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

ObjectiveTo 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.MethodsThe 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.ResultsIn 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.ConclusionOur 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.