Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: morbidity and long-term follow-up.
OBJECTIVE
To study the feasibility, morbidity and outcome of cervical cancer patients treated with laparoscopic assisted radical vaginal hysterectomy (LARVH).


METHODS
The study group included 53 women with cervical cancer (stage-Ib). They included women undergoing LARVH at the joint cancer-centres between 1994 and 2002. Data was collected on operating-time, nodal-yield, hospital-stay, complications recurrence rate and survival rate. The group was followed up until 2006.


RESULTS
Of 53 women who were selected for LARVH, in 2 women LARVH was abandoned when nodes were positive at frozen section. The median age was 42 years while the operating-time was 210 min with a nodal-yield of 23 and a hospital-stay of 5 days. Final histology revealed 10 women with lympho-vascular invasion, 1 nodal metastases and invasion of parametrium/vagina in 2 women. 7 received adjuvant radiotherapy. 3 had chemo-radiation. Complications included voiding difficulty (6), urinary tract infection (5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late complications included lymphoedema (4), urinary incontinence (4), voiding-problems (2), lymphocyst (1), venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months. 4 women had recurrence, of which 3 women died. The five-year survival was 89%.


CONCLUSIONS
Vaginal radical hysterectomy with laparoscopic pelvic lymphadenectomy is feasible and safe with regards to mortality and has low morbidity.
Gynaecological Oncology Cancer Centre, St. Bartholomew's Hospital, London, UK. g.mehra@doctors.org.uk
G
G
Mehra
A
A
Weekes
P
P
Vantrappen
D
D
Visvanathan
A
A
Jeyarajah
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*