Objective To compare long-term survival outcomes between laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in early-stage cervical adenocarcinoma under the new FIGO 2018 staging guideline. Design Retrospective study Setting and population Early-stage cervical adenocarcinoma received LRH and ORH; 47 Chinese hospitals. Methods We matched patients with early-stage cervical adenocarcinoma in the new FIGO 2018 staging guideline with known risk factors for recurrence who underwent ORH and LRH. Main Outcome Measures 5-year overall survival and 5-year disease-free survival rates Results In total, 549 patients were enrolled in our study, including 235 patients in LRH group and 314 in ORH group. After matching some factors that may affect the prognosis, each group had 223 patients. There was no difference in DFS between LRH and ORH in risk-adjusted analysis (HR1.258, 95% CI: 0.507-3.125, P=0.621). There was no difference in OS between LRH and ORH in risk-adjusted analysis (HR1.961, 95% CI: 0.536-7.183, P=0.309). LRH resulted in significantly lower estimated blood loss (361.2 versus 165.3 ml, P < 0.001) and shorter postoperative anal exhaust time (2.8 versus 2.5 days, P = 0.003) . Intraoperative complication ( 2.7% versus 5.8%，P=0.101) and postoperative complication ( 5.8% versus 6.3%, P=0.843) rates were similar in the two groups. Conclusions LRH has comparable survival outcomes with ORH and was associated with earlier recovery in early-stage adenocarcinoma of the uterine cervix. LRH may be an appropriate option for early-stage cervical adenocarcinoma compared with ORH.