[Impact on survival and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy to patients with early-stage cervical cancer].

OBJECTIVE

To compare intraoperative, pathologic, postoperative outcomes and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH + LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy (ARH + APL) for patients with early-stage cervical cancer.

METHODS

The consecutive cases with International Federation of Gynecology and Obstetrics (FIGO) stages Ia2-IIa cervical cancer who underwent surgery from Jan. 1, 2002 to Jan. 1, 2011 were documented, including 85 patients underwent LRH + LPL, and 85 patients underwent ARH + APL as control group. The clinical data of intraoperative, pathologic, postoperative outcomes and quality of life were compared between two groups. Survival data were estimated using Kaplan-Meier survival curves and compared with the log-rank test. Cox proportional hazards model was used for multivariate analysis.

RESULTS

All but 2 surgical procedures were completed laparoscopically because of right common iliac vein vessel injuries. Mean operative time, it was longer for LRH + LPL than that for ARH + APL [(242 ± 74) minutes vs. (190 ± 61) minutes, P = 0.000]. Mean recovery time of intestines function was less for LRH + LPL than that for ARH + APL [(45 ± 7) hours vs. (63 ± 11) hours, P = 0.000]. Mean estimated blood loss was less for LRH + LPL than that for ARH + APL [(367 ± 252) ml vs. (460 ± 220) ml, P = 0.006]. Mean recovery time of urinary function was less that for LRH + LPL than that for ARH + APL [(19 ± 4) days vs. (21 ± 4) days, P = 0.000]. There were no significant difference in numbers of the pelvic lymph nodes resected, the extent of parametrial tissue, vaginal cuff, negative margins obtained and complications. The median follow-up was 32 months (range 4 to 105 months), there was no significant difference in the recurrence rate (7% vs. 5%, P = 0.540) and mortality rate (7% vs. 5%, P = 0.540), 5 years disease-free survival (90% vs. 94%, P = 0.812), 5 years over survival (90% vs. 95%, P = 0.532). There were not significant difference in quality of life between ARH + APL group and LRH + LPL group (P > 0.05). Only lympho-vascular space invasion was an independent prognostic factor by multivariate analysis (P = 0.016).

CONCLUSIONS

For early-stage cervical cancer, LRH + LPL has similar outcomes compared with ARH + APL. Laparoscopic treatment by experienced surgeons should be an ideal alternative.