A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer.

ABSTRACT

OBJECTIVE: To compare the feasibility, morbidity, and survival outcome of the laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH+LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy (ARH+APL) for FIGO stage Ib-IIa cervical carcinoma. METHODS: The consecutive cases with FIGO Ib-IIa cervical cancer from August 1998 to December 2005 were documented, including 90 patients underwent LRH+LPL, and 35 patients underwent ARH+APL as control group. The clinic data of perioperative periods and survival were compared between groups. RESULTS: In laparoscopy group the operating time increased significantly (262.99+/-67.6 min vs. 217.2+/-71.56 min, P=0.001), and the recovery time of bowel decreased significantly (1.96+/-0.62 days vs. 2.40+/-1.06 days, P=0.025). No significant difference was found between groups when the blood loss during operation (369.78+/-249.94 ml vs. 455.14+/-338.05 ml, P=0.125), numbers of the pelvic lymph nodes resected (21.28+/-8.39 vs. 18.77+/-9.47, P=0.151), recovery time of bladder function and postoperative hospital stays were compared. All laparoscopic procedures were completed successfully except 2 cases converted to laparotomy. The median follow-up was 26 months (range 5 to 84 months). Ten and five cases lost to follow-up in laparoscopy and laparotomy group, respectively. Excluding the lost cases, the recurrence rate (13.75% vs. 12%, P>0.05) and the mortality rate (10% vs. 8%, P>0.05) between groups was similar. CONCLUSION: Our data demonstrated that cervical cancer could be treated successfully with LRH+LPL with similar efficacy and recurrence rates to ARH+APL. LRH+LPL is a safe and effective alternative to conventional abdominal surgery for stage Ib-IIa cervical cancer, and should be used if the surgeon is sufficiently trained. Its clinical value should be confirmed by multicenter randomized clinic trials.