title: Vaginal-assisted laparoscopic radical hysterectomy (VALRH) versus laparoscopic-assisted radical vaginal hysterectomy (LARVH) in the treatment of cervical cancer: surgical results and oncologic outcome.
abstract: OBJECTIVE
  The aim of this study was to compare the morbidity and survival rates of patients with early-stage cervical cancer treated by vaginal-assisted laparoscopic radical hysterectomy (VALRH) with pair-matched laparoscopic-assisted vaginal radical hysterectomy (LARVH) controls.
  
  
  METHODS
  One hundred nine patients who underwent VALRH for cervical cancer stage FIGO Ia1, L1 to IIb between 2007 and 2009 and 200 patients who underwent LARVH between 1994 and 2002 were analysed in their entirety and in a group of matched pairs.
  
  
  RESULTS
  In both groups, there was no conversion to laparotomy due to an intraoperative complication. Prevalence of blood transfusions was significantly lower in the VALRH group (2 vs. 39 patients; P < 0.001). Bladder function resumed sooner (P < 0.001), and patients were discharged earlier after VALRH (P < 0.001). There were no intraoperative injuries in the VALRH group. In the LARVH group, the most common intraoperative injury occurred to the bladder (7.0 %). Postoperatively, the most common complication in the VALRH group was ureterovaginal fistula (2.7 %) and fever (2.7 %) and in the LARVH ureterostenosis (3.5 %), uretero/bladder fistula (1 %), and fever (7 %). For patients with tumour stage Ib1 the 5-year recurrence-free survival was 92.8 % and 5-year overall survival 95.2 % following VALRH and 88.2 and 90.5 %, respectively, following LARVH. No significant difference in the survival rate was found (log rank, P = 0.740).
  
  
  CONCLUSIONS
  VALRH is a feasible and oncologically safe surgical option for patients with early-stage cervical cancer. We believe the complication rate is lowered in VALRH by the combination of the laparoscopic and vaginal approach.
authors.affiliation: Department of Gynecology, Charité-University Medicine Berlin, Campus Mitte and Benjamin Franklin, Charitéplatz 1, 10117, Berlin, Germany, malgorzata.lanowska@charite.de.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Lanowska
authors.forename: Verena
authors.initials: V
authors.lastname: Brink-Spalink
authors.forename: Mandy
authors.initials: M
authors.lastname: Mangler
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grittner
authors.forename: Elisabeth
authors.initials: E
authors.lastname: von Tucher
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007431:Intraoperative Complications; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D016555:Matched-Pair Analysis; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D014554:Urination; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult