Comparison of oncological outcomes and major complications between laparoscopic radical hysterectomy and abdominal radical hysterectomy for stage IB1 cervical cancer with a tumour size less than 2 cm

Eur J Surg Oncol. 2021 Aug;47(8):2125-2133. doi: 10.1016/j.ejso.2021.03.238. Epub 2021 Mar 22.

Abstract

Objective: To compare the oncological outcomes and major complications of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IB1 cervical cancer (FIGO 2009) with a tumour size less than 2 cm.

Methods: We retrospectively compared the oncological outcomes and major complications of 1207 stage IB1 cervical cancer patients with a tumour size less than 2 cm who received LRH (n = 546) or ARH (n = 661) in 37 hospitals.

Results: (1) There was no significant difference in 3-year overall survival (OS; 97.3% vs. 98.5%, P = 0.288) or 3-year disease-free survival (DFS; 95.1% vs. 95.4%, P = 0.792) between LRH (n = 546) and ARH (n = 661).(2) The rate of any 1 complication refers to the incidence of one or more complications in a patient, which was higher with LRH than ARH (OR = 4.047, 95% CI = 2.035-8.048, P < 0.001). Additionally, intraoperative complications occurred with LRH (OR = 12.313, 95% confidence intervals [CI] = 1.571-96.493, P = 0.017), and postoperative complications (OR = 3.652, 95% CI = 1.763-7.562, P < 0.001) were higher with LRH than ARH. The ureteral injury rate was higher with LRH than with ARH (1.50% vs. 0.20%, OR = 9.814, 95% CI = 1.224-78.712, P = 0.032). The ureterovaginal fistula rate was higher with LRH than ARH. The rates of obturator nerve injury, bladder injury, vesicovaginal fistula, rectovaginal fistula, venous thromboembolism, bowel obstruction, chylous leakage, pelvic haematoma, and haemorrhage were similar between the groups.

Conclusions: The oncological outcomes of LRH and ARH for stage IB1 cervical cancer patients with a tumour size less than 2 cm do not differ significantly. However, incidences of any 1 complication, intraoperative complications, and postoperative complications were higher with LRH than ARH, with complications manifesting mainly as ureteral injury and uterovaginal fistula.

Keywords: Abdominal radical hysterectomy; Cervical cancer; Laparoscopic radical hysterectomy; Major complications; Oncological outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adult
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Hysterectomy / methods*
  • Intestinal Obstruction / epidemiology
  • Intraoperative Complications / epidemiology*
  • Laparoscopy / methods*
  • Lymph Node Excision / methods*
  • Margins of Excision
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Obturator Nerve / injuries
  • Postoperative Complications / epidemiology*
  • Postoperative Hemorrhage / epidemiology
  • Proportional Hazards Models
  • Rectovaginal Fistula / epidemiology
  • Tumor Burden
  • Ureter / injuries
  • Ureteral Diseases / epidemiology
  • Urinary Bladder / injuries
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / surgery*
  • Vaginal Fistula / epidemiology
  • Venous Thromboembolism / epidemiology
  • Vesicovaginal Fistula / epidemiology