Combined laparoscopic and vaginal radical surgery in cervical cancer

Objective. The purpose of our study was to review our experience with lapar oscopic staging and vaginal radical surgery in the treatment of early stage cervical cancer. Study Design. We reviewed the charts of 102 patients who had a laparoscopic pelvic lymphadenectomy followed by vaginal radical hysterectomy (VRH) or v aginal radical trachelectomy (VRT). Results. Patients' age ranged from 25 to 68 years (median: 36). Squamous an d adenocarcinoma histology occurred in 68 and 32%, respectively. Stage Ib1 occurred in 77% of cases and the rest were stage Ia1 (1%), 1a2 (16%), and I Ia (6%). Patients were divided into three groups: VRH (57), VRT (34), and n ode only (NO) (11), when positive nodes were identified on frozen section. Median operative time for VRH and VRT were 270 and 260 min compared to 200 min in the NO group (half also had bilateral paraaortic node dissection, wh ich lengthened the OR time). Hospital stay was shorter in the NO group (2 d ays). For each group (VRH, VRT, and NO) the median pelvic node count was 27 , 26, and 23 and the median paraaortic node count was 3, 4, and 9. Two VRH were converted to an abdominal procedure because of technical difficulties and one VRT was converted to a VRH because of positive endocervical margins . Intraoperative complications related to laparoscopy included two iliac an d one epigastric vessel injuries. Complications related to the radical surg eries included three cystostomies, managed vaginally, and a laparotomy for parametrial bleeding after VRT. Postoperative complications occurred in 6% of patients and only one was considered major tan abscess which required su rgical drainage). Overall, there were only four recurrences in the vaginal surgery groups and one in the NO group. There were no ureteral or intestina l injuries and there have been no trocar site recurrences. Conclusion. Our data show that approaching cervical cancer with a combined laparoscopic and vaginal surgery is feasible. The overall morbidity and com plication rate are low and the lymph node count is satisfactory. Staging th e nodes laparoscopically first to identify positive nodes is advantageous, particularly since we favor the use of chemoradiation therapy in those case s. The laparoscopic node staging thus avoids an unnecessary laparotomy in p atients with positive nodes, reduces morbidity, and allows for early radiat ion therapy. (C) 2000 Academic Press.