Gynecologie, obstetrique, fertilite & senologie · 2026
[Long-term oncological outcomes and morbidity and mortality associated with radical hysterectomy by laparoscopy versus laparotomy for early-stage cervical cancer].
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Zabrian Cristina, Vanoost Antoine, Theret Pierrick, Mancaux Albine, Chatelain Denis, Sergent Fabrice
Аннотация
OBJECTIVE: Since the LACC trial, the ESGO has favoured laparotomy over laparoscopy for radical hysterectomy in early-stage cervical cancer. The aim of our study was to compare recurrence-free survival (RFS) and morbidity between laparoscopy and laparotomy.
MATERIALS AND METHODS: A single-centre, retrospective observational study (2005-2024) of patients treated with type C radical hysterectomy for stage IA2-IIA1 cervical cancer. The use of an intrauterine manipulator without creating a vaginal collar was routine in laparoscopic surgery.
RESULTS: One hundred and two female patients were included, 65 of whom underwent laparoscopic surgery and 37 laparotomy. With a mean follow-up of 6.2 years, no significant difference was observed in terms of disease-free survival (81.6% for laparoscopy vs 74.2% for laparotomy; P=0.24). After adjusting for stage and conisation, the hazard ratio for recurrence following laparotomy was 1.74 (95% CI: [0.67-4.51]). Long-term overall survival showed no difference between the surgical approaches. Laparoscopy offered significant advantages in terms of blood loss (140.6±264ml vs 228±229ml; P<0.05) and length of hospital stay (4.3±2.6 days vs 7.0±2.8 days; P<0.05). Major complications (Clavien-Dindo III-IV) were similar (7.7% with laparoscopy vs 5.4% with laparotomy; P=0.65).
CONCLUSION: When performed by surgeons trained to deal with tumours of a medium size (<2cm), laparoscopy did not compromise overall survival compared with laparotomy, whilst significantly reducing perioperative morbidity.
MATERIALS AND METHODS: A single-centre, retrospective observational study (2005-2024) of patients treated with type C radical hysterectomy for stage IA2-IIA1 cervical cancer. The use of an intrauterine manipulator without creating a vaginal collar was routine in laparoscopic surgery.
RESULTS: One hundred and two female patients were included, 65 of whom underwent laparoscopic surgery and 37 laparotomy. With a mean follow-up of 6.2 years, no significant difference was observed in terms of disease-free survival (81.6% for laparoscopy vs 74.2% for laparotomy; P=0.24). After adjusting for stage and conisation, the hazard ratio for recurrence following laparotomy was 1.74 (95% CI: [0.67-4.51]). Long-term overall survival showed no difference between the surgical approaches. Laparoscopy offered significant advantages in terms of blood loss (140.6±264ml vs 228±229ml; P<0.05) and length of hospital stay (4.3±2.6 days vs 7.0±2.8 days; P<0.05). Major complications (Clavien-Dindo III-IV) were similar (7.7% with laparoscopy vs 5.4% with laparotomy; P=0.65).
CONCLUSION: When performed by surgeons trained to deal with tumours of a medium size (<2cm), laparoscopy did not compromise overall survival compared with laparotomy, whilst significantly reducing perioperative morbidity.