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.