Effect of uterine manipulator on stage IB1 to IIA1 cervical cancer: A retrospective cohort study

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OBJECTIVE: This study aimed to evaluate the survival and surgical safety of using a uterine manipulator during laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer. METHODS: We retrospectively analyzed 673 patients with FIGO stage IB1 - IIA1 cervical cancer who underwent LRH between 2019 and 2022. Patients were divided into the uterine manipulator group (n = 395) and the uterine manipulator-free group (n = 278). Propensity score matching (PSM) was performed to minimize confounding effects. Statistical analysis was conducted on perioperative characteristics, pathological results, and follow-up data. RESULTS: In the unmatched cohort, no significant differences were observed between the uterine manipulator and uterine manipulator-free groups in 3-year disease-free survival (DFS) rates (94.43 % [95 % CI, 92.20 % - 96.72 %] vs. 93.88 % [95 % CI, 91.11% - 96.74 %]; P = 0.88) or overall survival (OS) rates (98.47 % [95 % CI, 97.27 % - 99.69 %] vs. 96.76 % [95 % CI, 94.70 % - 98.86 %]; P = 0.72). In the PSM-matched cohort, 3-year DFS (P = 0.53) and OS (P = 0.94) also showed no significant difference. Five-year survival rates were consistent with these findings. After PSM, multivariate Cox regression analysis identified FIGO stage (2018) IIA1 (HR, 5.82; 95 % CI, 1.11-30.69; P = 0.038) and ovarian invasion (HR, 26.82; 95 % CI, 1.22-589.87; P = 0.037) as the independent risk factors for 3-year DFS. No significant differences were found in major intraoperative complications. CONCLUSION: In patients with FIGO stage IB1 - IIA1 cervical cancer, uterine manipulator use during laparoscopic radical hysterectomy does not impact survival and safety.