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.