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1087 Comparing patient-reported outcome measures (PROM) and parameters of radicality in surgical approaches for early high-risk cervical carcinoma: nerve-preserving vaginally assisted laparoscopic radical hysterectomy vs. laparoscopically assisted radical vaginal hysterectomy
  1. Julie Schambach,
  2. Laura Putzke,
  3. Irina Cepraga,
  4. Valentina Auletta,
  5. Davit Bokhua,
  6. Angela Kather and
  7. Ingo B Runnebaum
  1. University Hospital Jena, Jena, Germany


Introduction/Background For surgical treatment of primary cervical carcinoma, there are numerous approaches with varying levels of radicality, novelty, and oncologic outcome. This study focuses on nerve-preserving vaginally assisted laparoscopic radical hysterectomy (npVA-LRH) as developed at the Department of Gynecology and Reproductive Medicine, Jena University Hospital, Germany, in 2006 for early high-risk cervical cancer with a type C1 radicality compared to laparoscopically assisted radical vaginal hysterectomy (LARVH).

Methodology This retrospective single-center study included 155 cervical carcinoma patients undergoing surgery between 2001 and 2013. Runnebaum and team developed npVA-LRH in 2006 by performing vaginal cuff preparation and closure before laparoscopy, therefore omitting the uterine manipulator. 79 npVA-LRH and 76 LARVH patients were included. Exclusion criteria were tumor stages >pT2b and there was no significant difference in baseline or tumor data. Perioperative and long-term outcomes regarding complications and sequelae was recorded, and quality of life was assessed retrospectively using EORTC-QLQ-C30 and CX24 questionnaires in 2015.

Results npVA-LRH exhibited increased radicality compared to LARVH, with more lymph nodes removed (33 vs. 38, p=0.025) and longer resected parametria (2.6 vs. 3.7 cm, p=0.001). LARVH involved more pelvic and paraaortic lymphonodectomies (70.5% vs. 24.1%, p<0.001). After npVA-LRH, earlier catheter removal (5.6 vs. 10 days, p<0.001) and shorter hospitalization (10.9 vs. 13.3 days, p<0.001) was recorded. Urologic complications were reduced in np-VALRH, including bladder dysfunction and incontinence (16.7% vs. 34.6%, p=0.034), and urinary stasis (7.3% vs. 24.5%, p=0.014). Lymphocele occurrence was higher in npVA-LRH (15.8% vs. 3.6%, p=0.031). Questionnaires revealed no significant differences in oncologic quality of life, however, npVA-LRH patients reported more sleep disorders (59.1% vs. 31.6%, p=0.017).

Conclusion Our study demonstrates that npVA-LRH with type C1 radicality offers advantages over LARVH, particularly regarding improved urologic outcomes. Further investigations are warranted to compare oncologic outcomes between combined vaginal with minimally-invasive techniques and abdominal radical hysterectomy.

Disclosures No conflicting interests.

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