Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2–IIA cervical cancer?

• Published in: Gynecologic oncology Vol. 127; no. 1; pp. 102 - 106
• Main Authors: Hong, Jin Hwa, Choi, Joong Sub, Lee, Jung Hun, Eom, Jeong Min, Ko, Jung Hwa, Bae, Jong Woon, Park, Seon Hye
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2012
• Subjects: Adult; Aged; Cervical cancer; Female; Hematology, Oncology and Palliative Medicine; Humans; Hysterectomy - methods; Hysterectomy - standards; Laparoscopy; Laparoscopy - methods; Laparoscopy - standards; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Radical hysterectomy; Retrospective Studies; Survival; Survival Analysis; Treatment Outcome; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Laparoscopy; Radical hysterectomy; Survival; Cervical cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.06.003

Abstract Objectives To determine if laparoscopic radical hysterectomy (LRH) can be substituted for radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IA2–IIA cervical cancer. Methods We retrospectively reviewed the medical records of cervical cancer patients who underwent LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) from March 2003 to December 2011. Results Of 118 enrolled patients, six were in FIGO stage IA2, 66 were in IB1, 41 were in IB2, one was in IIA1, and four were in IIA2. The median operating time, perioperative hemoglobin change, the number of harvested pelvic and para-aortic lymph nodes were 270 min (range, 120–495), 1.7 g/dL (range, 0.1–5), 26 (range, 9–55), and 7 (range, 1–39), respectively. There was no unplanned conversion to laparotomy. Intra- and postoperative complications occurred in 16 (13.5%) and 8 (6.7%) patients, respectively. In a median follow-up of 31 months (range, 1–89), 5-year recurrence-free and overall survival rates were 90% and 89%, respectively. Univariate analysis showed that cervical stromal invasion (P = 0.023) and lymph node metastasis (P = 0.018) affected survival rate. Cox-proportional hazards regression analysis showed that lymph node metastasis was the only independent factor for poor prognosis (hazard ratio = 7.0, P = 0.022). Conclusions LRH with LPL and/or LPAL in women with stage IA2–IIA cervical cancer is safe and feasible in terms of survival and morbidity. Our data suggest the need for larger prospective trials which could support this approach as a new standard of care for stage IA2–IIA cervical cancer.