Comparison of laparoscopic versus abdominal radical hysterectomy for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater

Abstract

OBJECTIVE: There have been many comparative reports on laparoscopic radical

hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage

cervical cancer. However, most of these studies included patients with

International Federation of Gynecology and Obstetrics (FIGO) stage IA2 and small

(tumor diameter </=2 or 3 cm) IB1 disease. The purpose of this study was to

compare the feasibility, morbidity, and recurrence rate of LRH and ARH for FIGO

stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater.

MATERIALS AND METHODS: We conducted a retrospective analysis of 88 patients with

FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. All

patients had no evidence of parametrial invasion and lymph node metastasis in

preoperative gynecologic examination, pelvic magnetic resonance imaging, and

positron emission tomography-computed tomography, and they all underwent LRH or

ARH between February 2006 and March 2013. RESULTS: Among 88 patients, 40 patients

received LRH whereas 48 underwent ARH. The mean estimated blood loss was 588.0 mL

for the ARH group compared with 449.1 mL for the LRH group (P < 0.001). The mean

operating time was similar in both groups (246.0 minutes in the ARH vs 254.5

minutes in the LRH group, P = 0.589). Return of bowel motility was observed

earlier after LRH (1.8 vs 2.2 days, P = 0.042). The mean hospital stay was

significantly shorter for the LRH group (14.8 vs 18.0 days, P = 0.044). There

were no differences in histopathologic characteristics between the 2 groups. The

mean tumor diameter was 44.4 mm in the LRH and 45.3 mm in the ARH group.

Disease-free survival rates were 97.9% in the ARH and 97.5% in the LRH group (P =

0.818). CONCLUSIONS: Laparoscopic radical hysterectomy might be a feasible

therapeutic procedure for the management of FIGO stage IB and IIA cervical cancer

with tumor diameter of 3 cm or greater. Further randomized studies that could

support this approach are necessary to evaluate long-term clinical outcome.