title: Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer: a randomised controlled trial.
abstract: BACKGROUND
  Non-randomised studies have suggested that the postoperative complications of (Campos LS, Limberger LF, Stein AT, Kalil AN) laparoscopic radical hysterectomy are similar to those in abdominal radical hysterectomy. However, no study evaluating postoperative pain comparing both techniques has been published thus far. Our objective was to compare pain intensity and other perioperative outcomes between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in early cervical cancer.
  
  
  METHODS
  This single centre, randomised, controlled trial enrolled 30 cervical cancer patients who were clinically staged IA2 with lymph vascular invasion and IB according to the FIGO (International Federation of Gynaecology and Obstetrics) classification, and underwent LRH or ARH between late 1999 and early 2004. Postoperative pain, as measured by a 10-point numerical rate scale, was considered the primary endpoint. Postoperative pain was assessed every six hours during a patient's usual postoperative care. Perioperative outcomes were also registered. Both surgical techniques were executed by the same surgical team. Secondary outcomes included intraoperative and other postoperative surgicopathological factors and 5-year survival rates.
  
  
  RESULTS
  IA2 patients with lymphatic vascular space invasion and IB cervical cancer patients were randomised to either the LRH group (16 patients) or the ARH group (14 patients). Four patients (25%) in the LRH group and 5 patients (36%) in the ARH group presented with transoperative or serious postoperative complications. All of the transoperative complications occurred in the LRH group. The relative risk of presenting with complications was 0.70; CI 95% (0.23-2.11); P = 0.694. LRH group mean pain score was significantly lower than ARH after 36 h of observation (P = 0.044; mean difference score: 1.42; 95% CI: 0.04-2.80). The survival results will be published elsewhere.
  
  
  CONCLUSIONS
  LRH provided lower pain scores after 36 h of observation in this series. The perioperative and serious postoperative complications ratios were comparable between the groups.
  
  
  BACKGROUND
  NCT01258413.
authors.affiliation: Serviço de Ginecologia do Hospital Nossa Senhora da Conceição, Av Francisco Trein, 596, Bairro Cristo Redentor CEP, Porto Alegre 91350-200, Brazil. dlu@terra.com.br.
authors.forename: Luciana Silveira
authors.initials: LS
authors.lastname: Campos
authors.forename: Leo Francisco
authors.initials: LF
authors.lastname: Limberger
authors.forename: Airton Tetelbom
authors.initials: AT
authors.lastname: Stein
authors.forename: Antonio Nocchi
authors.initials: AN
authors.lastname: Kalil
mesh_terms: D000328:Adult; D001938:Brazil; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
references.citation: Anesth Analg. 1998 Jan;86(1):102-6
references.pmid: 9428860
references.citation: Surg Endosc. 2011 Jan;25(1):336-7
references.pmid: 20419323
references.citation: J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):584-8
references.pmid: 18722970
references.citation: Am J Obstet Gynecol. 2010 Aug;203(2):118.e1-8
references.pmid: 20522410
references.citation: J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):531-7
references.pmid: 18657483
references.citation: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references.pmid: 15761078
references.citation: Gynecol Oncol. 2012 Oct;127(1):102-6
references.pmid: 22683586
references.citation: Hum Reprod. 2008 Apr;23(4):840-5
references.pmid: 18238905
references.citation: J Minim Invasive Gynecol. 2007 Mar-Apr;14(2):145-52
references.pmid: 17368247
references.citation: BMJ. 2005 Jan 8;330(7482):88
references.pmid: 15637373
references.citation: Int J Gynecol Cancer. 2008 May-Jun;18(3):387-99
references.pmid: 17692084
references.citation: Am J Obstet Gynecol. 2002 Aug;187(2):340-8
references.pmid: 12193922
references.citation: Int J Gynaecol Obstet. 2000 Aug;70(2):209-62
references.pmid: 11041682
references.citation: Br J Anaesth. 2008 Jul;101(1):17-24
references.pmid: 18487245
references.citation: Obstet Gynecol. 1974 Aug;44(2):265-72
references.pmid: 4417035
references.citation: Gynecol Oncol. 2007 Oct;107(1 Suppl 1):S147-9
references.pmid: 17720232
references.citation: Int J Gynecol Cancer. 2007 Sep-Oct;17(5):1075-82
references.pmid: 17386041
references.citation: Gynecol Oncol. 2007 Sep;106(3):502-6
references.pmid: 17553554
references.citation: Am J Obstet Gynecol. 1996 Jun;174(6):1763-7; discussion 1767-8
references.pmid: 8678138
references.citation: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD003677
references.pmid: 19588344
references.citation: Int J Colorectal Dis. 2011 Jan;26(1):53-9
references.pmid: 20922542
references.citation: JSLS. 2009 Oct-Dec;13(4):504-8
references.pmid: 20202391
references.citation: Anesth Analg. 2006 May;102(5):1480-4
references.pmid: 16632830
references.citation: Gynecol Oncol. 2011 Mar;120(3):362-7
references.pmid: 21168904
references.citation: BJOG. 2010 May;117(6):746-51
references.pmid: 20236108
references.citation: Gynecol Oncol. 2007 Apr;105(1):176-80
references.pmid: 17197013
references.citation: Gynecol Oncol. 2006 Aug;102(2):252-5
references.pmid: 16472844
references.citation: Gynecol Oncol. 2008 Sep;110(3 Suppl 2):S21-4
references.pmid: 18486966
references.citation: Obstet Gynecol. 2007 Jul;110(1):96-102
references.pmid: 17601902
references.citation: J Am Assoc Gynecol Laparosc. 2003 Aug;10(3):345-9
references.pmid: 14567809