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Open Versus Laparoscopic Pelvic Lymph Node Dissection in Early Stage Cervical Cancer: No Difference in Surgical or Disease Outcome
  1. Jonas van de Lande, MD*,
  2. Silvia von Mensdorff-Pouilly, MD, PhD*,
  3. Roelof G. Lettinga, MD,
  4. Jurgen M. Piek, MD, PhD* and
  5. René H.M. Verheijen, MD, PhD
  1. * Department of Obstetrics and Gynecology, Centre for GynecologicOncology Amsterdam, location VU, VU University Medical Centre, Amsterdam;
  2. Department of Obstetrics and Gynecology, Kennemer Gasthuis, Haarlem; and
  3. Division of Woman and Baby, Gynecologic Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands.
  1. Address correspondence and reprint requests to Jonas van de Lande, MD, Department of Obstetrics and Gynecology, Kennemer Gasthuis Haarlem, PO Box 417, 2000 AK Haarlem, The Netherlands. E-mail: lande{at}kg.nl.

Abstract

Objective This study aimed to investigate in a retrospective study the effect of laparoscopic surgery, introduced in our center in 1994 as part of the standard treatment of early stage cervical cancer, on surgical and disease outcomes.

Patients and Methods A total of 169 women with cervical carcinoma stage IB1 (n = 150) or IB2 (n = 19) were included in the study. Seventy-six patients who underwent laparoscopic pelvic lymph node dissection (LPLND), followed either by open radical hysterectomy (n = 63) or, in case of positive lymph nodes, by primary chemoradiation (n = 13), were compared with an historic cohort of 93 patients who underwent a fully open, traditional Wertheim-Meigs procedure (WM). Recorded clinical characteristics of patients included age, International Federation of Gynecology and Obstetrics stage, histologic diagnosis, differentiation grade, tumor diameter, lymph node status, and adjuvant therapy. Operation time; lymph node yield; intraoperative, early, and late complications; site of recurrences; and disease-free and overall survival rates were analyzed and compared between groups.

Results Clinical characteristics did not differ between groups. Duration of total surgery time was longer in patients with LPLND followed by open radical hysterectomy compared with that in the WM group (P < 0.001). In patients with negative lymph nodes (n = 129), the number of resected nodes was higher (P = 0.002) in the LPLND (median, 26 nodes; range, 8–55 nodes) than in the WM group (median, 21 nodes; range, 7–50 nodes). In patients with positive lymph nodes (n = 40), no significant difference in the number of resected lymph nodes between the 2 groups (P = 0.904) was found. Intraoperative, early, and late complications did not differ between the 2 surgical procedures. The number of locoregional recurrences, but not of distant metastases, was significantly higher (P = 0.018) in the WM group compared with the LPLND group. No difference in disease-free or disease-specific survival was found between the LPLND and WM group, neither with nor without adjuvant or primary (chemo)radiation. A benefit in disease-free survival (P = 0.044), but not in disease-specific survival (P = 0.070), was found in the LPLND compared with the WM group in those patients who received adjuvant therapy or primary chemoradiation.

Conclusions Introduction of a laparoscopic procedure in the surgical staging and treatment of cervical cancer patients did not have a detrimental effect on surgical or disease outcome, and this can be safely applied to the treatment of early stage cervical cancer.

  • Cervical cancer
  • Laparoscopy
  • Radical hysterectomy
  • Lymph node dissection

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Footnotes

  • The authors declare that there are no conflicts of interest.

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