Laparoscopic Lymph Node Assessment Prior to Open Radical Hysterectomy-A Two-Center Retrospective Study on Individualized Surgical Management of Early-Stage Cervical Cancer.

Background/Objectives: Recent evidence suggests open radical hysterectomy is safer than radical hysterectomy by minimally invasive surgery (MIS) in early-stage cervical cancer. This study evaluated the oncological safety of laparoscopic lymph node assessment followed by open radical hysterectomy and the rate of unnecessary laparotomies avoided compared with a completely open approach. Methods: This two-center retrospective study included patients with cervical cancer FIGO stage ≤ Ib3 treated at two Austrian centers between 2015 and 2023. Patients undergoing laparoscopic lymph node assessment followed by open radical hysterectomy were compared with a matched historical cohort treated with primary open surgery between 2012 and 2017. Recurrence rates and progression-free survival (PFS) were compared using univariate and multivariate analyses. Results: In total, 130 patients were included: 79 (60.8%) underwent the combined approach and 51 (39.2%) the completely open approach. Recurrence rates (10.1% vs. 5.9%, p = 0.53) and median PFS (p = 0.36; median 26.0 vs. 71.3 months) did not differ between the two approaches. All patients underwent thorough preoperative radiologic and clinical assessment without suspected nodal metastases and were scheduled for radical hysterectomy with prior nodal assessment by MIS or open surgery. Intraoperative lymph node metastases were incidentally detected in 21/130 (16.2%) patients (combined approach n = 12 [15.2%] vs. open approach n = 9 [17.6%]). In cases of positive lymph nodes, surgery was abandoned without performing open radical hysterectomy and patients were referred to chemoradiotherapy. The needed to treat number to prevent one unnecessary open surgery was 6.25. Conclusions: Laparoscopic lymph node assessment before open radical hysterectomy appears oncologically safe, with comparable recurrence rates and PFS, and could spare one unnecessary laparotomy in every 7th patient with early-stage cervical cancer undergoing the combined approach.