Minimally invasive surgery improves short-term outcomes of nerve-sparing radical hysterectomy in patients with cervical cancer: a propensity-matched analysis with open abdominal surgery

Abstract

Objectives Nerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes. Methods Data of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied. Results Thirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p<0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test). Conclusion Laparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.

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

“…Since the first MIS was performed 100 years ago, the application of laparoscopy has become a general trend in the era of surgical treatment of tumors. In the management of early-stage cervical cancer, LRH yields benefits such as less blood loss, lower transfusion rates, shorter operative and hospitalization times, faster bowel and bladder function recovery, and fewer postoperative complications than the open approach ( 10 – 14 ). The advantages of LRH were also identified in our study and included shorter operative time, less operative blood loss, and a lower incidence of postoperative ileus.…”

“…The utilization of laparoscopy for minimally invasive surgery (MIS) is a growing trend in gynecologic oncology ( 9 ). 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 ).…”

Primary conization overcomes the risk of developing local recurrence following laparoscopic radical hysterectomy in early stage cervical cancer

“…Propensity score matching allowed the identification of the individual probability of having been treated with laparoscopy or open surgery based on different co‐variables. A detailed description of the propensity score‐matching method is described elsewhere 13 . Demographic (age, BMI, previous abdominal surgery [yes vs no]), clinical (stage), and pathological (FIGO grade [grade 1 and 2 vs 3], histotype [squamous cell vs other]) characteristics were included in the model.…”

Burden of lymphatic disease predicts efficacy of adjuvant radiation and chemotherapy in FIGO 2018 stage IIICp cervical cancer

“…All patients undergoing neoadjuvant chemotherapy had class III radical hysterectomy until 2000 and a nerve-sparing class III (type C1) thereafter 12. Bilateral systematic pelvic lymphadenectomy was performed in all cases including external, internal, obturator fossa, and common iliac lymph nodes; aortic lymphadenectomy was performed routinely between 1990 and 1995, thereafter only in patients with bulky aortic nodes (evident at clinical and radiological examination) or in the presence of positive common iliac nodes assessed at frozen section.…”