TOTAL LAPAROSCOPIC VERSUS ABDOMINAL RADICAL HYSTERECTOMY WITH PELVIC AND PARAAORTIC LYMPHADENECTOMY IN MANAGEMENT OF GYNECOLOGIC MALIGNANCIES

K. Zakashansky, A.A. Shamshirsaz, S. Dennis, A. Mahdavi, J. Rahaman, H. Gretz, L. Chuang, C.J. Cohen, F.R. Nezhat

Mt. Sinai Hospital, New York, NY

OBJECTIVE: To compare the feasibility, safety and potential benefits of laparoscopic radical hysterectomy with laparoscopic pelvic and paraaortic lymph node dissection versus radical abdominal hysterectomy with pelvic and paraaortic lymphadenectomy in treatment of gynecologic malignancies.

MATERIALS AND METHODS: We identified all patients treated by total laparoscopic radical hysterectomy and lymph node dissection (TLRH) by our Gynecologic Oncology Division between August 2000 and September 2004. For the same time period a comparable sample of the patients who were treated with total radical abdominal hysterectomy and lymphadenectomy (ARH) was selected. Most of the laparoscopic surgeries were performed by a team consisting of gynecologic oncology attending with extensive laparoscopic experience, one fellow and one resident. Clinical data for both the abdominal and the laparoscopic groups was analyzed retrospectively by review of patients’ medical records and operative reports.

RESULTS: We identified a total of eighteen cases treated with TLRH, which were compared with a cohort of twenty four patients treated with ARH. All of the laparoscopic cases were completed laparoscopically without conversion to laparotomy. The difference in mean duration of surgery was not significant (312 vs 234 min), nor was the difference in number of pelvic and paraaortic lymph nodes removed (27 vs 24). Blood loss was significantly less (251 vs 402 cc) in the laparoscopic group. The difference in mean duration of hospitalization approached statistical significance (4.4 vs 5.5 days in laparotomy sample). The only intraoperative complication in the laparoscopic group was a bladder injury that was recognized intraoperatively and treated laparoscopically. Postoperatively, one patient developed femoral vein thrombosis and another developed small bowel obstruction and urinary dysfunction. The complications in the abdominal group included one postoperative hemorrhage necessitating re-exploration. Other complications in the abdominal group included wound infection and urinary retention.

CONCLUSION: Compared with laparotomy, the laparoscopic approach for treatment of gynecologic malignancies requiring radical hysterectomy is associated with less blood loss and shorter hospital stay. There was no significant difference in duration of surgery, and there was comparable lymph nodes yield and acceptable safety profile. Total laparoscopic radical hysterectomy seems to be a safe alternative to the traditional open abdominal approach.  Prospective studies are needed to show equivalency of these two approaches in terms of progression free and overall survival.

Key Words: laparoscopy, radical hysterectomy, gynecologic malignancy

Disclosure – Nothing to disclose.