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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2013

01-03-2013 | Gynecologic Oncology

Laparoscopic Radical Hysterectomy after Preoperative Brachytherapy for Stage IB1 Cervical Cancer: Feasibility, Results, and Surgical Implications in a Large Bicentric Study of 162 Consecutive Cases

Authors: Catherine Uzan, MD, PhD, Benjamin Merlot, MD, Sebastien Gouy, MD, Jérémie Belghiti, MD, Christine Haie-Meder, MD, Philippe Nickers, MD, Narducci Fabrice, MD, Philippe Morice, MD, PhD, Eric Leblanc, MD

Published in: Annals of Surgical Oncology | Issue 3/2013

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Abstract

Purpose

To examine the feasibility and to report the results of laparoscopic radical hysterectomy (LRH) after initial uterovaginal brachytherapy (BT) for stage IB1 cervical cancer.

Methods

We retrospectively reviewed patients at 2 comprehensive cancer centers who underwent initial BT followed 6–8 weeks later by LRH and lymph node dissection.

Results

Between 2003 and 2010, a total of 162 patients underwent LRH. The procedure was feasible via this approach in 160 cases (98.8 %) (2 conversions to laparotomy). Eight perioperative complications occurred. Nineteen patients had nodal involvement. Peri- or postoperative ureteral morbidity occurred in 10 patients (6 %). Twenty-four patients (15 %) experienced postoperative dysuria. Histologically, only 9 patients had residual cervical disease ≥5 mm, and only 1 patient had parametrial lymphovascular space involvement (associated with nodal spread). No patient had vaginal disease or involved surgical margins. After a median follow-up of 39 (range 3–118) months, 9 patients experienced relapse. Five-year overall survival was 95 % (range 88.2–97.9 %).

Conclusions

Radical hysterectomy using a laparoscopic approach is feasible and reproducible after initial BT for stage IB1 cervical cancer and is associated with excellent survival. Morbidity is close to that reported in patients treated with up-front surgery. In this large series, the morbidity associated with parametrial dissection and the fact that parametrial spread was observed in only 0.6 % of the patients suggest that a simple extrafascial hysterectomy is perhaps sufficient in this context; the rate of urinary tract morbidity would then be reduced.
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Metadata
Title
Laparoscopic Radical Hysterectomy after Preoperative Brachytherapy for Stage IB1 Cervical Cancer: Feasibility, Results, and Surgical Implications in a Large Bicentric Study of 162 Consecutive Cases
Authors
Catherine Uzan, MD, PhD
Benjamin Merlot, MD
Sebastien Gouy, MD
Jérémie Belghiti, MD
Christine Haie-Meder, MD
Philippe Nickers, MD
Narducci Fabrice, MD
Philippe Morice, MD, PhD
Eric Leblanc, MD
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2630-x

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