Evolution of radical hysterectomy for cervical cancer along the last two decades: single institution experience

Abstract

Background:The radical hysterectomy (RH) surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoscopy at our institution. Methods:We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery: 1990-1999, 2000-2009 and 2010-2013. Patients?characteristics, pathologic details, intraoperative and postoperative complications were analyzed and compared throughout the time periods. Results:A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences (P=0.124) were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 (85.7%), 53 (91.3%) and 26 (86.6%) respectively (P=0.406). Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy (P=0.015). Conclusions:Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation抯 field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.

Feasibility and early oncologic outcomes of Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage (TIRRHVC) for the treatment of clinical stage IB cervical cancer: A tumor containment technique

“…Traditionally, the surgical procedure was a laparotomy. In 1987, Dargent introduced a new surgical technique: laparoscopic radical vaginal hysterectomy and pelvic lymph node dissection ( Arispe et al, 2016 ). Then in 1989, Nezhat reported the first total laparoscopic radical hysterectomy with lymphadenectomy followed in 2006 by Sert and Abler performing the first robotic-assisted radical hysterectomy for early stage cervical cancer ( Arispe et al, 2016 , Geetha and Nair, 2012 ).…”

“…In 1987, Dargent introduced a new surgical technique: laparoscopic radical vaginal hysterectomy and pelvic lymph node dissection ( Arispe et al, 2016 ). Then in 1989, Nezhat reported the first total laparoscopic radical hysterectomy with lymphadenectomy followed in 2006 by Sert and Abler performing the first robotic-assisted radical hysterectomy for early stage cervical cancer ( Arispe et al, 2016 , Geetha and Nair, 2012 ). More surgeons began to adopt minimally invasive surgery (MIS) for the treatment of early-stage cervical cancer because retrospective studies reported decreased blood loss and hospital stay with equivalent oncologic outcomes with MIS compared to laparotomy ( Magrina et al, 2008 , Lee et al, 2011 , Malzoni et al, 2009 , Nam et al, 2012 , Frumovitz et al, 2007 ).…”