INTRODUCTION

Early 1900 radical hysterectomy was developed for the treatment of cervical cancer. Initially, this was associated with high morbidity and mortality, so radiation became the favored treatment modality. Notwithstanding, with the emergence of antibiotics, blood transfusions and improvements in anesthesia, surgery regained popularity for the treatment of early stage cervical cancer (stage IA2 and IB1). The National Comprehensive Cancer Network (NCCN), which publishes and continually updates practice guidelines for all areas of cancer care and is used in 115 countries around the world, currently recommends radical hysterectomy with pelvic lymphadenectomy for stage IA2 and IB1 disease in those patients who no longer desire fertility and are good surgical candidates. However, the guidelines do not specify the approach in which this procedure must be accomplished. Until the early 1990s, the standard surgical practice for early stage, non bulky disease was radical abdominal hysterectomy with pelvic lymphadenectomy. In the 1990s, gynecologic oncologists began using a laparoscopic approach with the aim of completing the same surgery with less morbidity. Since that time, several studies have looked at the feasibility of completing the surgery laparoscopically. More recently, researchers examined the morbidity and mortality rates associated with the newer technique. In this study, we compare a cohort of women who underwent laparoscopic radical hysterectomy for early stage cervical cancer to a matched group that underwent open radical hysterectomy and assess the surgical outcomes for both groups.

MATERIALS AND METHODS

After obtaining institutional review board approval, a retrospective chart review was performed looking for all women who had undergone a laparoscopic-assisted vaginal radical hysterectomy and pelvic lymph node dissection for early stage. Between July 2003 and April 2009, nine patients with stage IA2 and IB1 cervical cancer who had undergone the above procedure were identified. The initial diagnosis of cervical cancer was made by histologically confirmed biopsy prior to surgical resection. The patient's assigned stage was based on the clinical staging set forth by the Federation International of Gynecology and Obstetrics (FIGO). We matched a 2:1 cohort of patients by stage who underwent a radical hysterectomy and lymph node dissection through laparotomy. We chose the case immediately proceeding and following each laparoscopic case for comparison. The choice to perform the procedure laparoscopically was left to the discretion of the surgeon after a thorough discussion of risks and benefits with the patients.

Data were then collected on both the laparoscopic cases and the matched open cases. These data included patient demographics of age, body mass index (BMI), race, and tobacco use, tumor histological characteristics, the incidence of positive surgical margins, amount of lymph nodes, and the presence of positive lymph nodes. Additionally, we collected operative outcomes including operating time, blood loss, transfusion requirement, and operative complications, as well as postoperative follow-up including postoperative wound infections, length of stay, adjuvant treatment, and recurrence. None of the parameters analyzed during this study were used to include or exclude patients from the study. All data points were used for comparison between the 2 techniques to determine the feasibility of the laparoscopic technique as an alternative method to laparotomy. Statistical analysis was carried out using the chi-square test where appropriate, with a significance level of P less than .o5

DISCUSSION

Minimally invasive surgery is becoming increasingly popular choice for many gynecological surgery, due to reduced operating blood loss and length of stay after surgery time and faster recovery. Because of the advantages of this type of gynecological oncologists have tried to make the case traditionally opened by laparoscopy. This research focuses on a series of laparoscopic funded vaginal radical hysterectomy and compares the results of operations in the outcome of the case is conducted through traditional abdominal radical hysterectomy. Our results confirm previous findings that the blood loss and length of stay are reduced in laparoscopic cases. In addition, the laparoscopic group makes less operative and postoperative complications.

In order to determine whether a new surgical technique is equivalent to the quality of care, important aspects of criticism are the feasibility and applicability of new techniques, surgical complications and post-operative and cancer cases, survival and risk of recurrence. Several studies have examined the feasibility of laparoscopic radical hysterectomy is completed. In recent years, this technique has been directly compared to traditional laparotomy. Studies conducted before it suggests that laparoscopy is safe and feasible alternative to laparotomy, but to date, no large randomized controlled trials comparing the two techniques. Laparoscopic radical hysterectomy while the more widely practiced, the feasibility and applicability will be evaluated by retrospective studies.

This study adds to the already published data that support the use of laparoscopy as an alternative to laparotomy. Although there are a limited number of patients, this study compared with similar groups at the same time adding to the smaller pool of data that show equivalent results for this new procedure. Despite the difference in length of stay in hospital was the only measure that is not statistically significant, infection of postoperative wounds, blood loss, operative complications and everything seems to be less in cases of laparoscopic case of laparotomy, and may significantly differ in the larger series. In addition, a short stay after laparoscopy previously reported and confirmed once again our results.

It was found that the average operating time was not significantly different between the 2 procedures, 231.7 minutes (range, 148-313) for laparoscopic cases and 207.2 minutes (range 119-340) to be open, but that laparoscopic procedures are being slightly higher in the records of the average. It has been observed in other studies. However, not all studies have shown. Some reports have shown that the case was carried out laparoscopically were much longer. This is probably because laparoscopy is a newer technique, and the learning curve is due to the new procedures. As surgeons have become more comfortable with the technique, working hours should be reduced. It is important to note that there are cases that are more than expected in both open and laparoscopic operative group. The case of laparotomy was 340 minutes was pointed out by other cases less than 300 minutes. The case is complicated injury left external iliac artery and required operating time for most repairs. Early experiments with this technique can also be explained by the large difference in operative time in laparoscopic cases documented. There were no complications that occur in laparoscopic case took 313 minutes, nevertheless, it was the second case in the series. Comparing this with the last recorded case in this series, which was concluded in 148 minutes deprived of complications, it is easy to assume that with time and practice, this procedure has become easier and therefore performs operations faster, As a laparoscopic surgical approach accepted as equivalent results cancer, multiple surgeons aim to adopt the technique, due to decreased morbidity and faster recovery of the patient.

Finally, monitoring of this series is a long stretch of time, the case in 2003 and ending in 2009. The first cases allow a proper assessment of five years of monitoring of recurrence and survival. However, the data are clearly limited to the most recent event. Please note that we have had cases of recurrence or death that do not meet all the results of the literature found. This is probably due to the short follow-up interval following cases and a limited number of series. Despite these limitations, it is promising that these patients have similar results, and even improved in comparison with the case open.

CONCLUSION

Our results add to the results of a large number of surgeons and researchers have shown that laparoscopy can be an alternative to laparotomy for radical hysterectomy. This minimally invasive approach should be considered for the treatment of all women with a small volume of invasive cervical cancer.