Oncologic outcomes of minimally invasive surgery vs. abdominal hysterectomy in patients with low-risk, early-stage cervical cancer: A retrospective analysis of KGOG 1028 data based on SHAPE trial eligibility criteria

Objective: To compare the oncologic outcomes of minimally invasive surgery (MIS) and abdominal hysterectomy in patients with low-risk, early-stage cervical cancer, based on the SHAPE trial eligibility criteria. Methods: This retrospective study analyzed data from the Korean Gynecologic Oncology Group (KGOG) 1028 cohort, including patients with 2009 FIGO stage IB1 cervical cancer who met SHAPE trial criteria and underwent MIS or abdominal hysterectomy. Disease-free survival (DFS) was the primary outcome, whereas secondary outcomes included pelvic recurrence rates and prognostic factors influencing DFS. Results: A total of 508 patients were included (82 in the MIS group and 426 in the abdominal hysterectomy group). The MIS group had significantly shorter DFS (median, 55.4 vs. 66.5 months, P = 0.024) and a higher pelvic recurrence rate (6.10 % vs. 1.88 %, P = 0.024). Multivariable Cox regression analysis identified MIS as an independent predictor of recurrence (HR, 3.26; 95 % CI, 1.054–10.061; P = 0.040), along with a larger tumor size (HR, 3.65 per 1 cm increase; 95 % CI, 1.300–9.854; P = 0.011) and older age (HR, 1.05 per year; 95 % CI, 1.002–1.096; P = 0.043). Conclusions: Even in low-risk, early-stage cervical cancer patients meeting SHAPE trial criteria, MIS was associated with shorter DFS and a higher pelvic recurrence risk than abdominal hysterectomy. These findings are consistent with concerns raised by the LACC trial, suggesting a potential oncologic disadvantage of MIS. Further prospective, randomized studies with standardized patient selection are needed to validate these results and guide decision-making.