Article Text
Abstract
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.