Prognostic Factors and Impact of Minimally Invasive Surgery in Early-stage Neuroendocrine Carcinoma of the Cervix

Abstract Study Objective To investigate the prognostic factors and impact of minimally invasive surgery (MIS) in surgically treated early-stage high-grade (HG) neuroendocrine cervical carcinoma (NECC). Design A retrospective cohort study Setting Asan Medical Center, Seoul, Korea Patients Patients with International Federation of Obstetrics and Gynecology (FIGO) (2009) stage IB1-IIA HG NECC Interventions All patients underwent radical hysterectomy (RH) with a laparotomy or an MIS approach. Measurements and Main Results Between 1993 and 2017, 47 patients with FIGO stage IB1-IIA1 HG NECC were initially treated with RH. Clinicopathological variables of patients were retrospectively reviewed from electronic medical records. The median follow-up period was 28.2 months (interquartile range, 17.1-42). Stage IB1 disease was the most common (70.2%). Twenty-nine patients (61.7%) underwent RH via MIS. The overall survival (OS) and disease-free survival (DFS) rates were 63.8% and 38.3%, respectively. Lymph-node (LN) metastasis and resection margin (RM) involvement were significant risk factors for DFS (hazard ratio [HR], 2.227; 95% confidence interval [CI], 1.018-4.871; P=0.045, and HR, 6.494; 95% CI, 1.415-29.809; P=0.016, respectively) and OS (HR, 3.236; 95% CI, 1.188-8.815; P=0.022, and HR, 12.710; 95% CI, 1.128-143.152; P=0.040, respectively). The Kaplan–Meier survival curves revealed no significant differences in OS and DFS between the laparotomy and MIS groups (50% vs. 72.4% log-rank P=0.196, 38.9% vs. 37.9% P=0.975). Conclusion LN metastasis and RM involvement were poor prognostic factors of survival outcomes in initially surgically treated early-stage HG NECC. No difference was observed in the survival outcomes between the MIS and laparotomy approaches.