Laparoscopic Versus Open Abdominal Management of Cervical Cancer: Long-Term Results From a Propensity-Matched Analysis

摘要

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 500mL; p<.001), a lower transfusion rate (6% vs 22%; p=.02), similar operative time (245vs 259.5minutes; 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.