Gynecology
Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: Surgical morbidity and intermediate follow-up

https://doi.org/10.1067/mob.2002.123035Get rights and content

Abstract

Objective: The purpose of this study was to determine the risk of recurrence and to quantify morbidity and mortality rates in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy (type III) and retroperitoneal lymphadenectomy. Study Design: Seventy-eight consecutive patients with stage IA2 and IB cervical cancer with at least 3 years of follow-up consented to undergo this surgical procedure with argon beam coagulation and endoscopic staplers. All patients had a Quetelet index of <35. The average age was 41.5 years (range, 26-62 years). Sixty-eight patients had squamous cell carcinomas; 8 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix. Results: All but 5 surgical procedures were completed laparoscopically. The average operative time was 205 minutes (range, 150-430 minutes). The average blood loss was 225 mL (range, 50-700 mL). One patient (1.3%) had transfusion. Operative cystotomies occurred for 3 patients: 2 cystotomies were repaired laparoscopically, and 1 cystotomy required laparotomy. One patient underwent laparotomy because of equipment failure, and another patient underwent laparotomy to pass a ureteral stent. Two other patients underwent laparotomy to control bleeding sites. The average lymph node count was 34 (range, 19-68). Nine patients (11.5%) had positive lymph nodes. All surgical margins were macroscopically negative, but 3 patients had microscopically positive and/or close surgical margins. One patient had a ureterovaginal fistula after the operation that required reoperation. Follow-up has been provided every 3 months. There have been 4 documented recurrences (5.1%), with a minimum of 3 years of follow-up. Conclusion: Laparoscopic radical hysterectomy (type III) can be successfully completed in patients with early-stage cervical cancer with acceptable morbidity. Intermediate-term follow-up validates the adequacy of this procedure. (Am J Obstet Gynecol 2002;187:340-8.)

Section snippets

Material and methods

From July 1, 1994, through December 31, 1996, 84 patients with stage IA2 or IB cervical cancer underwent laparoscopy with the intent to perform a radical hysterectomy (type III) with pelvic and aortic lymph node dissection (Table).

Table. Patients with recurrent disease and survival categorized by surgical and pathologic findings

FindingPatients (No.)Recurrent disease (%)Patients alive (%)
Stage
Ia226896
IB521292
Grade
192278
220095
3491296
Cell type
Squamous681096
Adenocarcinoma81388
Adenosquamous25050

Results

Six of the 84 patients were found to have either microscopically or macroscopically positive aortic lymph nodes, macroscopically positive pelvic lymph nodes, or extracervical disease and were excluded from this analysis. The remaining 78 patients serve as the basis of this report. All patients had a GOG performance status of 0 or 1 and a Quetelet index of <35.4, 5 The average age was 41.5 years (range, 26-62 years).9 Sixty-eight patients had squamous cell carcinoma; 8 patients had

Comment

Issues regarding the use of minimally invasive surgical techniques in the patient cervical cancer, center on (1) applicability, (2) operative and postoperative morbidity and mortality, (3) risk of recurrence and overall survival, and (4) adequacy.

Seventy-three of 84 patients (89%) with stage IA and IB cervix cancer successfully underwent laparoscopic radical hysterectomy with or without adnexectomy and aortic and pelvic lymph node dissection in patients with Quetelet indices <35. To discuss the

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Reprint requests: Nick M. Spirtos, MD, Women's Cancer Center, 900 Welch Road, Suite 300, Palo Alto, CA 94304.

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