Effect of modified no-touch laparoscopic radical hysterectomy on outcomes of early stage cervical cancer: A retrospective cohort study

Objectives We aimed to compare the prognosis of modified no-touch laparoscopic radical hysterectomy (MLRH) and laparoscopic radical hysterectomy (LRH) on survival in patients with early stage cervical cancer. Materials and Methods The clinicopathological data of patients with stage IB1 and IIA1 cervical cancer, who underwent radical surgery between 2014 and 2019, were retrospectively reviewed. The 5-year disease-free survival (DFS) and overall survival (OS) were compared between the MLRH and LRH groups using the Kaplan-Meier method. Independent prognostic factors for 5-year DFS and OS were identified using multivariate, forward, stepwise Cox proportional hazards regression models. Results A total of 223 patients with stage IB1 and IIA1 cervical cancer were included. Kaplan-Meier analysis revealed that the 5-year DFS and OS rates in the MLRH (n = 81) group were significantly higher than those in the LRH group (n = 142) (DFS, 94.5% vs. 78.8%, p = 0.007; OS, 96.7% vs. 87.6%, p = 0.033). No significant differences were identified between the two groups in terms of operative time, blood loss, transfusion requirement, and intraoperative or postoperative complications. MLRH was an independent prognostic factor associated with increased 5-year DFS (adjusted hazard ratio [HR], 0.202; 95% confidence interval [CI], 0.069-0.594; p = 0.004) and 5-year OS (adjusted HR, 0.163; 95% CI, 0.035-0.748; p = 0.020). Conclusion The oncologic outcomes were superior with MLRH than with LRH in patients with stage IB1 and IIA1 cervical cancer. Contact of cervical tumor cells with the pelvic cavity likely explains the worse prognosis associated with LRH.