Abstract
Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.
Highlights
Radical hysterectomy with pelvic lymphadenectomy is the suggested treatment for cervical cancer FIGO stages 1A2 to 1B1 [1]
The ARH cases selected after propensity score full matching presented a mean difference for distance of 0.0073 to the 36 cases of laparoscopic radical hysterectomy (LRH)
All 36 patients offered both options of LRH and ARH opted for laparoscopic surgery
Summary
Radical hysterectomy with pelvic lymphadenectomy is the suggested treatment for cervical cancer FIGO stages 1A2 to 1B1 [1]. Available evidence is derived from large retrospective case series The value of such studies in the assessment of implementation of novel surgical techniques has been criticised to obscure results during the learning curve of the technique [6]. The already low incidence of cervical cancer in the developed countries where advanced laparoscopic surgery is commonly available is expected to decrease further following the implementation of HPV vaccination programs. This along with the expanding availability of radiotherapy will eventually decrease the number of radical hysterectomies performed. In the modern practice of higher turnover of surgeons, evidence derived from studies assessing the learning curve of less commonly performed surgical techniques may be of higher clinical relevance
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