Long-Term Oncological Outcomes of Laparoscopic Versus Open Radical Surgery in Early-Stage Cervical Cancer: A Propensity Score–Matched Analysis

<b>Objective</b>: To assess the oncological outcomes of laparoscopic versus open radical hysterectomy (RH) in patients with early-stage cervical cancer using propensity score-matched analysis. <b>Methods</b>: We conducted a retrospective cohort study of 1244 patients who underwent RH with pelvic lymphadenectomy at Chiang Mai University Hospital between 2003 and 2019. Of these, 82 patients received a laparoscopic approach (LAP) and 1162 underwent open radical hysterectomy. Propensity-score matching was performed in a 1:4 ratio using a caliper of 0.2 standard deviations to achieve balance between groups. Overall survival (OS) and progression-free survival (PFS) were analyzed with Kaplan-Meier curves and the log-rank test. Subgroup analysis was conducted based on tumor size (≤ 2 cm vs. > 2 cm). In addition, multivariable Cox proportional hazards models incorporating all relevant clinical and pathological variables were applied to the overall cohort to assess independent predictors of OS and PFS. <b>Results</b>: After matching, 72 LAP RH cases were compared with 279 open RH cases, showing well-balanced baseline features. At 5 years, OS was nearly the same between the LAP and the open groups (95.8% vs. 95.5%; <i>p</i> = 0.95), and PFS was also similar (92.3% vs. 93.8%; <i>p</i> = 0.85). Subgroup analyses demonstrated that LAP RH did not result in a survival disadvantage for tumors ≤ 2 cm or > 2 cm. In multivariable Cox analysis, surgical approach was not an independent predictor of (HR 0.83, 95% CI 0.40-1.71, <i>p</i> = 0.61) or PFS (HR 1.12, 95% CI 0.44-2.84, <i>p</i> = 0.82). <b>Conclusions</b>: In our single-center cohort analyzed using propensity score matching, LAP RH showed long-term oncological outcomes comparable to those of open RH. These results support LAP RH as a safe surgical option for selected patients with early-stage cervical cancer within our setting, where procedures were performed by experienced surgeons following standardized techniques. Further evaluation in diverse clinical contexts is still needed.