Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Oct 1;2013(10):CD006651.
doi: 10.1002/14651858.CD006651.pub3.

Laparoscopically assisted radical vaginal hysterectomy versus radical abdominal hysterectomy for the treatment of early cervical cancer

Ali Kucukmetin  1 , Ioannis Biliatis, Raj Naik, Andrew Bryant
Affiliations
Comparative Study

Laparoscopically assisted radical vaginal hysterectomy versus radical abdominal hysterectomy for the treatment of early cervical cancer

Ali Kucukmetin et al. Cochrane Database Syst Rev. .

Abstract

Background: Cervical cancer is the second most common cancer among women and is the most frequent cause of death from gynaecological cancers worldwide. Standard surgical management for selected early-stage cervical cancer is radical hysterectomy. Traditionally, radical hysterectomy has been carried out via the abdominal route and this remains the gold standard surgical management of early cervical cancer. In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery.

Objectives: To compare the effectiveness and safety of laparoscopically assisted radical vaginal hysterectomy (LARVH) and radical abdominal hysterectomy (RAH) in women with early-stage (1 to 2A) cervical cancer.

Search methods: We searched the Cochrane Gynaecological Cancer Group Trials Register, and Cochrane Register of Controlled Trials (CENTRAL) Issue 7, 2013, MEDLINE, and EMBASE up to July 2013. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.

Selection criteria: Randomised controlled trials (RCTs) that compared laparoscopically assisted radical hysterectomy and radical abdominal hysterectomy, in adult women diagnosed with early (stage 1 to 2A) cervical cancer.

Data collection and analysis: Two review authors independently abstracted data and assessed risk of bias.

Main results: We found one RCT, which included 13 women, that met our inclusion criteria and this trial reported data on LARVH versus RAH.Women who underwent LARVH for treatment of early-stage cervical cancer appeared to have less blood loss compared with those who underwent RAH. The trial reported a borderline significant difference between the two types of surgery (median blood loss 400 mL (interquartile range (IQR): 325 to 1050) and 1000 mL (IQR: 800 to 1025) for LARVH and RAH, respectively, P value = 0.05). RAH was associated with significantly shorter operation time compared with LARVH (median: 180 minutes with LARVH versus 138 minutes with RAH, P value = 0.05).There was no statistically significant difference in the risk of perioperative complications in women who underwent LARVH and RAH. The trial reported two (29%) and four (57%) cases of intraoperative and postoperative complications, respectively, in the LARVH group and no (0%) reported cases of intraoperative complications and five (83%) cases of postoperative complications in the RAH group. There were no reported cases of severe perioperative complications.Bladder and bowel dysfunction of either a transient or chronic nature remain major morbidities after radical hysterectomy, and the one included study showed that there may be significantly less after LARVH.

Authors' conclusions: The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore, the absence of reliable evidence, regarding the effectiveness and safety of the two surgical techniques for the management of early-stage cervical cancer, precludes any definitive guidance or recommendations for clinical practice. The trial did not report data on long-term outcomes, but was at moderate risk of bias due to very low numbers of included women.

PubMed Disclaimer

Conflict of interest statement

Raj Naik is an author of the included randomised controlled trial and was involved in the conduct of the trial.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD006651.pub2

References

References to studies included in this review

Naik 2010 {published data only}
    1. Naik R, Jackson KS, Lopes A, Cross P, Henry JA. Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy - a randomised phase II trial: perioperative outcomes and surgicopathological measurements. BJOG: An International Journal of Obstetrics and Gynaecology 2010;117(6):746-51. - PubMed

Additional references

Bergmark 2002
    1. Bergmark K, Avall-Lundqvist E, Dickman P, Henningsohn L, Steineck G. Patient rating of distressful symptoms after treatment for early cervical cancer. Acta Obstetrica Gynaecologica Scandinavica 2002;81:443-50. - PubMed
Canis 1992
    1. Canis M, Maze G, Wattiez A, Pouly JL, Chapron C, Bruhat MA. Vaginally assisted laparoscopic radical hysterectomy. Journal of Gynaecological Surgery 1992;8:103-5.
Cantrell 2010
    1. Cantrell LA, Mendivil A, Gehrig PA, Boggess JF. Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience. Gynecologic Oncology 2010;117:260-5. - PubMed
Childers 1995
    1. Childers JM, Nasseri A. Minimal access surgery in gynaecologic cancer: we can but should we? Current Opinion in Obstetrics and Gynecology 1995;7:17-62. - PubMed
Comerci 1998
    1. Comerci G, Bolger B, Flannelly G, Maini M, Lopes AD, Monaghan JM. Prognostic factors in surgically treated Stage 1B-11B carcinoma of the cervix with negative lymph nodes. International Journal of Gynaecological Cancer 1998;8:23-6. - PubMed
CTCAE 2006
    1. CTCAE. Common Terminology Criteria for Adverse Events. ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3... (accessed 6 September 2013);v3.0 (CTCAE).
Cuschieri 1999
    1. Cuschieri A. Technology for minimal access surgery. BMJ 1999;319:1304-19. - PMC - PubMed
Dargent 1987
    1. Dargent D. A new future for Schauta's hysterectomy through pre-surgical retroperitoneal pelviscopy. European Journal of Gynaecological Oncocology 1987;8:292-5.
Dargent 2000
    1. Dargent D, Martin X, Ansquer Y, Benchaim M, Mathevet P. Laparoscopic vaginal radical hysterectomy (LVRH) or celioschauta: evolution of the concept and outcomes in. Gynecologic Oncology 2000;76:230-84.
Dargent 2003
    1. Dargent D. Laparoscopic assisted radical vaginal hysterectomy: evolution of a concept. CME Journal of Gynecology and Oncology 2003;20:102-9.
Deeks 2001
    1. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors(s). Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd edition. London: BMJ Publication Group, 2001.
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials 1986;7:177-88. - PubMed
Di Saia 2002
    1. Di Saia PJ, Creasman W. Invasive cervical cancer. In: Di Saia, Creasman WT, editors(s). Clinical Gynecologic Oncology. St Louis, MO, USA: Mosby, 2002.
Eltabbakh 2000
    1. Eltabbakh GH. Effect of surgeon's experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer. Gynecological Oncology 2000;78:58-61. - PubMed
EUROCARE 2003
    1. Sant M, Aareleid T, Berrino F, Bielska Lasota M, Carli PM, et al, and the EUROCARE Working Group. EUROCARE-3: survival of cancer patients diagnosed 1990-94 - results and commentary. Annals of Oncology 2003;14 (Suppl 5):v61-v118. - PubMed
Geisler 2010
    1. Geisler JP, Orr CJ, Khurshid N, Phibbs G, Manahan KJ. Robotically assisted laparoscopic radical hysterectomy compared with open radical hysterectomy. International Journal of Gynecological Cancer 2010;20(3):438-42. - PubMed
GLOBOCAN 2008
    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008, cancer incidence and mortality worldwide. International Agency for Research on Cancer CancerBase No. 10, 2010. globocan.iarc.fr (accessed 8 September 2013).
GRADE Working Group
    1. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490-94. - PMC - PubMed
Hagen 2000
    1. Hagen B, Shepherd JH, Jacobs IJ. Parametrial resection for invasive cervical cancer. International Journal of Gynaecological Cancer 2000;10:1-6. - PubMed
Hertel 2003
    1. Hertel H, Kohler C, Michels W, Possover M, Tozzi R, Schneider A. Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecologic Oncology 2003;90:505-11. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Jackson 2004
    1. Jackson KS, Das N, Naik R, Lopes AD, Godfrey KA, Hatem MH, et al. Laparoscopically assisted radical vaginal hysterectomy vs. radical abdominal hysterectomy for cervical cancer: a match controlled study. Gynecologic Oncology 2004;95:655-61. - PubMed
Johnson 2008
    1. Johnson NP, Selman T, Zamora J, Khan KS. Gynaecologic surgery from uncertainty to science: evidence-based surgery is no passing fad. Human Reproduction 2008;23(4):832-9. - PubMed
Kadar 1993
    1. Kadar N, Reich H. Laparoscopic assisted radical Schauta hysterectomy and bilateral pelvic lymphadenectomy for the treatment of bulky stage 1B cancers of the cervix. Gynaecological Endoscopy 1993;2:135-42.
Lopes 1995
    1. Lopes AD, Hall JR, Monaghan JM. Drainage following radical hysterectomy and pelvic lymphadenectomy: dogma or need? Obstetrics and Gynecology 1995;86:960-3. - PubMed
Malur 2001
    1. Malur S, Possover M, Schneider A. Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer. Surgical Endoscopy 2001;15:289-92. - PubMed
NICE 2010
    1. National Institute for Health and Clinical Excellence (NICE). Laparoscopic radical hysterectomy for early stage cervical cancer. Interventional procedure guidance 338, 2010. guidance.nice.org.uk/IPG338 (assessed 8 September 2013).
Obermair 2008
    1. Obermair A, Gebski V, Frumovitz M, Soliman PT, Schmeler KM, Levenback C, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. Journal of Minimally Invasive Gynecology 2008;15(5):584-8. - PubMed
Pahisa 2010
    1. Pahisa J, Martinez-Roman S, Torne A, Fuste P, Alonso I, Lejarcegui JA, et al. Comparative study of laparoscopically assisted radical vaginal hysterectomy and open Wertheim-Meigs in patients with early-stage cervical cancer: eleven years of experience. International Journal of Gynecological Cancer 2010;20:173-8. - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815-34. - PubMed
Pecorelli 2009
    1. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. International Journal of Gynaecology and Obstetrics 2009;105(2):103-4. - PubMed
Querleu 1993
    1. Querleu D. Laparoscopic assisted radical vaginal hysterectomy. Gynaecological Oncology 1993;51:248-54. - PubMed
Roy 2011
    1. Roy M, Plante M. Place of Schauta's radical vaginal hysterectomy. Best Practice and Research Clinical Obstetrics and Gynaecology 2011;25(2):227-37. - PubMed
Sharma 2006
    1. Sharma R, Bailey J, Anderson R, Murdoch J. Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta): A comparison with open Wertheim/Meigs hysterectomy. International Journal of Gynecological Cancer 2006;16:1927-32. - PubMed
Spirtos 1996
    1. Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC. Laparoscopic radical hysterectomy with aortic and pelvic lymphadenectomy: surgical morbidity and intermediate follow-up. American Journal of Obstetrics and Gynaecology 1996;174:1763-8. - PubMed
Yim 2011
    1. Yim GW, Kim SW, Nam EJ, Kim YT. Role of robot-assisted surgery in cervical cancer. International Journal of Gynecological Cancer 2011;21(1):173-81. - PubMed

Publication types