Surgical Approach and Use of Uterine Manipulator Are Not Associated with LVSI in Surgery for Early-stage Cervical Cancer

Abstract Study Objective In 2018, the Laparoscopic Approach to Cervical Cancer (LACC) trial reported that patients undergoing minimally invasive surgery for cervical cancer had poorer outcomes than patients undergoing open surgery. Several hypotheses have been made to explain the results. We aimed to investigate whether laparoscopic procedures and use of uterine manipulator increase the risk of lymphovascular space invasion (LVSI) in early-stage cervical cancer. Design A retrospective study. Setting A Chinese women's and children's hospital. Patients Patients with early-stage cervical cancer who underwent radical hysterectomy in West China Second University Hospital between April 2019 and May 2020. Interventions Laparoscopic surgery (with uterine manipulator and uterine manipulator-free) and open surgery. Measurements and Main Results A total of 979 patients with cervical cancer were registered in West China Second University Hospital for surgical treatment. Of these, 525 patients underwent laparoscopic surgery, and 454 patients underwent open surgery. In total, 735 early-stage patients underwent radical hysterectomy and pelvic lymphadenectomy, including 357 via laparoscopic and 378 via open surgery. For patients underwent radical hysterectomy and pelvic lymphadenectomy, the incidence of LVSI was 48.41% and 47.34% in laparoscopic and open groups, respectively (p=.771). After 1:1 propensity score matching (PSM) with age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, and tumor size, the incidence of LVSI was 45.54% and 51.79% in laparoscopic and open groups, respectively (p=.186). Subdividing the laparoscopic group into uterine manipulator and uterine manipulator-free groups, the incidence of LVSI was 45.22% and 48.35%, respectively (p=.580). After PSM with age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, and tumor size, the incidence of LVSI was 45.78% and 55.42% in these two groups, respectively (p=.214). Multiple factor analysis revealed that lymph node metastasis and deep stromal invasion were associated with LVSI (P value Conclusion The surgical approach and use of uterine manipulator are not associated with LVSI in surgery for early-stage cervical cancer. Lymph node metastasis and deep stromal invasion are associated with LVSI.