Outcome and prognostic factors of laparoscopic radical hysterectomy and pelvic lymphadenectomy in 148 patients with stage IB1 cervical cancer

Abstract

Objective: To evaluate the surgical, oncological outcome and prognostic factors of laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy in patients with stage IB1 cervical cancer.

Materials and methods: Patients with IB1 cervical cancer undergoing LRH at the First People's Hospital of Foshan between January 2000 and March 2010 were enrolled in this study. Follow-up data were available.

Results: A total of 148 patients were identified. One case converted to laparotomy. Median number of resected pelvic lymph nodes was 23. Median blood loss was 250 mL and median operative time was 257 minutes. Intraoperative and postoperative complications occurred in 5.4% and 6.75% patients, respectively. Other medical problems included 47 cases (31.75%) of bladder dysfunction. Twenty-seven patients (18.24%) had microscopic nodal metastasis. A total of 37 patients received adjuvant therapy. After a median follow-up of 28 months, 21 patients had a recurrence. The overall 5-year survival rate is 82%. Univariate analysis showed the factors affecting the survival rate were nonsquamous histologic type, high grade, deep cervical stromal invasion, lymphovascular space invasion, and lymph node metastasis (P = 0.016, P = 0.045, P = 0.021, P = 0.038, and P = <0.001). The Cox proportional hazards regression analysis indicated only lymph node metastasis (odds ratio = 6.293, P < 0.001) was an independent poor prognostic factor.

Conclusions: Laparoscopic radical hysterectomy can be a safe alternative to abdominal RH for patients with IB1 cervical cancer. Lymph node metastasis was an independent poor prognostic factor.