Surgical approach and five year survival in early stage cervical cancer: A national cancer database analysis

Background: The optimal surgical approach for early-stage cervical cancer remains debated, especially after the Laparoscopic Approach to Cervical Cancer (LACC) trial raised concerns about minimally invasive surgery (MIS). This study evaluates the association between surgical approach (robotic/MIS vs. open surgery) and five-year survival, accounting for demographic, facility, and clinical factors. Methods: We analyzed data from the National Cancer Database (NCDB) for patients diagnosed with AJCC stage I-IIA cervical cancer from 2004-2022 who underwent surgery. Patients were classified as cases (died within five years) or controls (alive at five years). Multivariable logistic regression assessed the association between surgical approach and five-year mortality, adjusting for age, race, insurance, facility type, geographic region, distance traveled, tumor grade, comorbidity, adjuvant therapy, length of stay, and 30-day readmission. Results: Among 18,849 patients, 2,263 (12.0%) died within five years. Robotic/MIS was associated with lower five-year mortality compared to open surgery (adjusted OR: 0.86; 95% CI: 0.76-0.99). Higher mortality was independently associated with receipt of adjuvant therapy (aOR: 1.79), older age (aOR per year: 1.05), Black race (aOR: 1.40), public insurance (aOR: 1.41), treatment at comprehensive community cancer centers (aOR: 1.38), travel >50 miles (aOR: 1.35), higher tumor grade (aOR: 2.66), and greater comorbidity burden (aOR: 2.30). Readmission rates did not differ significantly by surgical approach. Conclusions: Robotic/MIS was significantly associated with improved five-year survival compared to open surgery in early-stage cervical cancer. However, demographic, facility, and clinical factors, including race, insurance, facility type, and comorbidities, were also strong predictors of mortality, highlighting persistent disparities. These findings underscore the need to address healthcare inequities and optimize care delivery. Future research should further explore how patient and systemic factors modify survival outcomes.