Survival after Minimally Invasive Surgery versus Abdominal Radical Hysterectomy for Early-Stage Cervical Cancer in dr. Cipto Mangunkusumo National Hospital, Jakarta

Abstract

stract Cervical cancer is one of the most frequent cancer among women in the world. Indonesian’s gynecologic oncologists have started using laparoscopic approach for radical hysterectomy for early stage cervical cancer. There are still limited data and studies reporting survival outcomes after laparoscopic or open abdominal radical hysterectomy, thus we would like to compare the survival outcomes between laparoscopic and open technique of radical hysterectomy in early stage cervical cancer. A retrospective study included 415 early stage cervical cancer was conducted in dr. Cipto Mangunkusumo Hospital. Patient were treated with radical hysterectomy, laparotomy, or laparoscopy, and followed for 3 years period. Survival outcome was reported in univariate and multivariate design, to know the effect of age, parity, tumor size, free margin, and lymph nodal status on overall survival. From 415 patients, 268 patients fulfilled the inclusion criteria. A total of 44 patients underwent laparoscopy radical hysterectomy and 224 to open surgery. Positive resection margins rate for laparoscopic patient was lower than open group (25,9% versus 12.5%). The mean survival of laparoscopic patient was 30 months while open surgery patient was 34 months. The overall 3-year survival rate in open surgery group was 90.2% and 81.8% among those who underwent minimally invasive surgery (hazard ratio 1.7; 95% confidence interval 0.9 to 3.1; p=0.11 by the log-rank test). Laparoscopic approach for radical hysterectomy is a feasible method for early stage cervical cancer other than laparotomy. Sintasan Bedah Invasif Minimal Dibandingkan Radikal Abdominal Histerektomi pada Kanker Serviks Stadium Awal di RSUPN dr. Cipto Mangunkusumo Jakarta Kanker serviks adalah kanker yang paling sering pada perempuan di dunia. Onkologi ginekologis Indonesia telah menggunakan pendekatan laparoskopi untuk melakukan histerektomi radikal pada kanker serviks stadium awal. Data dan penelitian yang melaporkan hasil sintasan laparoskopi atau radikal abdominal histerektomi, masih terbatas sehingga perlu penelitian untuk membandingkan kesintasan laparoskopi dan radikal abdominal histerektomi pada kanker serviks stadium awal. Studi dilakukan secara retrospektif dengan menginklusi 415 data pasien kanker serviks stadium awal di RSUPN dr. Cipto Mangunkusumo. Pasien ditatalaksana dengan histerektomi radikal, laparotomi atau laparoskopi, dan ditindaklanjuti selama 3 tahun. Kesintasan dilaporkan dalam data univariat dan multivariat, untuk mengetahui hubungan usia, paritas, ukuran tumor, batas tumor, dan status kelenjar getah bening pada seluruh sintasan. Dari 415 pasien, sebanyak 268 pasien memenuhi kriteria inklusi. Sebanyak 44 pasien menjalani laparoskopi histerektomi radikal dan 224 menjalani laparotomi. Angka kejadian batas reseksi positif untuk pasien laparoskopi lebih rendah dari laparotomi (25,9% versus 12,5%). Rerata kesintasan pasien laparoskopi adalah 30 bulan dan laparotomi adalah 34 bulan. Seluruh sintasan pasien laparotomi dalam 3 tahun adalah 90,2%, dan 81,8% pada pasien operasi invasif minimal (hazard ratio 1,7; 95% confidence interval 0,9-31; p=0,11 dengan tes log-rank). Disimpulkan metode laparoskopi untuk histerektomi radikal dapat dikerjakan untuk pasien kanker serviks stadium awal.