Comparison of open and minimally invasive radical hysterectomy for cervical cancer: a systematic review and meta-analysis of survival outcomes

AIM: To systematically evaluate the impact of open versus minimally invasive radical hysterectomy on survival outcomes in cervical cancer patients. METHODS: Relevant literature from the past 10 years was searched in PubMed, Web of Science, and Cochrane Library databases. Clinical studies comparing open radical hysterectomy (ORH) and minimally invasive surgery (MIS) were included. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale. A meta-analysis was performed to compare survival outcomes between ORH and MIS, with subgroup analysis stratified by tumor size (≤ 2 cm vs. > 2 cm). RESULTS: Fifteen clinical studies met the inclusion criteria. All observational studies scored ≥ 7 on the Newcastle-Ottawa Scale. Patients undergoing ORH showed significantly improved 5-year disease-free survival compared with MIS (OR = 1.70 [1.27, 2.27], P < 0.001, I² = 58%). However, no significant difference was observed in overall survival between the two surgical approaches (OR = 1.08 [0.90, 1.15], P > 0.05). Subgroup analysis showed no significant differences in overall survival between ORH and MIS, regardless of tumor size (≤ 2 cm: HR = 1.10 [0.28, 4.31], P = 0.89; >2 cm: HR = 0.82 [0.38, 1.77], P = 0.61). CONCLUSIONS: These findings suggest that open radical hysterectomy is associated with better disease-free survival, whereas overall survival does not differ significantly between the two approaches.