Total laparoscopic vs. conventional open abdominal nerve-sparing radical hysterectomy: clinical, surgical, oncological and functional outcomes in 301 patients with cervical cancer

Abstract

Objective: Total laparoscopic nerve-sparing radical hysterectomy (TL-NSRH) has been considered a promising approach, however, surgical, clinical, oncological and functional outcomes have not been systematically addressed. We present a large retrospective multicenter experience comparing TL-NSRH vs. open abdominal NSRH (OA-NSRH) for early and locally-advanced cervical cancer, with particular emphasis on post-surgical pelvic function. Methods: All consecutive patients who underwent class C1-NSRH plus bilateral pelvic + paraaortic lymphadenectomy for stage IA2-IIB cervical cancer at 4 Italian gynecologic oncologic centers (Negrar, Varese, Bologna, Avellino) were enrolled. Patients were divided into TL-NSRH and OA-NSRH groups and were investigated with preoperative questionnaires on urinary, rectal and sexual function. Postoperatively, patients filled a questionnaire assessing quality of life, taking into account sexual function and psychological status. Oncological outcomes were analyzed using Kaplan-Meyer method. Results: 301 consecutive patients were included in this study: 170 in the TL-NSRH group and 131 in the OA-NSRH group. Patients in the OA-NSRH group were more likely to experience urinary incontinence and (after 12-months follow-up) urinary retention. No patient in the TL-NSRH group vs. 5 (5.5%) in the OA-NSRH group had complete urinary retention (at the >24-month follow-up [p=0.02]). A total of 20 (11.8%) in the TL-NSRH and 11 (8.4%) patients in the OA-NSRH had recurrence of disease (p=0.44) and 14 (8.2%) and 9 (6.9%) died of disease during follow-up, respectively (p=0.83). Conclusion: Our study shows that TL-NSRH is feasible, safe and effective and conjugates adequate radicality and improvement in post-operative functional outcomes. Oncological outcomes of laparoscopic procedures deserve further investigation.

A simplified procedure of nerve‐sparing radical hysterectomy

“…In addition, compared to a recent study on NSRH using laparoscopy and laparotomy, our data showed improvement in terms of duration of surgery and blood loss, indicating that the surgical procedure used in our study is less invasive to patients 11 …”

“…In addition, compared to a recent study on NSRH using laparoscopy and laparotomy, our data showed improvement in terms of duration of surgery and blood loss, indicating that the surgical procedure used in our study is less invasive to patients. 11 In recent years, the development of minimally invasive surgery (MIS) has progressed, and laparoscopic surgery and robotic surgery have become more common. There have also been several reports on minimizing the invasiveness of nerve-sparing methods.…”

Can laparoscopic nerve-sparing ultra-radical hysterectomy play a role in locally advanced cervical cancer? A single-center retrospective study

“…However, owing to the difference in the advancement of medical and healthcare facilities across the world, there is a deviation in clinical staging before surgery, an imbalance in the radiotherapy resources, limitations of regional-related medical conditions, and the subjective choice made by patients, considering that a considerable number of patients continue to opt for surgical resection as an initial treatment ( 33 – 35 ). In recent years, with the development of the minimally invasive concept, surgical instruments, and relevant technology, laparoscopic RH for cervical cancer has been proved to be safe and effective, thereby gradually replacing the traditional open surgery approach ( 36 , 37 ).…”

Association of preoperative cone biopsy with recurrences after radical hysterectomy

“…Although the LACC trial did not demonstrate a significant quality-of-life benefit from a laparoscopic procedure, other studies suggest reduced complication rates, shorter hospital stays and lower costs [15,[26][27][28][29]. The question arises whether laparoscopic radical hysterectomy is a medically justifiable procedure in certain cases.…”