Class I versus Class III radical hysterectomy in stage IB1 (tumor ≤ 2 cm) cervical cancer: a matched cohort study

Background & Aims: The long-term oncological outcome of Class I hysterectomy to treat stage IB1 cervical cancer is unclear. The aim of the present study was to compare the surgical and long-term oncological outcomes of Class I hysterectomy and Class III radical hysterectomy for treatment of stage IB1 cervical cancer (tumor ≤ 2 cm). Methods: Seventy stage IB1 cervical cancer patients (tumor ≤ 2 cm) underwent Class I hysterectomy and 577 stage IB1 cervical cancer patients (tumor ≤ 2 cm) underwent Class III radical hysterectomy were matched with known risk factors for recurrence by greedy algorithm. Clinical, pathologic and follow-up data were retrospectively collected. Five-year survival outcomes were assessed using Kaplan-Meier model. Results: After matching, a total of 70 patient pairs (Class I - Class III) were included. The median follow-up times were 75 (range, 26-170) months in the Class III group and 75 (range, 27-168) months in the Class I group. The Class I and Class III group had similar 5-year recurrence-free survival rates (RFS) (98.6% vs. 97.1%, P = 0.56) and overall survival rates (OS) (100.0% vs. 98.5%, P = 0.32). Compared with the Class III group, the Class I group resulted in significantly shorter operating time, less intra-operative blood loss, less intraoperative complications, less postoperative complications, and shorter hospital stay. Conclusions: These findings suggest that Class I hysterectomy is an oncological safe alternative to Class III radical hysterectomy in treatment of stage IB1 cervical cancer (tumor ≤ 2 cm) and Class I hysterectomy is associated with fewer perioperative complication and earlier recovery.