Comparative evaluation of surgical stress of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy and laparotomy for early-stage cervical cancer

Abstract

Abstract. The aim of this study was to objectively evaluate the benefits of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy for early-stage cervical cancer. Clinical data were prospectively collected from patients with IA-IIB cervical cancer who underwent laparoscopically assisted vaginal radical hysterectomy (n1=33) and laparotomy (n2=30). Peripheral blood samples were obtained prior to surgery and at 1 and 2 h into the operation, as well as on days 1, 4 and 7 following surgery to measure serum interleukin-6, C-reaction protein and cortisol. Results showed that there was no conversion to laparotomy in the laparoscopy group. The average blood loss was 317.23±217.20 ml (laparoscopy group) and 872.58±693.16 ml (laparotomy group). No significant difference was found in the number of resected pelvic lymph nodes (19.74±7.43 in the laparoscopy group and 20.35±6.62 in the laparotomy group). At days 1 and 7 after surgery, the serum IL-6 level was significantly different in the laparoscopy and laparotomy groups (day 1: laparoscopy group 17.14±16.53 pg/ml and laparotomy group 34.32±20.97 pg/ml, p= 0.001; day 7: laparoscopy group 6.7±7.21 pg/ml and laparotomy group 17.54±16.47 pg/ml, p=0.001). The serum CRP level was significantly different at days 1 and 7 after the operation (day 1: laparoscopy group 7024.72±949.12 ng/ml and laparotomy group 7586.61±869.42 ng/ml, p=0.018; day 7: laparoscopy group 4357.71±2108.85 ng/ml and laparotomy group 6967.96±995.02 ng/ml, p<0.001). A significant difference was noted in the serum cortisol level at day 4 after the operation (122.29±65.17 ng/ml in the laparoscopy group and 186.76±68.61 ng/ml in the laparotomy group, p<0.001). In conclusion, the differences in clinical data and the various parameters pertinent to surgical stress evaluated in this study suggest that laparoscopic surgery for cervical cancer causes less postoperative stress than conventional open surgery.

Comparison of long-term survival of total abdominal radical hysterectomy and laparoscopy-assisted radical vaginal hysterectomy in patients with early cervical cancer: Korean multicenter, retrospective analysis

“…Most published studies on LARVH are retrospective on surgical and pathological data and only a few authors reported the survival outcomes and recurrence rates after LARVH [2,[23][24][25]. Like our study, Zhang et al [26] compared LARVH with TARH in 77 women with early cervical cancer that confirmed no difference in recurrence rate (9.4% in LARVH and 33.3% in TARH), length of disease free survival (DFS) (46.4 months in LARVH and 45.4 months in TARH), OS rate (93.8% in LARVH and 86.7% in TARH) between the two groups.…”

Comparison of laparoscopic-assisted radical vaginal hysterectomy and abdominal radical hysterectomy in patients with early stage cervical cancer

“…[17,18] Many studies have shown that LARVH is associated with less intra- and postoperative complications universally. [7–11,13–16] However, in China no one reported the long-term prognosis of LARVH maybe because of new technique without long time follow up. In our study, we reported the survival outcomes based on long-term follow up which was scarce data.…”

“…The technical feasibility of laparoscopically assisted radical vaginal hysterectomy (LARVH) as treatment for early-stage cervical cancer has been well established through a series of institution, [7–16] which suggest that LARVH may have an intraoperative reduction in blood loss, transfusion requirement, and hospital stay but longer operative time. But just a few authors [8,12,13,15] reported the survival outcomes which was most important question to evaluate the prognosis of therapy.…”

Multi-dose parecoxib provides an immunoprotective effect by balancing T helper 1 (Th1), Th2, Th17 and regulatory T cytokines following laparoscopy in patients with cervical cancer

“…Postoperative immune dysfunction is a problem for patients undergoing surgery for malignant tumors, as it affects the rate of infectious complications, clinical outcomes and the growth of disseminated tumor cells (4)(5)(6). Particularly in the elderly with cancer, improved postoperative immunity may result in more favorable long-term oncological results (7,8). Therefore, it is critically important to improve the surgery-induced immune suppression and restore the immune function following surgery in patients with cancer.…”