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
In brief
Manipulator-free minimally invasive hysterectomy yields cancer-free survival comparable to open surgery
In a propensity-matched cohort of 539 early-stage cervical cancer patients per group, recurrence and death rates were similar, showing no significant difference in disease-free or overall survival between manipulator-free minimally invasive and open radical hysterectomy. MIS offered less blood loss, fewer transfusions and a day shorter hospital stay, but shorter follow-up limits conclusions about long-term equivalence.
- Journal
- Gynecologic oncology (Q1)
- Published
- 8 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Lusi Deng, Ying Zheng, Fan Yang, Qiao Wang, Yu Chen, Jianhong Liu, et al.
- PMID
- 42710320
- DOI
- 10.1016/j.ygyno.2026.08.022
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 12 September 2026): Propensity-matched cohort MIS vs open hysterectomy
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.