Original
Clinical Evaluation of Laparoscopic-Assisted Radical Vaginal Hysterectomy with Pelvic and/or Paraaortic Lymphadenectomy

https://doi.org/10.1016/S1074-3804(05)60104-1Get rights and content

Abstract

Study Objective

To report our experience with radical laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral pelvic and/or paraaortic lymphadenectomy.

Design

Retrospective review (Canadian Task Force classification III).

Setting

University-affiliated hospital.

Patients

Fifty-two women with invasive carcinoma of the cervix, stage Ib1, smaller than 3 cm.

Intervention

Radical LAVH with pelvic and/or paraaortic lymphadenectomy.

Measurements and Main Results

Total operating time ranged from 230 to 650 minutes (mean 380 min). Major surgical complications were two cases of ureter injury, two cases of ureteral stricture, and one case of hematoma at the cannula site. Two cases were converted to laparotomy due to incomplete hemostasis of the uterine artery and obturator vein. The mean hemoglobin decrement was 1.7 g/dl the day after operation. Thirty patients received blood transfusion (mean 1.8 pints). Average numbers of pelvic and paraaortic lymph nodes removed were 27.7 (range 9–63) and 22.1 (range 6–52), respectively. After surgery, patients passed gas in 2.2 days and self-voided in 18.4 days on average. One woman had pelvic recurrence at 26 months after surgery. One died from brain metastasis 10 months after surgery.

Conclusion

This technique is feasible for treatment of early cervical carcinoma. An experienced surgeon could shorten operating time and reduce complications.

Section snippets

Materials And Methods

The series consisted of 52 women (mean age 45.8yrs, range 27–63 yrs) operated on for invasive carcinoma of the cervix, stage Ib1, smaller than 3 cm. They all underwent laparoscopic pelvic and/or paraaortic lymphadenectomy, followed by RVH.

Results

After operation, only one patient had parametrial metastasis (upstaging to IIb). At staging laparoscopy, pelvic lymph nodes were positive in five women. Of these, three patients also had metastasis in paraaortic lymph nodes. These three women did not have RVH and were treated with extended-field irradiation and intracavitary irradiation. The chances for pelvic and paraaortic involvement were 9.6% and 5.8%, respectively. Mean hemoglobin decrement was 1.7 g/dl (range 0–6.6 g/dl) the day after

Discussion

Conventional management of patients with early cervical cancer is radical abdominal hysterectomy or radiation therapy after identifying nodal metastasis at laparotomy.6, 7 However, many gynecologic oncologists5, 8, 9, 10, 11, 12, 13 use laparoscopic techniques for management of early disease. In a review of the literature, average numbers of lymph nodes removed laparoscopically were 31.4,512.6,10 and 26.8 pelvic nodes and 7.3 paraaortic nodes.11 In our study, the average numbers of pelvic and

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Presented at the VIII meeting of the International Gynecologic Cancer Society, Buenos Aires, Argentina, October 22–26, 2000.

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