Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer: a randomised controlled trial

Abstract

BackgroundNon-randomised studies have suggested that the postoperative complications of (Campos LS, Limberger LF, Stein AT, Kalil AN) laparoscopic radical hysterectomy are similar to those in abdominal radical hysterectomy. However, no study evaluating postoperative pain comparing both techniques has been published thus far. Our objective was to compare pain intensity and other perioperative outcomes between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in early cervical cancer.MethodsThis single centre, randomised, controlled trial enrolled 30 cervical cancer patients who were clinically staged IA2 with lymph vascular invasion and IB according to the FIGO (International Federation of Gynaecology and Obstetrics) classification, and underwent LRH or ARH between late 1999 and early 2004. Postoperative pain, as measured by a 10-point numerical rate scale, was considered the primary endpoint. Postoperative pain was assessed every six hours during a patient’s usual postoperative care. Perioperative outcomes were also registered. Both surgical techniques were executed by the same surgical team. Secondary outcomes included intraoperative and other postoperative surgicopathological factors and 5-year survival rates.ResultsIA2 patients with lymphatic vascular space invasion and IB cervical cancer patients were randomised to either the LRH group (16 patients) or the ARH group (14 patients). Four patients (25%) in the LRH group and 5 patients (36%) in the ARH group presented with transoperative or serious postoperative complications. All of the transoperative complications occurred in the LRH group. The relative risk of presenting with complications was 0.70; CI 95% (0.23–2.11); P = 0.694. LRH group mean pain score was significantly lower than ARH after 36 h of observation (P = 0.044; mean difference score: 1.42; 95% CI: 0.04–2.80). The survival results will be published elsewhere.ConclusionsLRH provided lower pain scores after 36 h of observation in this series. The perioperative and serious postoperative complications ratios were comparable between the groups.Trial RegistrationNCT01258413

Prognostic and Safety Roles in Laparoscopic Versus Abdominal Radical Hysterectomy in Cervical Cancer: A Meta-analysis

“…Twenty-two studies including 2922 cases (1230 LRH cases and 1692 ARH cases) met the inclusion criteria. Twenty-one publications were full-text articles, 15–36 and one publication was an abstract. 37 The references listed for these studies and review articles were also examined, but no further studies were included.…”

“…Table 1 shows the characteristics of included studies, which included 1 small RCT 15 (Level of Evidence 2b), 15 retrospective studies, 16–29 , 37 and 6 prospective studies 30–33 , 35 , 36 comparing a contemporary series of patients (Level of Evidence 3b). Five studies examined cases with Stage IB1 or below disease.…”

“…Five studies examined cases with Stage IB1 or below disease. 15 , 16 , 26 , 32 , 37 Sixteen studies included cases with locally advanced Stage IB2–IIB disease, 17–20 , 22–25 , 27–30 , 34–36 and only two studies 31 , 33 included cases with Stage IIB disease. One study defined stage IB1 as a tumor size of less than 2 cm.…”

<p>No Differences in the Prevalence and Intensity of Chronic Postsurgical Pain Between Laparoscopic Hysterectomy and Abdominal Hysterectomy: A Prospective Study</p>

“…Several studies have compared laparoscopic surgery for treatment of gynecologic diseases with abdominal or vaginal procedures, and their results support our findings. [27][28][29] The differences in the pain scores may have been due to two main reasons. First, laparoscopic surgery involves electrosurgical instruments for coagulation and dissection, whereas abdominal procedures involve clamps, scissors, and tying knots.…”

Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

“…High quality evidence for the comparison of open versus the laparoscopic route of radical hysterectomy is lacking [3]. The only reported randomised controlled trial (RCT) included 30 women and revealed superior early postoperative pain outcomes in the laparoscopic arm at the expense of higher major complication rate [4]. An adequately powered RCT would require a sample size up to 1400 patients to detect differences in the safety outcomes between the two techniques [5].…”