GO20 : Impact of laparoscopic and robotic intracorporeal colpotomy on survival outcomes during radical hysterectomy for the cervical cancer

Objective: To compare survival outcomes of minimally invasive surgery for cervical cancer by using intracorporeal colpotomy or transvaginal colpotomy. Methods: A retrospective cohort study of 380 patients with cervical cancer, who underwent laparoscopic or robotic radical hysterectomy for cervical cancer between 1995 and 2019 were analyzed; 86 patients with transvaginal colpotomy, 294 patients with intracorporeal colpotomy. Propensity scores, logistic regression analysis and univariate, multivariate Cox regression analyses were performed to compare survival outcomes between groups in a cohort matched for age, body mass index, gravida, parity, stage, histologic type, diameter of cervical cancer mass, preoperative gynecologic history and preoperative neoadjuvant chemotherapy, lymphovascular invasion, deep stromal invasion and lymph node metastasis. Results: 73 patients were selected in each group after PS matching. Prematched cohort showed no significant difference in Disease free survival (DFS) and overall survival (OS) between two groups. (hazard ratio HR; 1.12, 95% confidence interval CI (0.576-2.182, p=0.737 vs HR; 0.81 CI (0.370-1.899) p=0.607). After adjusted with covariate variable showed similar results (HR; 1.241, 95% CI (0.610-2.528), p=0.551 vs HR; 1.035 95% CI (0.436-2.454) p=0.938). PS matched cohort showed DFS(HR 1.706; 95% CI (0.736-3.954), p=0.213) and OS (HR 1.125; 95% CI (0.388-3.264), p=0.828). Moreover adjusted with many covariate showed DFS (HR 1.489; 95% CI (0.621-3.573), p=0.372) and OS (HR 0.840; CI (0.271-2.601, p=0.762). Log-rank test for survival outcomes showed no significant difference in DFS (p= 0.207) and OS (p=0.828) in PS matched group. Multivariable analysis of OS showed age, stage, tumor size, neoadjuvant chemotherapy, positive resection margin, combined IR with HR were found independent risk factors. Multivariable analysis of DFS showed only tumor size, resection margin and neoadjuvant chemotherapy were found independent risk factors. However, intracorporeal colpotomy was not independent risk factor for DFS and OS. Conclusion: Even though intracorporeal colpotomy was not impact on the DFS and OS, we recommend not using intracorporeal colpotomy for minimal invasive radical hysterectomy for cervical cancer.