Feasibility and safety of type C2 total extraperitoneal abdominal radical hysterectomy (TEARH) for locally advanced cervical cancer

IntroductionRadical hysterectomy represents the gold standard treatment in patients with early-stage cervical cancer and a valid choice of treatment, after neoadjuvant chemotherapy (NACT), in locally advanced tumors. Laparotomy is still considered the standard approach for radical hysterectomy; however, the extraperitoneal route has been described as a valid alternative for pelvic lymphadenectomy, with shorter operative time, shorter ileus and reduced postoperative pain and hospitalization. We designed the first prospective study to evaluate the technique of total extraperitoneal radical hysterectomy for surgical treatment of locally advanced cervical cancer after platinum-based NACT, in terms of feasibility and safety.MethodsConsecutive patients affected by locally advanced cervical carcinoma were considered for eligibility in this observational study. After a primary complete evaluation, all patients were submitted to platinum-based NACT. Inclusion criteria were: stage IB2–IIIB cervical carcinoma already submitted to neoadjuvant chemotherapy with a complete or partial response after three cycles of chemotherapy, WHO performance status ≤ 1, adequate renal, hepatic and cardiac function, BMI < 40, age ≤ 75 years, no concurrent or previous malignant disease, no previous radiation therapy, and signed informed consent. Patients included in the study were submitted to type C2 extraperitoneal radical hysterectomy.ResultsFrom January 2006 to October 2008, 46 patients were enrolled and compared with a control group selected from the historical database. The mean operative time in the extraperitoneal radical hysterectomy group was 195 min (range: 120–240) versus 235 min (range: 215–310) in the intraperitoneal radical hysterectomy group (P < 0.05). Median postoperative ileus was 32 h (range: 24–36) versus 67 h (range: 42–78) (P < 0.05). VAS (Visual Analogue Scale) score at 24 and 48 h was 8 (range: 6–8) versus 8 (range: 6–9) (P = NS) and 3.5 (range: 2–7) versus six (range: 5–9) (P < 0.05) respectively. No differences in terms of intraoperative and postoperative complications were recorded.ConclusionsTotal extraperitoneal radical hysterectomy in locally advanced cervical cancer is feasible and safe. If compared with intraperitoneal abdominal radical hysterectomy, no significant differences in terms of surgical data or complications were found. Extraperitoneal radical hysterectomy seems to compare favorably to the intraperitoneal approach in terms of operative time, postoperative ileus, and VAS score at 48 h.

Research Highlights
► Extraperitoneal route is a valid alternative for pelvic lymphadenectomy.
► None studies have evaluated the feasibility and safety of TEARH.
► TEARH has a shorter operative time and postoperative ileus.
► Total extraperitoneal radical hysterectomy is feasible and safe.