatment for cervical cancer, and both
treatments are thought to have similar survival
outcomes.6 However, patients with early-stage cervical
cancer (2009 FIGO stage IA2-IB2) are usually treated with radical
hysterectomy.7
Laparoscopic surgery is the standard treatment for radical hysterectomy
from 2014.8 Subsequently, the NCCN recommended
laparoscopic radical hysterectomy and robotic radical hysterectomy as
the standard procedure for radical hysterectomy.9Nevertheless, in phase III the laparoscopic approach to cervical cancer
(LACC) trial, minimally invasive surgery (MIS) was associated with lower
rates of disease-free survival (DFS) and overall survival (OS) than open
surgery among women with early-stage cervical
cancer.10, 11 These recent findings are contradictory
to the earlier referenced guidelines, which leads to widely
controversial. Therefore, in this study we summarized the case data of
cervical cancer patients in a single center for 5 years (January 2013 to
December 2017), and evaluated survivals of four different surgical
approaches including abdominal (ARH), laparoscopic (LRH),
robotic-assisted (RRH) and vaginal (VRH) radical hysterectomy for
early-stage cervical cancer in order to define benefits of the different
radical hysterectomy approaches.