Elsevier

Gynecologic Oncology

Volume 90, Issue 3, September 2003, Pages 505-511
Gynecologic Oncology

Regular article
Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer

https://doi.org/10.1016/S0090-8258(03)00378-0Get rights and content

Abstract

Objective

The purpose of this study was to determine the survival of cervical cancer patients treated with laparoscopically assisted radical vaginal hysterectomy (LARVH). We quantify morbidity and correlate survival with known risk factors.

Methods

Between August 1994 and June 2002, 200 patients with cervical cancer (TNM stage 1a1, L1 n = 6, 1a2 n = 21, 1b1 n = 89, 1b2 n = 26, 2a n = 11, 2b n = 45, 3a n = 1, 4 n = 1; squamous cell carcinoma 76.5%, adenocarcinoma 23.5%) were treated with LARVH (type II n = 102, type III n = 98).

Results

Paraaortic lymphadenectomy was performed in 170 (85%) patients and pelvic lymphadenectomy was performed in all 200 patients. In 26 (13%) patients positive lymph nodes were found. Major intraoperative injuries occurred in 6% of patients. Postoperative complications occurred in 8% of patients. Incidence of complications decreased significantly when comparing the first half with the second half of patients. After a median follow-up time of 40 months, overall 5-year survival could be projected to 83%; 18.5% of patients experienced recurrence with 35% exclusively extrapelvic and 11% of patients died of recurrence. Independent prognostic factors for recurrence-free survival were tumor stage, lymph node status, and combined involvement of lymphovascular and angiovascular space. In the absence of these risk factors projected 5-year survival was 98%.

Conclusion

Patients with tumor <4 cm, negative lymph nodes, and the absence of the combination of angio- and lymphovascular space involvement can be identified by laparoscopic staging and are ideal candidates for LARVH.

Introduction

Surgical treatment of patients with cervical cancer was standardized 100 years ago by Schauta and his disciple Wertheim in Vienna. Since only an abdominal approach allowed removal of possibly affected regional lymph nodes, the Wertheim operation prevailed. With the introduction of laparoscopic lymphadenectomy radical hysterectomy got its second chance. However, the Schauta operation has not been done for more than 50 years in most institutions. Thus, reintroduction of this type of surgery in combination with laparoscopy was associated with a considerable learning curve and the technique had to be standardized.

Several groups have performed a combination of a laparoscopic and vaginal approach over the past 15 years [1], [2], [3], [4], [5], [6] and for the community of gynecologic oncologists the most important question arises: How safe is this operation with respect to morbidity and cure? We developed and standardized our own technique of laparoscopic-assisted radical vaginal approaches consistent with radicalness of a type II or type III procedure [7], [8], [9], [10], [11]. In this study we focus on our experience with survival, prognostic risk factors, and surgery-associated short-term morbidity in patients with cervical cancer treated by a combined laparoscopic–vaginal approach.

Section snippets

Patients and methods

Between August 1994 and June 2002, 268 consecutive patients underwent primary surgery for cervical cancer FIGO stage 1a1 L1 to 2b of which 200 patients were treated by LARVH at the Department of Gynecology at the Friedrich Schiller University of Jena, Germany. Permission to study the laparoscopic assisted radical vaginal approach for treatment of patients with cervical cancer was given by the Ethical Committee of the Friedrich Schiller University of Jena. During this period 30 patients with

Results

The median age of patients was 46 (17–78) years and median weight was 65 (44–108) kg with a median Quetelet index of 25 (14–38). Stage of disease (TNM) was distributed as follows: stage 1a1, L1 (n = 6), stage 1a2 (n = 21), stage 1b1 (n = 89), stage 1b2 (n = 26), stage IIa (n = 11), stage IIb (n = 45), stage IIIa (n = 1), and stage IV (n = 1). Squamous carcinoma was found in 150 (75%), adenocarcinoma in 47 (23.5%), and neuroendocrine carcinoma in 3 (1.5%) patients. Lymphovascular space

Discussion

Radical abdominal hysterectomy with pelvic and possibly paraaortic lymphadenectomy represents the surgical standard procedure for patients with FIGO stage I–II cervical cancer. Laparoscopic lymphadenectomy in combination with vaginal radical hysterectomy is used as alternative surgical strategy. Experiences of various surgeons showed that a laparoscopic-assisted approach in patients with gynecologic malignancies is associated with low morbidity, little blood loss, good cosmetic results and,

Acknowledgements

We appreciate the assistance of Mrs. Kathleen Polte in data collection and monitoring.

References (35)

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