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Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched
Giorgio Bogani1, Antonella Cromi1, Stefano Uccella1
1Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Study Objective:
To compare perioperative and long-term outcomes related to laparoscopic and open abdominal surgical management of cervical cancer.
Design:
Propensity-matched comparison of prospectively collected data (Canadian Task Force classification II-1).
Setting:
University teaching hospital.
Patients:
Sixty-five propensity-matched patient pairs (130 patients) undergoing either laparoscopy or open abdominal surgical procedures to treat cervical cancer.
Intervention:
Radical hysterectomy plus lymphadenectomy was performed via the laparoscopic (LRH) or open abdominal approach (RAH).
Measurement And Main Results:
Baseline characteristics of the study populations were similar. In the LRH group the procedure was converted to open surgery in 2 patients (2%). Compared with the RAH group, patients undergoing LRH experienced less blood loss (200 vs 500 mL; p < .001), a lower transfusion rate (6% vs 22%; p = .02), similar operative time (245 vs 259.5 minutes; p = .26), and shorter length of hospital stay (4 vs 8 days; p < .001). No between-group differences in intraoperative complications were recorded (p = 1.0); however, a trend toward a lower postoperative complication rate (Accordion system grade ≥ 3) was observed for LRH compared with RAH (4 patients [6%]) vs 12 patients [18%]; p = .06). Five-year disease-free survival (p = .6, log-rank test) and overall survival (p = .31, log-rank test) did not differ statistically between women undergoing LRH or RAH.
Conclusion:
Laparoscopy ensures the same results as open surgery insofar as radicality and long-term survival. Use of the laparoscopic approach is associated with improved short-term results, minimizing the occurrence of severe postoperative complications.
