Laparoscopically-assisted radical vaginal hysterectomy with five years follow-up: a case control study

Objective: To compare a novel surgical approach, laparoscopically-assisted radical vaginal hysterectomy (LARVH) with abdominal radical hysterectomy in women with cervical cancer, and to investigate whether selected women benefit from the minimally-invasive approach without high recurrence rate and complications. Materials and Methods: Forty women undergoing LARVH were included and compared with 40 women undergoing abdominal radical hysterectomy. The control group was matched for age and disease stage. Retrospective chart review was performed and patients were followed for an average of 2.5 years. Results: Blood loss was significantly increased in the control group (343.3 vs 606.3 ml, p = 0.012). Transfusions were given in 42.5% of women in the control group and 17.5% in the LARVH group. Mean operative time was longer in the control group (151 vs 240 minutes p = 0.0001). Mean nodal counts did not show a significant difference (27.3 in control vs 21.4 in LARVH, p = 0.886). Recurrence group was 7.5% at mean follow up of 30.1 months in LARVH group and in 30.8 months follow-up. Conclusions: The LARVH procedure was comparable in terms of safety (recurrence and complication rates) meanwhile LARVH showed minimally-invasive advantages in terms of blood loss, operative time, and shorter hospital stay.

Cervical carcinoma; Laparoscopic surgery; LARVH.

[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”. Gynecol. Oncol., 2003, 90, 505.

[2] Jackson K.S., Das N., Naik R., Lopes A.D., Godfrey K.A., Hatem M.H., Monaghan J.M.: “Laparoscopically assisted radical vaginal hysterectomy vs radical abdominal hysterectomy for cervical cancer: a match controlled study”. Gynecol. Oncol., 2004, 95, 655.

[3] Steed H., Rosen B., Murphy J., Laframboise S., De Petrillo D., Covens A.: “A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer”. Gynecol. Oncol., 2004, 93, 588.

[4] Morgan D.J., Hunter D.C., McCracken G., McClelland H.R., Price J.H., Dobbs S.P.: “Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up”. BJOG, 2007, 114, 537.

[5] Pomel C., Atallah D., Le Boueded G., Rouzier R., Morice P., Castaigne D., Dauplat J.: “Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study”. Gynecol. Oncol., 2003, 91, 534.

[6] Nezhat F., Yadav J., Rahaman J., Gretz H., Gardener G.J., Cohen C.J.: “Laparoscopic lymphadenectomy for gynecologic malignancies using ultrasonically activated shears: analysis of first 100 cases”. Gynecol. Oncol., 2005, 97, 813.

[7] Querleu D.: “Laparoscopically assisted radical vaginal hysterectomy”. Gynecol. Oncol., 1993, 51, 248.

[8] Sardi J., Vidaurreta J., Bermudez A., di Paola G.: “Laparoscopically assisted Schauta operation: learning experience at the gynaecologic oncology unit” Buenos Aires University Hospital. Gynecol. Oncol., 1999, 75, 361.

[9] 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”. Gynecol. Oncol., 2003, 90, 505.

[10] Roy M., Plante M., Renaud M.C., Tetu B.: “Vaginal radical hysterectomy versus abdominal radical hysterectomy in the treatment of early-stage cervical cancer”. Gynecol. Oncol., 1996, 62, 336.

[11] Spiritos N.M., Eisenkop S.M., Schlaerth J.B., Ballon S.C.: “Laparoscopic radicalhysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow up”. Am. J. Obstet. Gynecol., 2002, 187, 340.

[12] Steed H., Rosen B., Murphy J., Laframboise S., De Petrillo D., Covens A.: “A comparison of laparoscopic-assisted radical vaginal hysterectomy in the treatment of cervical carcinoma”. Gynecol. Oncol., 2004, 93, 588.

[13] Plante M., Renaud M.C., Hoskins I.A., Roy M.: “Vaginal radical trachelectomy: a valuable fertility preserving option in the management of early stage cervical cancer. A series of 50 pregnancies and review of the literature”. Gynecol. Oncol., 2005, 98, 3.

[14] Plante M., Renaud M.C., Roy M.: “Radical vaginal trachelectomy: a fertility preserving option for young women with early stage cervical cancer”. Gynecol. Oncol., 2005, 99, 143.

[15] Boss E.A., van Golde R.J., Beerendonk C.C., Massuger L.F.: “Pregnancy after radical trachelectomy: a real option?”. Gynecol. Oncol., 2005, 99, 152.

[16] Eltabbakh G., Shamonki M.I., Moody J.M., Garafeno L.L.: “Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma”. Cancer, 2001, 91, 378.

[17] Zapico A., Fuentes P., Grassa A., Arnanz F., Otazua J., Cortes-Prieto J.: “Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in Stages I and II endometrial cancer: Operating data, follow-up and survival”. Gynecol. Oncol., 2005, 98, 222.

[18] Tozzi R., Malur S., Kochler C., Schneider A.: “Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy?” Gynecol. Oncol., 2005, 97, 4.