A randomized non-inferiority trial showed worse survival in women with early-stage cervical cancer treated with radical hysterectomy by minimally invasive approach compared to laparotomy; the impact of surgical approach on survival following radical trachelectomy is unknown. To examine oncologic outcomes in women with early-stage cervical cancer who underwent robotic or vaginal radical trachelectomy at Canadian cancer centers with the highest volumes of radical trachelectomy procedures. Retrospective multi-centre cohort analysis which includes patients who had surgery between 2006 and 2019. Women with International FIGO 2009 stage IA-IB cervical cancer who underwent radical trachelectomy and lymph node assessment were grouped by surgical approach (vaginal versus robotic surgery). A total of 197 patients were included from 4 regional referral centres. 56 women underwent robotic radical trachelectomy and 141 underwent vaginal radical trachelectomy. All patients had lymph node assessment by a minimally invasive technique. Median age was 32 years, median tumor size was 12 mm, and median depth of invasion was 5 mm. Recurrence-free survival was 97% in both groups at a median follow-up of 57 months. On multivariable analysis, after adjusting for previously chosen confounders (high risk pathologic criteria, tumor size, and LVSI) there was no statistically significant difference in PFS between the 2 groups (HR 2.1, 95%CI 0.3–7.1, = 0.5). Tumor size larger than 2 cm (HR 9.4, 95%CI 2.8–26, = 0.003) was the only variable predictive of recurrence. Survival outcomes were excellent in both cohorts of patients undergoing robotic vs. vaginal radical trachelectomy. The surgical approach was not significantly associated with risk of recurrence after adjusting for clinically important confounders.

中文翻译：

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机器人与阴道根治性宫颈切除术治疗育龄早期宫颈癌患者：一项多中心队列研究

一项随机非劣效性试验显示，与剖腹手术相比，接受微创根治性子宫切除术治疗的早期宫颈癌女性的生存率较差；手术方法对根治性宫颈切除术后生存的影响尚不清楚。旨在检查在根治性宫颈切除术数量最多的加拿大癌症中心接受机器人或阴道根治性子宫颈切除术的早期宫颈癌女性的肿瘤学结果。回顾性多中心队列分析，包括 2006 年至 2019 年期间接受手术的患者。根据手术方式（阴道手术与机器人手术）对接受根治性子宫颈切除术和淋巴结评估的国际FIGO 2009 IA-IB期宫颈癌女性进行分组。共有来自 4 个区域转诊中心的 197 名患者被纳入。56 名女性接受了机器人根治性子宫颈切除术，141 名女性接受了阴道根治性子宫颈切除术。所有患者均通过微创技术进行淋巴结评估。中位年龄为 32 岁，中位肿瘤大小为 12 毫米，中位浸润深度为 5 毫米。中位随访时间为 57 个月，两组无复发生存率为 97%。在多变量分析中，调整先前选择的混杂因素（高风险病理标准、肿瘤大小和 LVSI）后，两组之间的 PFS 没有统计学上的显着差异（HR 2.1，95% CI 0.3–7.1，= 0.5）。肿瘤大小大于 2 cm（HR 9.4，95% CI 2.8-26，= 0.003）是唯一预测复发的变量。接受机器人根治性子宫颈切除术和阴道根治性子宫颈切除术的两组患者的生存结果均优异。在调整临床重要的混杂因素后，手术方法与复发风险没有显着相关。