A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

Abstract

Objective To investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer. Methods This retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000–2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups. Results The ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups ( P = 0.122, adjusted HR = 0.449, 95% CI: 0.162–1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively ( P = 0.578, adjusted HR = 0.650, 95% CI: 0.143–2.961). The presence of more than two comorbidities led to poor OS ( P = 0.011). For patients with a BMI greater than 24 kg/m 2 , LRH was associated with better PFS ( P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006–2012, 2013–2015, and 2016–2018 in the LRH group ( P = 0.126 and P = 0.583). Conclusion Compared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.

Effect of modified no‐touch laparoscopic radical hysterectomy on outcomes of early stage cervical cancer: A retrospective cohort study

“…In this study, patients with cervical cancer who underwent MLRH by Dr. Songhua Yuan had a satisfactory prognosis, and the 5‐year DFS and OS were comparable with those of open surgery, as reported in the Laparoscopic Approach to Cervical Cancer Trial (5‐year DFS, 94.5% vs. 96.5%; 5‐year OS, 96.7% vs. 97.6%) 2 . Some studies reported 5‐year DFS and OS of 89.3%–97.7% and 95.2%–99.4%, respectively, in patients with early stage cervical cancer by laparotomy 19–21 . The long‐term prognoses of the patients in our study who underwent MLRH were not inferior to those described in the above studies.…”

“…18 Furthermore, CO 2 pneumoperitoneum has been found to promote tumor cell growth or spread in cell-culture and animal trials. [19][20][21] The long-term prognoses of the patients in our study who underwent MLRH were not inferior to those described in the above studies. Moreover, several studies with high levels of evidence have revealed that laparoscopic surgery is not inferior to open surgery in patients with gastric or colorectal cancer in terms of long-term survival.…”

Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta‐analysis

“…Table 1 presents the characteristics of the included studies. All 30 studies 8,14,15,18,23–48 were retrospective cohort studies. Two studies involved comparisons among three groups, including LRH versus ORH versus LVRH, and RRH versus LRH versus ORH; the remaining 28 studies compared two groups, LRH versus ORH (14 studies), RRH versus ORH (6 studies), VALRH versus ORH (4 studies), and LRH versus RRH (4 studies).…”

Minimally invasive surgery and abdominal radical hysterectomy in patients with early‐stage cervical cancer: A meta‐analysis

“…By reading the full texts, 32 articles were further excluded because 10 among them had patients with FIGO Stage IIb, while 15 did not discuss the main study outcome and 7 involved duplicate data. Finally, 22 retrospective studies in keeping with the inclusion criteria were selected for analysis 2,7–11,13–28 . The literature screening process is illustrated in Figure 1.…”

“…Finally, 22 retrospective studies in keeping with the inclusion criteria were selected for analysis. 2,[7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The literature screening process is illustrated in Figure 1.…”