Nationwide trends in surgery selection and minimally invasive surgery for cervical cancer with preoperative T1B1/T1B2 disease in Japan

The Laparoscopic Approach to Cervical Cancer trial and FIGO 2018 staging revision have significantly influenced the management of cervical cancer; however, their impact on treatment selection in Japan remains unclear.

We analyzed 16,054 patients with squamous cell carcinoma, usual-type adenocarcinoma, or adenosquamous carcinoma registered in the nationwide Japan Society of Obstetrics and Gynecology registry (2015–2022) with FIGO 2018 stage IB1, IB2, or IIIC1 corresponding to T1B1 or T1B2. Temporal changes in surgery selection and minimally invasive surgery (MIS) utilization by pelvic lymph node metastasis (LNM) and local T stage were evaluated.

Pelvic LNM was associated with reduced surgery selection during 2015–2018 (OR 0.38, 95% CI 0.30–0.48), with no significant change after 2018 (interaction OR 0.76, 95% CI 0.56–1.02). Among surgical patients, MIS utilization did not differ by pelvic LNM status before 2018; however, MIS avoidance in LNM-positive cases became evident after 2018 (interaction OR 0.41, 95% CI 0.26–0.64). T1B2 exhibited lower MIS utilization than T1B1 (OR 0.62, 95% CI 0.54–0.71), with a greater decline post-2018 (interaction OR 0.44, 95% CI 0.36–0.54). In an exploratory survival analysis, MIS utilization was not significantly associated with overall survival after adjustment (HR 0.96, 95% CI 0.89–1.04), although this finding should be interpreted cautiously.

In Japan, the trend of avoiding surgery for pelvic LNM-positive disease existed before the FIGO 2018. However, MIS avoidance became evident after 2018, particularly in pelvic LNM-positive disease and T1B2 tumors.