Surgicopathologic outcome of laparoscopic versus open radical hysterectomy

Abstract

Objective.

To compare the surgicopathologic outcome of total laparoscopic radical hysterectomy (LRH) with that of abdominal radical hysterectomy (ARH) for the treatment of early-stage cervical cancer.

Methods.

Radical hysterectomy specimens of sequential patients undergoing LRH (N = 50) were compared with those of historical controls selected from consecutive women who have had conventional ARH (N = 48), and who met the same criteria for eligibility as the cases. To evaluate the extent of parametrial resection, parametrial tissues were systematically measured at their widest dimensions before tissue processing.

Results.

No difference was found in demographics, histologic type, tumor stage and grade between the two groups. The parametrial width was similar between LRH and ARH in both type II (right parametrium: 2.4 cm (1–3) vs. 2.3 (1.8–4.0), p = 0.28; left parametrium: 2.3 cm (1.8–4) vs. 2.2 (1.2–3.0), p = 0.54) and type III radical hysterectomy (right parametrium: 3.8 cm (2.3–6.5) vs. 3.4 (1.7–7.0), p = 0.59; left parametrium: 3.6 cm (2–6) vs. 3.5 (1.5–6.5), p = 0.82). There were no significant differences between the two groups with regard to lymph nodes yield and likelihood of identifying positive margins or metastatic disease.

Conclusion.

Our results suggest that laparoscopically managed patients with cervical cancer undergo a similar extent of surgery as those treated with the traditional ARH, as judged by objective pathologic criteria.

Introduction

The role of minimally invasive surgery in gynecologic oncology continues to expand and provide less invasive alternatives in the surgical management of an ever increasing number of women with pelvic malignancies. Total laparoscopic radical hysterectomy (LRH) for the treatment of cervical cancer was initially met with strong skepticism, like most other advanced laparoscopic procedures in oncology. Nevertheless, the introduction and acceptance of LRH as a suitable substitute for the established open approach have been considerably slower compared with other endoscopic anticancer procedures for several reasons, including the perceived prohibitively difficult technique to master and concerns over potential inadequacy of oncological resection.

At least 17 series involving more than 400 laparoscopically managed patients with early staged cervical cancer have now been reported, showing that LRH can be performed with reasonable operative outcomes [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. Since more and more reports demonstrate surgical techniques and safety, the feasibility issue for LRH seems to be overcome. However, before the laparoscopic approach can be considered a fully satisfactory alternative to open conventional radical hysterectomy, we must ensure that, in our enthusiasm to embrace new technology, we do not affect our patients' chance of survival by inadequate surgery. In the absence of randomized trials to provide definitive evidence of comparable cure rates, determination of adequacy can be made on an objective basis by proving equivalency in the extent of resection between new procedures and the established standard of care. Since the aim of radical pelvic surgery in the management of early cervical cancer is resection of the uterus and cervix with wide vaginal and parametrial margins, laparoscopic approach should be evaluated by its ability to meet these goals as compared to abdominal radical hysterectomy. The notion that LRH and radical abdominal hysterectomy (ARH) result in a similar extent of resection has never been verified in comparative trials.

Purpose of this study was to assess the oncologic adequacy of total LHR by analyzing surgical–pathologic outcomes of laparoscopically managed women with early staged cervical cancer and to compare these results with the pathologic findings of a cohort of sequential open radical procedures.