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Comparison of laparoscopic versus abdominal radical hysterectomy for bulky (≥ 3 cm) FIGO stage IB and IIA cervical cancer

Kong, Tae Wook; Lee, Jisun; Paek, Jiheum; Chang, Suk-Joon; Chang, Ki-Hong; Ryu, Hee-Sug
Department of Obstetrics & Gynecology, Ajou University School of Medicine
OBJECTIVE : Laparoscopic radical hysterectomy (LRH) is an alternative surgery to abdominal radical hysterectomy (ARH). There have been many comparative reports on LRH versus 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 size ≤2 or 3 cm) IB1 disease. The purpose of this study was to compare the safety, morbidity, and recurrence rate of LRH and ARH with pelvic and/or para-aortic lymphadenectomy for bulky (tumor size ≥3 cm) FIGO stage IB and IIA cervical cancer.
METHODS : We conducted a retrospective analysis of 85 patients with bulky (tumor size ≥3 cm) FIGO stage IB and IIA cervical cancer. All patients showed no evidence of parametrial invasion and lymph node metastasis in preoperative gynecologic examination, pelvic MRI and PET-CT and underwent LRH or ARH with pelvic and/or para-aortic lymphadenectomy between May 2006 and July 2012.
RESULTS : Among 85 patients, 37 patients received LRH and 48 underwent ARH. There were no differences in demographic data between the two groups. Mean estimated blood loss was 588.0 mL for ARH group compared to 449.1 mL for LRH group (p<0.01). Mean operative time was 246.0 minutes for ARH group compared to 254.5 minutes for LRH group (p=0.589). Return of bowel motility was observed earlier after LRH (p<0.05). The laparoscopic group had an average of 22.7 pelvic lymph nodes retrieved, as compared to 21.5 pelvic lymph nodes removed in the laparotomy group (p=0.256). The mean duration of hospital stay was significantly shorter for LRH (p<0.05) group. No statistically significant difference was found between the two groups when the recurrence rate was compared. Fiveyear disease-free survival rates were 94.0% in ARH group and 100% in LRH group, respectively (p=0.284). With a median follow up of 43 months, all patients were alive with no disease-related deaths.
CONCLUSION : LRH is a safe and effective therapeutic procedure for management of bulky FIGO stage IB and IIA cervical cancer with reducing blood loss, postoperative morbidity, and postoperative hospital stay and oncologic results of this procedure are comparable to ARH with the limitation of a short follow-up period. Further randomized studies are necessary to evaluate long-term clinical outcome.
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