Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2–IIA cervical cancer?
Highlights
► LRH with LPL and/or LPAL for stage IA2–IIA cervical cancer is safe and feasible, including tumors > 4 cm in size. ► LPAL can be performed when indicated without increasing morbidity. ► LRH can be a standard treatment, sharing same surgical indication for radical abdominal hysterectomy.
Introduction
Laparoscopic radical hysterectomy with lymphadenectomy for the treatment of early stage cervical cancer was initially introduced by Nezhat et al. and Querleu et al. in the early 1990s [1], [2]. Since then, several groups have reported the feasibility and the safety of this procedure [3], [4]. Laparoscopic radical hysterectomy resulted in lower morbidity rates, including less postoperative pain, less blood loss, and shorter hospital stays with oncological outcomes comparable to open procedures, as noted by many studies [5], [6], [7]. Although these optimistic results have not been evaluated by randomized trials, laparoscopic radical hysterectomy is progressively recognized as a new standard treatment strategy for early stage cervical cancer. Although primary surgical treatment is one of several therapeutic options for cervical cancer with a tumor size > 4 cm, the majority of previous studies on laparoscopic radical hysterectomy in early stage cervical cancer showed surgical and survival data for patients with tumor size < 2 cm or < 4 cm [5], [6], [7], [8], [9]. Consequently, the safety and feasibility of laparoscopic radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage IA2–IIA cancers, including IB2 and IIA2 cancers, and laparoscopic para-aortic lymphadenectomy (LPAL) have rarely been highlighted. This might be why laparoscopic radical hysterectomy is not substituted for radical abdominal hysterectomy for patients with stage IA2–IIA cervical cancers. The aim of this study was to determine if laparoscopic radical hysterectomy (LRH) can substitute for conventional radical abdominal hysterectomy — that is, if LRH can be applied to all operable cervical cancer patients. Hence, we evaluated the operative feasibility and the surgical/oncological outcomes of LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or LPAL in patients with stage IA2–IIA cervical cancers in a single institution.
Section snippets
Materials and methods
We collected data on 130 consecutive patients who underwent laparoscopic surgery for cervical cancer at Kangbuk Samsung Hospital from March 2003 to December 2011. Initial staging was defined according to FIGO criteria and evaluated by clinical pelvic examination and magnetic resonance imaging scan. We excluded 12 patients from the study: two with FIGO stage IB1 who underwent laparoscopic radical trachelectomy with LPL for future pregnancy, one with FIGO stage IA1 with LVSI who underwent
Patient characteristics
Clinical and histopathological characteristics of the patients are summarized in Table 1. On pathological examination, 46 (39.0%) patients had tumors > 4 cm and 18 (15.3%) had tumors > 6 cm in longest diameters. A majority of patients had squamous cell carcinoma. Lymph node metastases were noted in 28 (23.8%) patients. Pelvic lymph node metastases were noted in 19 (16.1%), para-aortic lymph node metastasis in 1 (0.8%), and both in 8 (6.4%) patients.
Surgical data
Table 2 presents surgery-related measurements.
Discussion
Laparoscopic radical hysterectomy has been increasingly performed over the last two decades, and has now been established as the standard surgical modality for treating early cervical cancer at some specialized centers [5], [7], [14], [20]. The shift in surgical paradigm from open to minimally invasive procedures for cervical cancer is based on evidence revealing comparable surgical and oncological outcomes between the two modalities [8], [9], [22], [23].
In this study, we also found favorable
Conflict of interest statement
The authors declare no conflicts of interest regarding this study.
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