Impact on survival and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy to patients with early-stage cervical cancer / 中华妇产科杂志

ABSTRACT

Objective To compare intraoperative,pathologic,postoperative outcomes and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy ( LRH + LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy ( ARH + APL) for patients with early-stage cervical cancer.Methods The consecutive cases with International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ a2 - Ⅱ a cervical cancer who underwent surgery from Jan.1,2002 to Jan.1,2011 were documented,including 85 patients underwent LRH + LPL,and 85 patients underwent ARH + APL as control group.The clinical data of intraoperative,pathologic,postoperative outcomes and quality of life were compared between two groups.Survival data were estimated using Kaplan-Meier survival curves and compared with the log-rank test.Cox proportional hazards model was used for multivariate analysis.Results All but 2 surgical procedures were completed laparoscopically because of right common ihac vein vessel injuries.Mean operative time,it was longer for LRH + LPL than that for ARH + APL [ (242 ±74) minutes vs.( 190 ±61 ) minutes,P =0.000 ].Mean recovery time of intestines function was less for LRH + LPL than that for ARH + APL [ (45 ± 7 ) hours vs.(63 ± 1 1 ) hours,P =0.000 ].Mean estimated blood loss was less for LRH + LPL than that for ARH + APL[ (367 ±252) ml vs.(460 ±220) ml,P =0.006].Mean recovery time of urinary function was less that for LRH + LPL than that for ARH + APL [ ( 19 ±4) days vs.(21 ±4) days,P =0.000 ].There were no significant difference in numbers of the pelvic lymph nodes resected,the extent of parametrial tissue,vaginal cuff,negative margins obtained and complications.The median follow-up was 32 months (range 4 to 105 months),there was no significant difference in the recurrence rate (7％ vs.5％,P=0.540) and mortality rate (7％ vs.5％,P=0.540),5 years disease-free survival(90％ vs.94％,P =0.812),5 years over survival ( 90％ vs.95％,P =0.532 ).There were not significant difference in quality of life between ARH + APL group and LRH + LPL group( P ＞ 0.05 ).Only lympho-vascular space invasion was an independent prognostic factor by multivariate analysis (P =0.016).Conclusions For early stage cervical cancer,LRH + LPL has similar outcomes compared with ARH + APL.Laparoscopic treatment by experienced surgeons should be an ideal altemative.