Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in early stage cervical cancer.

OBJECTIVES: The aim of the study was to evaluate the adequacy, morbidity, and survival outcome of laparoscopic type II radical hysterectomy and pelvic lymphadenectomy in patients with early invasive cervical cancer.

PATIENTS AND METHODS: Between February 2003 and December 2005, 57 patients underwent total laparoscopic radical hysterectomy (TLRH) with pelvic lymphadenectomy. Eligibility criteria were good general condition, tumor size < 3 cm, no evidence of lymph node metastases in imaging study (magnetic resonance imaging and/or computed tomography and/or positron emission tomography) and body mass index < or = 35.

RESULTS: TLRH was completed in 56 patients; in 1 patient, surgery was converted to laparotomy because of positive nodal status at the frozen section. Median age was 43 years and median body mass index was 21.5 kg/m2. The majority of patients (86%) had FIGO stage Ib1 cervical cancer, and the predominant histotype was squamous (59%). Median operating time was 310 minutes and median blood loss 200 mL. No patient required hemotransfusion. Median number of resected lymph nodes was 24, and 6 patients had microscopic node metastasis. Margins were positive in one patient. The only intraoperative complication was a 1-cm cystotomy repaired laparoscopically during the intervention. Four patients required a second surgery, 2 for ureteral stenosis and 2 for the reparation of vaginal cuff diastasis. After a median follow-up of 13 months, 4 patients had a relapse; all 56 patients are alive at present.

CONCLUSIONS: TLRH with pelvic lymphadenectomy is an adequate and feasible surgical option in treating early invasive cervical cancer; however a longer follow-up is required to evaluate the oncologic outcome of these patients.