Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched analysis.
OBJECTIVE
To compare perioperative and long-term outcomes related to laparoscopic and open abdominal surgical management of cervical cancer.


METHODS
Propensity-matched comparison of prospectively collected data (Canadian Task Force classification II-1).


METHODS
University teaching hospital.


METHODS
Sixty-five propensity-matched patient pairs (130 patients) undergoing either laparoscopy or open abdominal surgical procedures to treat cervical cancer.


METHODS
Radical hysterectomy plus lymphadenectomy was performed via the laparoscopic (LRH) or open abdominal approach (RAH).


RESULTS
Baseline characteristics of the study populations were similar. In the LRH group the procedure was converted to open surgery in 2 patients (2%). Compared with the RAH group, patients undergoing LRH experienced less blood loss (200 vs 500 mL; p < .001), a lower transfusion rate (6% vs 22%; p = .02), similar operative time (245 vs 259.5 minutes; p = .26), and shorter length of hospital stay (4 vs 8 days; p < .001). No between-group differences in intraoperative complications were recorded (p = 1.0); however, a trend toward a lower postoperative complication rate (Accordion system grade ≥ 3) was observed for LRH compared with RAH (4 patients [6%]) vs 12 patients [18%]; p = .06). Five-year disease-free survival (p = .6, log-rank test) and overall survival (p = .31, log-rank test) did not differ statistically between women undergoing LRH or RAH.


CONCLUSIONS
Laparoscopy ensures the same results as open surgery insofar as radicality and long-term survival. Use of the laparoscopic approach is associated with improved short-term results, minimizing the occurrence of severe postoperative complications.
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: giorgiobogani@yahoo.it.
Giorgio
G
Bogani
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Antonella
A
Cromi
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Stefano
S
Uccella
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Maurizio
M
Serati
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Jvan
J
Casarin
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Ciro
C
Pinelli
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
Fabio
F
Ghezzi
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
Cervical cancer; Laparoscopy; Radical hysterectomy; Recurrence; Survival