Laparoscopic pelvic lymphadenectomy and radical vaginal hysterectomy vs. radical abdominal hysterectomy and pelvic lymphadenectomy: a feasibility study

Objective To evaluate the feasibility, complications and preliminary result s of laparoscopic pelvic lymphadenectomy and radical vaginal hysterectomy f or the treatment of early invasive carcinoma of the cervix. Design A retrospective randomized clinical study, Setting The Gynaecology Oncology Unit at the National Women's Hospital, Auc kland, New Zealand. Subjects These were 30 women who had presented to the unit with early stage cervical cancer for whom surgery was thought to be the most appropriate pr imary treatment. Interventions The first 15 consecutive patients who were diagnosed in 1997 (group A) underwent a standard class 2 abdominal radical hysterectomy and p elvic lymphadenectomy The first 15 consecutive patients who were diagnosed in 1998 (group B) underwent a laparoscopic pelvic lymphadenectomy and a vag inal radical hysterectomy. Main outcome measures These included the clinical factors of operating time s, blood loss, complications and hospital stay, and the pathological factor s of lymph node yield, surgical margins and residual tumour size. Results The operating time was slightly longer in group B (mean = 3.18 h). There were no complications in either group but blood loss was halved in gr oup B (mean = 353 mi), Hospital stay was also shorter (mean = 6 days) compa red with group A (mean = 8 days). Lymph node yield was comparable to that o btained in open surgery (mean = 18.1 nodes) and clear margins were obtained in 14 out of 15 patients. Conclusion Our preliminary results demonstrate the feasibility and safety o f laparoscopic pelvic lymphadenectomy and vaginal radical hysterectomy as a n alternative to open radical hysterectomy and pelvic lymphadenectomy.