Survival after Laparoscopic versus Abdominal Radical Hysterectomy in Early Cervical Cancer: A Randomized Controlled Trial

Abstract

Background: Previous studies have reported the safety of laparoscopic radical hysterectomy for treatment of early cervical cancer, as option to laparotomy. This study aims to compare overall survival between laparoscopic versus abdominal radical hysterectomy for early cervical cancer. Methods: A single-center randomized controlled trial enrolled 30 patients with clinically staged IA2 cervical cancer and lymphovascular invasion, IB and IIA, who underwent laparoscopic radical hysterectomy ( 16) or abdominal radical hysterectomy (14). Result: The mean overall survival time was 74.74 months (CI 95%: 54.15-95.33) for LRH 91.67 months (CI 95%: 74.97-108.37) for ARH (logrank test = 0.30). The mean disease-free survival time was 81.07 months (CI 95%: 60.95-101.19) for LRH and 95.82 months ) for ARH (log-rank test = 0.371). The overall survival hazard ratio was 2.05 (CI 95%: 0.51-8.24), and the disease-free hazard ratio was 2.13 (CI 95%: 0.39-11.7). Conclusion: Our study suggests a nonsignificant trend of worse outcomes for LRH. In light of recent controversy and need for prospective studies, further studies in different populations are required for definite conclusions and until then, patients should be aware of risks and benefits, survival data and quality of life outcomes related to both surgical techniques.

Radical Hysterectomy for Early Stage Cervical Cancer

“…The pooled hazard ratio was 71% higher for patients having minimally invasive surgery in comparison with patients having open radical hysterectomy [ 18 ]. After the publication of the results of LACC trial, other studies observed similar findings, even in the population with tumor diameter < 2 cm [ 19 , 20 ]. However, another randomized prospective study (a part of the LACC trial [ 13 ]) compared minimally invasive and open radical hysterectomy [ 20 ].…”

“…After the publication of the results of LACC trial, other studies observed similar findings, even in the population with tumor diameter < 2 cm [ 19 , 20 ]. However, another randomized prospective study (a part of the LACC trial [ 13 ]) compared minimally invasive and open radical hysterectomy [ 20 ]. This study enrolled only 30 patients (including 16 and 14 laparoscopic and open radical hysterectomy, respectively).…”

“…The overall survival hazard ratio was 2.05 (CI 95%: 0.51–8.24), and the disease-free survival hazard ratio was 2.13 (CI 95%: 0.39–11.7). The difference was not statistically significant (possibly due to the small sample size) [ 20 ].…”

“…The MEMORY study had a particularly high proportion of patients who underwent robotic-assisted procedures [ 38 ]. The LACC trial, the SUCCOR study, and other studies were evaluated for most patients who had laparoscopic surgery [ 13 , 20 , 34 ]. A notable criticism against the LACC trial is the low prevalence of robotic-assisted radical hysterectomy [ 13 ].…”

Comparison of Minimally Invasive Versus Abdominal Radical Hysterectomy for Early-Stage Cervical Cancer: An Updated Meta-Analysis

“…The basic characteristics of selected studies are listed in Table 1 . Two studies were RCTs ( 12 , 29 ), and the remaining were observational studies ( 10 , 11 , 14 – 17 , 21 – 28 , 30 – 61 ) (n=46). Three treatment modalities were adopted by contrast: MIS (laparoscopic radical hysterectomy plus robot-assisted radical hysterectomy) versus ARH (n=10), laparoscopic radical hysterectomy versus ARH (involved 31 studies), and robot-assisted radical hysterectomy versus ARH (involved 10 studies).…”