Abstract A142: Equity in surgical outcomes: Evaluating robotic/minimally invasive vs. open surgery for early-stage cervical cancer across diverse populations in the national cancer database

Abstract Background: Minimally invasive surgery (MIS) offers perioperative advantages for early-stage cervical cancer. However, concerns about long-term survival persist, particularly following the 2018 Laparoscopic Approach to Cervical Cancer trial, which reported inferior survival outcomes with MIS. While this led to changes in clinical practice, real-world evidence reflecting outcomes across diverse patient populations remains limited. Objective: To evaluate the association between surgical approach (robotic/MIS vs. open surgery) and five-year survival in early-stage cervical cancer, with attention to demographic and systemic factors contributing to outcome disparities. Methods: We conducted a case-control study using the National Cancer Database, identifying patients diagnosed with early-stage cervical cancer between 2004 and 2017 who underwent surgery. Cases included patients who died within five years; controls survived beyond five years. Multivariable logistic regression was used to assess the relationship between surgical approach and mortality, adjusting for demographic, clinical, and facility-level characteristics. Results: Among 8,988 patients, 1,742 (19.4%) died within five years. Surgical approach was not independently associated with five-year mortality (adjusted OR: 1.15; 95% CI: 0.98–1.35). However, survival disparities were evident: higher mortality was associated with older age, Black race, public insurance, receipt of adjuvant therapy, treatment at comprehensive community cancer centers, longer travel distances for care (>50 miles), higher tumor grade, and comorbidities. Conclusion: Surgical approach did not significantly impact five-year mortality in early-stage cervical cancer. Instead, survival was more strongly influenced by demographic and structural factors, highlighting persistent inequities in cancer care. These findings underscore the urgent need for inclusive strategies that address social determinants of health and ensure equitable access to high-quality, culturally competent cancer care. Citation Format: Sejong Bae, Vishruti N. Pandya, Marguerite R. Irvin, Sharad Ghamande, Charles A. Leath III, Warner K. Huh. Equity in surgical outcomes: Evaluating robotic/minimally invasive vs. open surgery for early-stage cervical cancer across diverse populations in the national cancer database [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A142.