Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up.

OBJECTIVE

The purpose of this study was to determine the risk of recurrence and to quantify morbidity and mortality rates in patients with cervical cancer who consented to undergo laparoscopic radical hysterectomy (type III) and retroperitoneal lymphadenectomy.

STUDY

DESIGN

Seventy-eight consecutive patients with stage IA(2) and IB cervical cancer with at least 3 years of follow-up consented to undergo this surgical procedure with argon beam coagulation and endoscopic staplers. All patients had a Quetelet index of <35. The average age was 41.5 years (range, 26-62 years). Sixty-eight patients had squamous cell carcinomas; 8 patients had adenocarcinomas, and 2 patients had adenosquamous carcinomas of the cervix.

RESULTS

All but 5 surgical procedures were completed laparoscopically. The average operative time was 205 minutes (range, 150-430 minutes). The average blood loss was 225 mL (range, 50-700 mL). One patient (1.3%) had transfusion. Operative cystotomies occurred for 3 patients: 2 cystotomies were repaired laparoscopically, and 1 cystotomy required laparotomy. One patient underwent laparotomy because of equipment failure, and another patient underwent laparotomy to pass a ureteral stent. Two other patients underwent laparotomy to control bleeding sites. The average lymph node count was 34 (range, 19-68). Nine patients (11.5%) had positive lymph nodes. All surgical margins were macroscopically negative, but 3 patients had microscopically positive and/or close surgical margins. One patient had a ureterovaginal fistula after the operation that required reoperation. Follow-up has been provided every 3 months. There have been 4 documented recurrences (5.1%), with a minimum of 3 years of follow-up.

CONCLUSION

Laparoscopic radical hysterectomy (type III) can be successfully completed in patients with early-stage cervical cancer with acceptable morbidity. Intermediate-term follow-up validates the adequacy of this procedure.