Elsevier

Gynecologic Oncology

Volume 102, Issue 2, August 2006, Pages 252-255
Gynecologic Oncology

Total laparoscopic radical hysterectomy and lymphadenectomy: The M. D. Anderson Cancer Center Experience

https://doi.org/10.1016/j.ygyno.2005.12.013Get rights and content

Abstract

Objective.

To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy.

Methods.

We performed a retrospective review of all patients who underwent a total laparoscopic radical hysterectomy at our institution between May 2004 and August 2005. Data collected included age, body mass index, stage, histopathologic subtype, tumor grade, estimated blood loss, perioperative blood transfusions, number and status of lymph nodes obtained, status of surgical margins, length of hospital stay, time to resumption of normal bladder function, intraoperative and postoperative complications, and disease-free interval.

Results.

Twenty patients underwent total laparoscopic radical hysterectomy during the study period. None of the surgeries required conversion to laparotomy. The median patient age was 41.5 years (range, 25–76). Eighteen patients had cervix cancer (5 stage IA2 and 13 stage IB1), and 2 had endometrial cancer (1 stage IB and 1 stage IIIA). Among those with cervix cancer, 12 had adenocarcinoma, 4 squamous cell carcinoma, and 2 adenosquamous carcinoma. The median weight was 70 kg (range, 49–112). The median number of resected pelvic lymph nodes was 13 (range, 9–26). One patient had nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 200 ml (range, 25–700 ml). Only 1 patient required an intraoperative blood transfusion (1 U packed red blood cells). The median length of hospital stay was 1 day (range, 1–5). There were 3 short-term complications—unintentional cystotomy, pulmonary embolus, and pneumomediastinum with subcutaneous emphysema. There were 2 long-term complications—vaginal eviscerations and a lymphocyst. The median time to resumption of normal bladder function was 16 days (range, 13–29). The median follow-up time was 8 months range (1–16). All patients remain free of disease at the time of this report.

Conclusions.

Total laparoscopic radical hysterectomy can be performed safely with minimal blood loss and postoperative morbidity, and patients undergoing this procedure may be discharged after an overnight stay in the hospital.

Introduction

Total laparoscopic radical hysterectomy was described initially by Canis et al. [1] and Nezhat et al. [2]. Since those initial reports, a number of other groups have published their experiences showing the feasibility and safety of this procedure [3], [4], [5], [6], [7], [8]. These experiences have also suggested that performing the procedure laparoscopically does not adversely affect the patient's overall prognosis and survival [3], [4], [5], [6], [7], [8]. Nevertheless, few long-term data are available on the morbidity of laparoscopic radical hysterectomy and survival after this procedure.

The purpose of this study was to evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy performed at The University of Texas M. D. Anderson Cancer.

Section snippets

Materials and methods

The medical records of all patients who underwent total laparoscopic radical hysterectomy and lymphadenectomy at M.D. Anderson Cancer Center between May 2004 and August 2005 were reviewed. Institutional Review Board approval was obtained. Data were obtained from medical and pathologic records. All patients entered on the study had their initial pathologic diagnosis confirmed at our institution.

The patient characteristics retrieved were age, body mass index, stage of disease according to the

Results

Twenty patients underwent total laparoscopic radical hysterectomy at M. D. Anderson between May 2004 and August 2005. None of the surgeries required conversion to a laparotomy. No procedures were aborted secondary to evidence of microscopically or macroscopically positive lymph nodes or extracervical disease. Four patients underwent lymphatic mapping and sentinel node biopsy.

The median patient age was 41.5 years (range, 25–76). Eighteen patients had cervix cancer (5 had stage IA2 and 13 stage

Discussion

Our experience shows that total laparoscopic radical hysterectomy is feasible and safe and is associated with a significant lower morbidity rate than the rates reported in the literature for open radical hysterectomy. To date, no randomized trials have been performed comparing laparoscopic and open radical hysterectomy. The largest series thus far on laparoscopic radical hysterectomy, by Spirtos et al. [9], describes 78 consecutive patients, all with early cervical cancer. In that series, 94%

References (16)

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