Comparative single-center study between modified laparoscopic radical hysterectomy and open radical hysterectomy for early-stage cervical cancer

• Published in: World journal of surgical oncology Vol. 20; no. 1; p. 392
• Main Authors: Li, Xuqing, Pei, Xueting, Li, Hongyan, Wang, Yan, Zhou, Youwei, Wei, Zhaolian, Yin, Zongzhi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12-12-2022; BioMed Central; BMC
• Subjects: Bladder; Blood clots; Body mass index; Cancer; Cancer therapies; Carbon dioxide; Care and treatment; Cervical cancer; Chemotherapy; Complications; Diagnosis; Early-stage cervical cancer; Female; Gynecology; Health services; Humans; Hysterectomy; Laparoscopy; Ligaments; Lymph Node Excision - methods; Lymph nodes; Lymphatic system; Medical prognosis; Metastases; Metastasis; Modified laparoscopic radical hysterectomy; Neoplasm Staging; Normal distribution; Obstetrics; Open radical hysterectomy; Patient outcomes; Patients; Postoperative; Prevention; Prospective Studies; Radiation therapy; Recovery time; Retrospective Studies; Risk factors; Surgery; Surgical outcomes; Survival; Survival rate; Tumors; Uterine Cervical Neoplasms - pathology; Uterus; Vagina; China; Survival rate; Early-stage cervical cancer; Modified laparoscopic radical hysterectomy; Open radical hysterectomy
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-022-02866-x

Since the release of the LACC trial results in 2018, the safety of laparoscopic radical hysterectomy (LRH) for cervical cancer has received huge attention and heated discussion. We developed modified laparoscopic radical hysterectomy (MLRH) incorporating a series of measures to prevent tumor spillage, which has been performed in our center since 2015.
Present study retrospectively analyzed relevant indicators of MLRH and evaluated disease-free survival (DFS) primarily in the treatment of early cervical cancer compared with open surgery.
Patients with 2014 International Federation of Gynecology and Obstetrics clinical stages 1B1 and 2A1 cervical cancer who underwent radical hysterectomy in the gynecological department of our hospital from October 2015 to June 2018 were enrolled retrospectively in this study. Patients were divided into two groups based on the surgical procedure: open radical hysterectomy (ORH) group (n = 336) and MLRH group (n = 302). Clinical characteristics, surgical indices, and survival prognosis were analyzed, including 2.5-year overall survival (OS) rate, 2.5-year DFS rate, recurrence rate, and recurrence pattern.
Compared to the ORH group, the MLRH group exhibited a longer operative time, longer normal bladder function recovery time, less intraoperative blood loss volume, and more harvested pelvic lymph nodes (P < 0.05). No significant differences were observed in postoperative complications, the 2.5-year OS, 2.5-year DFS, and recurrence rate between the two groups (P > 0.05); however, the recurrence pattern was significantly different (P < 0.05). The MLRH group mainly exhibited local single metastasis (7/11), whereas the ORH group mainly exhibited distant multiple metastases (14/16). Stratified analysis revealed that overall survival rate was higher in the MLRH group than in the ORH group in patients with stage 1B1 and middle invasion (P < 0.05).
MLRH does not show a survival disadvantage in the treatment of early-stage cervical cancer when compared with open surgery. In addition, MLRH shows a survival advantage in patients with stage 1B1 and middle 1/3 invasion. Considering this is a retrospective study, further prospective study is necessary for more sufficient data support.
Present research is a retrospective study. The study had retrospectively registered on Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), and the registered number is ChiCTR1900026306.