title: Open versus laparoscopic pelvic lymph node dissection in early stage cervical cancer: no difference in surgical or disease outcome.
abstract: OBJECTIVE
  This study aimed to investigate in a retrospective study the effect of laparoscopic surgery, introduced in our center in 1994 as part of the standard treatment of early stage cervical cancer, on surgical and disease outcomes.
  
  
  METHODS
  A total of 169 women with cervical carcinoma stage IB1 (n = 150) or IB2 (n = 19) were included in the study. Seventy-six patients who underwent laparoscopic pelvic lymph node dissection (LPLND), followed either by open radical hysterectomy (n = 63) or, in case of positive lymph nodes, by primary chemoradiation (n = 13), were compared with an historic cohort of 93 patients who underwent a fully open, traditional Wertheim-Meigs procedure (WM). Recorded clinical characteristics of patients included age, International Federation of Gynecology and Obstetrics stage, histologic diagnosis, differentiation grade, tumor diameter, lymph node status, and adjuvant therapy. Operation time; lymph node yield; intraoperative, early, and late complications; site of recurrences; and disease-free and overall survival rates were analyzed and compared between groups.
  
  
  RESULTS
  Clinical characteristics did not differ between groups. Duration of total surgery time was longer in patients with LPLND followed by open radical hysterectomy compared with that in the WM group (P < 0.001). In patients with negative lymph nodes (n = 129), the number of resected nodes was higher (P = 0.002) in the LPLND (median, 26 nodes; range, 8-55 nodes) than in the WM group (median, 21 nodes; range, 7-50 nodes). In patients with positive lymph nodes (n = 40), no significant difference in the number of resected lymph nodes between the 2 groups (P = 0.904) was found. Intraoperative, early, and late complications did not differ between the 2 surgical procedures. The number of locoregional recurrences, but not of distant metastases, was significantly higher (P = 0.018) in the WM group compared with the LPLND group. No difference in disease-free or disease-specific survival was found between the LPLND and WM group, neither with nor without adjuvant or primary (chemo)radiation. A benefit in disease-free survival (P = 0.044), but not in disease-specific survival (P = 0.070), was found in the LPLND compared with the WM group in those patients who received adjuvant therapy or primary chemoradiation.
  
  
  CONCLUSIONS
  Introduction of a laparoscopic procedure in the surgical staging and treatment of cervical cancer patients did not have a detrimental effect on surgical or disease outcome, and this can be safely applied to the treatment of early stage cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Centre for Gynecologic Oncology Amsterdam, location VU, VU University Medical Centre, Amsterdam.
authors.forename: Jonas
authors.initials: J
authors.lastname: van de Lande
authors.forename: Silvia
authors.initials: S
authors.lastname: von Mensdorff-Pouilly
authors.forename: Roelof G
authors.initials: RG
authors.lastname: Lettinga
authors.forename: Jurgen M
authors.initials: JM
authors.lastname: Piek
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy