[Long-term oncological outcomes after laparoscopic versus abdominal radical hysterectomy in stage I a2- II a2 cervical cancer: a matched cohort study].Zhonghua Fu Chan Ke Za Zhi. 2015 Dec; 50(12):894-901.ZF
To investigate the long- term oncological outcomes of laparoscopic radical hysterectomy (LRH) plus lymph node dissection (LND) and abdominal radical hysterectomy (ARH) plus LND for patients with stage Ia2-IIa2 cervical cancer.
A retrospective review of stage Ia2- II a2 cervical cancer patients who underwent LRH + LND (n=372) and ARH + LND (n=434) at the First Affiliated Hospital of Sun Yat- sen University from Jan. 2005 to Aug. 2013 was performed. Individual patient matching was performed by the risk factors for recurrence [tumor size, lymph vascular space invasion (LVSI), depth of cervical stromal invasion, lymph node metastasis, parametrial involvement, and resection margin involvement] between two groups. After matched, a total of 203 patient pairs (LRH- ARH) were enrolled. The survival data, surgery data, intraoperative and postoperative complications were compared between the two groups. To assess the prognosis factors, the univariate and multivariate Cox's proportional hazards model analysis were conducted. Stratified analysis was performed based on the independent prognosis factors to investigate the survival data between the two surgery groups.
(1) Surgery data: The operating time [(239±44) vs (270±42) minutes], estimated blood loss [(210±129) vs (428±320) ml], the duration of bowel motility return [(2.0±0.8) vs (3.0±1.6) days] and hospital stay [(11±6) vs (13±6) days] in the LRH group were significantly shorter than those in ARH group (all P<0.01). (2) Intraoperative and postoperative complications: The intraoperative complications rate was similar betweentwo groups [6.4%(13/203) vs 6.9%(14/203), P=1.000]. The rate of postoperative complications (excluded bladder dysfunction) in the LRH group were significantly lower than those in the ARH group [9.4% (19/203) vs 20.2% (41/203), P=0.002]. While there was no significant difference in the rates of bladder dysfunction between two groups [36.5% (74/203) vs 37.4% (76/203), P=0.910]. (3) Recurrence and survival data: There was no significant difference in the recurrence rates between the LRH group and ARH groups [7.9% (16/203) vs 9.4% (19/203), P=0.850]. There were similar 5-year recurrence-free survival (RFS; 92.1% vs 91.1%, P=0.790) and 5-year overall survival (OS; 93.7% vs 96.1%, P=0.900). (4) Prognosis factor: In univariate analysis, the results showed that tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, adjuvant therapy, LVSI, stromal invasion, parametrium invasion, pelvic lymph node metastasis, and para-aortic lymph node metastasis were significantly associated with poor prognosis (all P<0.01). However, age, body mass index (BMI), surgery type, histological type, grade were not significantly associated with poor prognosis (all P>0.05). The multivariate analysis results, showed that tumor size, pelvic lymph node metastasis,and para- aortic lymph node metastasis were significantly associated with poor prognosis (all P<0.01). Stratified analysis showed that, even in patients with tumor size >4 cm, pelvic lymph node metastasis positive, and para-aortic lymph node metastasis positive in all subgroups, there were not significant difference for the estimated 5-year RFS and 5-year OS between LRH and ARH group (all P>0.05).
For patients with stage Ia2-IIa2 cervical cancer, LRH plus lymph node dissection is an oncologically safe and surgical feasible alternative to ARH.