Abstract
This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer.
Highlights
Cervical cancer is the second most common cancer and the third most common cause of cancer deaths in women worldwide [1].Radical hysterectomy (RH) with pelvic and/or para-aortic lymph node (LN) dissection is a standard primary treatment for early-stage cervical cancer [2]
A laparoscopic approach is not yet incorporated into the treatment guidelines, laparoscopic radical hysterectomy (LRH) has become increasingly popular among gynecologic oncologists based on growing evidence supporting its safety and feasibility with equivalent oncologic outcomes of LRH compared with abdominal radical hysterectomy (ARH) for early-stage cervical cancer [3,4]
Body mass index, and menopausal status were similar between LRH and ARH in both experienced surgeon and inexperienced surgeon groups (Table 1)
Summary
Cervical cancer is the second most common cancer and the third most common cause of cancer deaths in women worldwide [1].Radical hysterectomy (RH) with pelvic and/or para-aortic lymph node (LN) dissection is a standard primary treatment for early-stage cervical cancer [2]. A laparoscopic approach is not yet incorporated into the treatment guidelines, laparoscopic radical hysterectomy (LRH) has become increasingly popular among gynecologic oncologists based on growing evidence supporting its safety and feasibility with equivalent oncologic outcomes of LRH compared with abdominal radical hysterectomy (ARH) for early-stage cervical cancer [3,4]. It is assumed that studies comparing LRH versus ARH might be based on the premise that LRH had been performed by an experienced surgeon, especially for cases with bulky tumor [1]. It is known that at least 40–50 cases are required to reach a turning point in the learning curve of LRH where the operation time and the performance are thought acceptable [3,5]
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