Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study

• Published in: Annals of oncology Vol. 23; no. 4; pp. 903 - 911
• Main Authors: Nam, J.-H., Park, J.-Y., Kim, D.-Y., Kim, J.-H., Kim, Y.-M., Kim, Y.-T.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-04-2012; Oxford University Press
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Antineoplastic agents; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Disease-Free Survival; early-stage cervical cancer; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy - methods; Kaplan-Meier Estimate; laparoscopic radical hysterectomy; Laparoscopy; Medical sciences; Middle Aged; Neoplasm Staging; open radical hysterectomy; Pharmacology. Drug treatments; Proportional Hazards Models; Retrospective Studies; surgical outcomes; survival outcomes; Tumors; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; open radical hysterectomy; laparoscopic radical hysterectomy; surgical outcomes; survival outcomes; early-stage cervical cancer; Prognosis; Early stage; Uterine cervix; Radical; Surgery; Cohort study; Endoscopy; Public health; Human; Laparoscopy; Malignant tumor; Hysterectomy; Long term; Survival; Female genital diseases; Treatment; Uterine cervix diseases; Cervical cancer; Comparative study; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdr360

To compare the long-term survival outcomes between laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH).
We matched patients with stage IA2 to IIA cervical cancer with known risk factors for recurrence who underwent ORH and LRH.
Compared with ORH (n = 263), LRH (n = 263) did not have higher risks of recurrence [hazard ratio (HR) = 1.28; 95% confidence interval (CI) 0.62–2.64] or death (HR = 1.46; 95% CI 0.62–3.43). Even in patients with tumors >2 cm in diameter, the risks of recurrence (HR = 0.82; 95% CI 0.31–2.16) or death (HR = 1.01; 95% CI 0.35–2.95) were not higher for LRH than for ORH. The LRH and ORH group had 5-year recurrence-free survival rates of 92.8% and 94.4%, respectively (P = 0.499). LRH resulted in significantly lower estimated blood loss (379.6 versus 541.1 ml, P < 0.001) and shorter postoperative hospital stay (12.5 versus 20.3 days, P < 0.001). Intraoperative complication rates were similar in the two groups (6.8% versus 5.7%, P = 0.711), but postoperative complication rate was lower in the LRH than in the ORH group (9.2% versus 21%, P < 0.001).
LRH is an oncologically safe alternative to ORH and was associated with fewer postoperative complication and earlier recovery.