Long-Term Oncological Outcomes in Intermediate-Risk Cervical Cancer After Radical Surgery: A Single-Center Retrospective Cohort Study

Background/Objectives: The optimal postoperative management of intermediate-risk cervical cancer remains uncertain. We aimed to describe long-term outcomes and explore differences by postoperative treatment. Methods: This single-center retrospective cohort study included patients undergoing radical hysterectomy and pelvic lymph node assessment who fulfilled intermediate-risk criteria aligned with the CERVANTES trial. Disease-free survival (DFS) was the primary outcome and overall survival (OS) the secondary outcome. Observed 3- and 5-year survival proportions were compared among patients with documented follow-up at each time point. Results: Of 186 patients undergoing primary surgery, 41 fulfilled the intermediate-risk criteria: 30 were managed with surgery alone and 11 received adjuvant treatment. Median maximum tumor diameter was smaller in the surgery-alone group than in the adjuvant-treatment group (28.5 mm [IQR, 24.25–34.00] vs. 41.0 mm [IQR, 33.5–47.5]; p = 0.003), and FIGO stage IB3 was less frequent (6.7% vs. 63.6%; p < 0.001). No recurrences or deaths occurred in the surgery-alone group. One patient in the adjuvant-treatment group died from an unrelated cause; this was the only DFS event. At 3 years, observed OS and DFS were 100% (23/23) in the surgery-alone group and 90.0% (9/10) in the adjuvant-treatment group (p = 0.303). At 5 years, the corresponding proportions were 100% (16/16) and 85.7% (6/7; p = 0.304). Conclusions: Patients managed with surgery alone had favorable observed outcomes. However, baseline risk differed between groups, and time-point proportions included only patients with documented follow-up. The retrospective design, small sample, and non-randomized allocation preclude conclusions about the comparative effectiveness or safety of omitting adjuvant treatment. Prospective randomized studies are needed.