Abstract
ObjectiveTo investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer.MethodsThis retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000–2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups.ResultsThe ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups (P = 0.122, adjusted HR = 0.449, 95% CI: 0.162–1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively (P = 0.578, adjusted HR = 0.650, 95% CI: 0.143–2.961). The presence of more than two comorbidities led to poor OS (P = 0.011). For patients with a BMI greater than 24 kg/m2, LRH was associated with better PFS (P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006–2012, 2013–2015, and 2016–2018 in the LRH group (P = 0.126 and P = 0.583).ConclusionCompared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.
Highlights
Cervical cancer is one of the most common cancers among women and ranks fourth globally in both incidence and mortality, with 570,000 cases and 311,000 deaths in 2018 [1]
We evaluated the factors associated with progression-free survival (PFS) and overall survival (OS) that can be acquired preoperatively in the Abdominal radical hysterectomy (ARH) and Laparoscopic radical hysterectomy (LRH) groups according to different stratifying variables, which are shown in Supplementary Table S1
The Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial found unexpected results that the PFS after minimally invasive surgery (MIS) for cervical cancer ranging from IA1 disease with lymphovascular space invasion (LVSI) to IB1 disease was significantly worse than that after open surgery (3-year rate, 91.2% vs. 97.1%; 4.5-year rate, 86.0% vs. 96.5%), and the same was reported for the OS (3-year rate, 93.8% vs. 99.0%) [19]
Summary
Cervical cancer is one of the most common cancers among women and ranks fourth globally in both incidence and mortality, with 570,000 cases and 311,000 deaths in 2018 [1]. In China, newly diagnosed cases account for 12% of new cases worldwide and contribute to a progressive increase among young women, probably due to the popularization of screening and a greater incidence of human papillomavirus infections [3, 4]. Patients are increasingly diagnosed with cervical cancer at an early stage in China, and most are treated by surgery [5]. Radical hysterectomy (RH) with bilateral pelvic lymph node dissection has become the standard treatment for early-stage cervical cancer, that is, stage IA1 with lymphovascular space invasion (LVSI)-IB1 disease, as defined by the International Federation of Gynecology and Obstetrics (FIGO) staging system in 2009 [6]. For patients with locally advanced disease with a bulk lesion >4 cm (FIGO stage IB2 or IIA2), radical surgery accompanied by adjuvant therapy is a curative treatment modality [7, 8]
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