Minimally invasive surgery without a uterine manipulator versus open radical hysterectomy for early-stage cervical cancer: A retrospective propensity-score-matched single-center cohort study.

OBJECTIVE: To compare oncologic and perioperative outcomes between minimally invasive radical hysterectomy (MIS-RH) without a uterine manipulator and open radical hysterectomy (O-RH) for early-stage cervical cancer (CC). METHODS: This retrospective propensity-score-matched cohort study included 1798 patients treated from 2019 to 2023 (539 MIS-RH and 1259 O-RH). All MIS-RH procedures were performed without a uterine manipulator and incorporated uterine-exposure techniques and protective vaginal transection. After 1:1 matching, 539 patients remained in each group. The primary outcome was disease-free survival (DFS); secondary outcomes included overall survival (OS), perioperative outcomes, and postoperative complications. RESULTS: Median potential follow-up was shorter after MIS-RH (18.93 vs 31.30 months). Recurrence occurred in 18 and 30 patients, respectively, and 17 deaths were recorded (9 vs 8). DFS did not differ significantly between MIS-RH and O-RH (HR, 0.863; 95% CI, 0.480-1.553; P = .623), nor did OS (HR, 1.735; 95% CI, 0.666-4.518; P = .259). Results remained consistent after calendar-year adjustment and administrative censoring at 24 months. MIS-RH was associated with lower estimated blood loss (100 vs 300 mL), fewer intraoperative transfusions (0.56% vs 6.31%), shorter time to first flatus (48 vs 60 h), and shorter postoperative hospitalization (6 vs 7 days), but longer operative time (260 vs 235 min; all P < .001). CONCLUSION: No statistically significant DFS or OS differences were detected between manipulator-free MIS-RH and O-RH. MIS-RH was associated with several favorable perioperative outcomes, but shorter follow-up and the small number of deaths preclude conclusions of equivalence or noninferiority. Longer follow-up and prospective validation are required.