Laparoscopic Radical Parametrectomy for Incidental Invasive Cervical Cancer after Previous Simple Hysterectomy

Abstract

Study Objective: To evaluate the outcome of laparoscopic radical parametrectomy performed for in incidental invasive cervical cancer following a simple hysterectomy in patient with benign pelvic disease or with in situ carcinoma of cervix. Design: Retrospective study. Setting: Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University. Patients: From July 2002 to December 2008. 29 patients underwent laparoscopic or laparotomy hysterectomy that were found to have incidental early stage cervical cancer. At the same time, negative surgical margins and no gross tumor were found at initial hysterectomy specimen. Intervention: We performed laparoscopic radical parametrectomy and pelvic lymph nodes resection. Measurements and Main Results: The mean age of these patients was 43.6 ± 3.2 years (range 36 to 51). The laparoscopic radical parametrectomy was performed on average 4.23 ± 0.32 weeks after a simple hysterectomy (range 2 to 6) with benign diseases, and was performed immediately after an extrafascial hysterectomy with in situ carcinoma of cervix. All patients were performed successfully laparoscopic retrieval of pelvic lymph nodes and radical parametrectomy. The mean number of laparoscopic retrieval of pelvic lymph nodes was 21.6 ± 1.31 (17 to 32). The mean blood loss was 252.2 ± 21.1 ml (150 to 300). The mean reoperation time was 178 ± 26 min (range 96 to 196). Operative complications occurred in only one patient with cystotomy and repaired laparoscopically. Operative pathologic findings of radical specimens indicated no evidence of residual lesions in 93.1% (27/29) patients. The average of admission was shortened 7.7 days than primary radical hysterectomy. Only one patient had a local recurrence within a median follow-up 49.6 ± 8.8 months (5 to 82). Conclusion: Laparoscopic radical parametrectomy was an acceptable option for patient with incidental early stage of cervical cancer after a simple hysterectomy and produces low morbidity with excellent oncological outcome.