Laparoscopic vs. Open Abdominal Radical Hysterectomy for Cervical Cancer: A Single-Institution, Propensity Score Matching Study in China

Abstract

Study Objective: To compare the surgical and oncologic outcomes between open abdomen radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) for cervical cancer.Methods: Retrospective observational study with propensity score matching was used to ensure balanced groups for ARH and LRH. One-hundred-and-ninety-eight women with cervical cancer, 99 treated using ARH and 99 using LRH, between January 2012 and December 2014. Outcomes included disease-free survival (DFS), overall survival (OS), intra-operative factors, post-operator recovery, urinary retention, and adverse events. Moreover, the inverse probability of the treatment weighting (IPTW) method was also used.Main Results: Compared with ARH, LRH was associated with a lower volume of blood loss (P < 0.001) and transfusion rate (P < 0.001), with a broader resection of the parametrium (P < 0.001). Post-operatively, the time to first flatus was shorter for LRH than ARH (P < 0.001) but the rate of urinary retention was higher for LRH (22.2%) than ARH (8.1%; P = 0.009). DFS and OS were similar between groups. By IPTW, laparoscopy was also not associated with poorer survival in terms of DFS (HR 1.52, CI 0.799–2.891, P = 0.202) or OS (HR 0.942, HR 0.425–2.09, P = 0.883).Conclusion: Compared with ARH, LRH provided better intra-operative and post-operative outcomes, with no significant difference in oncologic outcomes and survival. Urinary retention remains a clinical issue to improve with LRH. The technology of LRH has been improved in China to address the inconsistent results of oncologic outcomes in previous studies. Whether these improvements could be effective needs to be investigated in the future.

Comparison of Survival Outcomes after Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Patients with Cervical Cancer

“…After reviewing the full text of the remaining 77 articles, we included 36 articles in the final analysis (41)(42)(43)(44)(45)(46). Forty studies were excluded from the final review ; they had no available survival outcome data (N = 19).…”

“…Study design Matched 10 (5,11,13,15,16,19,28,30,41,43) 1.49 (1.19-1.88) 0.001 27.5 Fixed effect Retrospective 26 (6-10, 12, 14, 17, 18, 20-27, 29, 31-34, 42, 44-46) 1. (12,13,19,23,24,(27)(28)(29)(30)(31)(32)(33)(34)(42)(43)(44)(45)(46) 1. Small (at least one arm < 90) 18 (5-11, 14-18, 20-22, 25, 26, 41) 0.90 (0.67-1.20)…”

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience

“…Laparoscopic radical hysterectomy (LRH) was shown to have more favorable short-term outcomes than open surgery, including less blood loss, lower transfusion rates, shorter operative times and hospital stays, and fewer postoperative complications ( 10 – 14 ). Several retrospective studies also showed that LRH and ARH have equivalent progression-free survival (PFS) and overall survival (OS) rates ( 11 , 15 , 16 ). LRH has been gradually accepted as a reasonable alternative to ARH for patients with early-stage cervical cancer.…”

Time to accept a new old standard of care in cervical cancer

“…Finally, their efforts to assess how manipulator use and vaginal closure may modify the magnitude of the associations between minimally invasive hysterectomy and adverse survival outcomes is an important step in elucidating the factors that may mediate these effects. While some recent well-designed observational studies have not found an association between minimally invasive radical hysterectomy and recurrence or death, 17 18 the majority of such studies [6][7][8][9][10][11][12][13][14][15] have found evidence of harm. The SUCCOR study delivers another significant blow to a surgical paradigm that is increasingly difficult to justify in routine clinical practice.…”

“…[2][3][4][5] In addition to LACC, these guidelines have cited a growing literature of adequately powered, well-designed observational studies that, overall, have had concordant results. [6][7][8][9][10][11][12][13][14][15] In this issue of the International Journal of Gynecological Cancer, Chiva and colleagues 16 present additional evidence of the deleterious effect of minimally invasive radical hysterectomy, and suggest possible mechanisms underlying this association. The SUCCOR study is a large, retrospective, observational cohort study that evaluates associations between surgical approach and survival outcomes among women with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage 1B1 cervical cancer within 126 institutions in 29 European countries.…”