Laparoscopic Radical Surgery In Early-Stage Cervical Cancer: Short-Term And Long-Term Outcomes And Survival Analysis

The purpose of this study was to compare the long-term survival outcomes between laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in early-stage cervical cancer. A multi-center retrospective study was conducted in 1,863 patients who underwent either LRH (n= 1,071) or ORH (n= 792) between January 2007 and May 2014, for FIGO stage IA2-IIA2 cervical cancer. We observed significant differences in operating time, estimated blood loss, complications of vascular injury, return of bowel movement, removal of Foley catheter, post-operative hospital stay, post-operative complications and wound dehiscence between the LRH group and the ORH group (P< 0.05). We did not find any significant difference in the number of lymph nodes removed, overall intra-operative complications, the length of parametrial resection and vaginal cuff, the degree of incontinence, recurrence rate, 5-year overall survival (OS) rate and 5-year disease-free survival (DFS) rate between the two groups (P> 0.05). In addition, we found a significant difference in the 12-month post-operative period for incontinence and sexual dysfunction between the nerve-sparing LRH subgroup and the ORH group, as measured by a stratified analysis of the ICIQ-FLUTS and FSFI (six different domains) questionnaire scores, P< 0.05). In univariate analyses, tumor dimension, clinical stage, deep stromal invasion, LVSI, and LN metastasis significantly affected the 5-year OS and 5-year DFS (P< 0.05). In multivariate analyses, pathological type, clinical stage, LVSI, and LN metastasis were independent of prognostic factors (P< 0.05). LRH for early-stage cervical cancer reduced the estimated blood loss and accelerated the post-operative recovery compared to a laparotomy. The nerve-sparing LRH, in particular improved the quality of life after surgery. Finally, LRH has a similar survival prognosis as ORH.