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Catastrophic intraperitoneal recurrence in patients with early cervical cancer treated with laparoscopic/robotic radical hysterectomy

Kong, Tae-Wook; Chang, Suk-Joon; Son, Joo-Hyuk; Paek, Jiheum; Lee, Yonghee; Lee, Eun Ju; Ryu, Hee-Sug
Department of Obstetrics & Gynecology, Ajou University School of Medicine; Department of Pathology, Ajou University School of Medicine; Department of Radiology, Ajou University School of Medicine
OBJECTIVE: This study was aimed to investigate the pattern of disease recurrence and identify the clinicopathologic prognostic factors for patients with FIGO stage IB and IIA cervical carcinoma treated with abdominal radical hysterectomy (ARH) and laparoscopic/robotic radical hysterectomy (LRH/RRH).
METHODS: We conducted a retrospective analysis of 239 patients with FIGO stage IB and IIA cervical cancer. All patients had no definite evidence of parametrial invasion and lymph node metastasis in preoperative examination and underwent ARH and LRH/RRH with retroperitoneal lymphadenectomy between April 2006 and December 2013. Sites of disease recurrence and all possible clinicopathologic factors related to the risk of disease recurrence were determined.
RESULTS: Of the 239 patients, 111 patients (46.4%) and 128 patients (53.6%) received ARH and minimally invasive surgery (MIS), respectively. We categorized MIS group into LRH through vaginal colpotomy (LRH-VC; 79 patients) and LRH/RRH through intracorporeal colpotomy (LRH/RRH-IC; 49 patients) according to the colpotomic approaches. Multivariate analysis in MIS group demonstrated that laparoscopic intracorporeal colpotomy (p<0.041, OR = 7.038, 95% CI = 1.059 – 15.183) represented a strong prognostic factor related to disease recurrence. Five-year disease-free survival rates were 88.1% in ARH group and 88.7% in MIS group (p=0.940), respectively. However, the disease recurrence was higher in LRH/RRH-IC group than in LRH-VC group (16.3% vs 5.1%, p=0.057), showing that 5 patients in LRH/RRH-IC group had intraperitoneal spreads.
CONCLUSION: It remains to be elucidated that laparoscopic intracorporeal colpotomy under CO2 pneumoperitoneum might be related to disease recurrence including intraperitoneal spreads for early stage cervical cancer patients who underwent laparoscopic/robotic radical hysterectomy.
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