title: Laparoscopic hysterectomy after concurrent radiochemotherapy in locally advanced cervical cancer compared to laparotomy: A multi institutional prospective pilot study of cost, surgical outcome and quality of life.
abstract: OBJECTIVE
  Laparoscopy allows hysterectomies after chemoradiation to be performed without opening the abdominal wall. We measured the costs and quality of life for locally advanced cervical cancer patients operated on via laparoscopy compared to laparotomy.
  
  
  METHODS
  We conducted an observational prospective multicenter study on locally advanced cervical cancer patients undergoing an extrafascial hysterectomy after concurrent chemoradiotherapy (CRT). We assessed the costs from the medical visit before surgery up to the first month after surgery from the providers' perspective and measured the quality of life using the EORTC QLQ-C30 and QLQ-CX24 up to six months.
  
  
  RESULTS
  Sixty two patients (39 laparoscopy and 23 laparotomy) from December 2008 to November 2011 were included. There was no difference in operative time, or intraoperative and post-operative complication rates between the two groups. Intraoperative transfusion and abdominal drain were significantly lower in the laparoscopy group (respectively, p = 0.04 and p < 0.01), as well as the duration of hospital stay (7.3 d vs. 5.7 d, p < 0.001). All patients who underwent laparoscopic hysterectomy were discharged to home, whereas 4 laparotomy patients used convalescence homes (p = 0.01). Mean costs at one month were €10,991 for laparotomy and €11,267 for laparoscopy (p = 0.76). Sexual activity is better for the laparoscopy group at six months (p = 0.01).
  
  
  CONCLUSIONS
  Laparoscopy for an extrafascial hysterectomy after CRT in locally advanced cervical cancer patients brought better quality of life with similar costs compared to laparotomy, and should therefore be the first choice for surgeons.
authors.affiliation: Department of Health Technology Assessment, Health Economic Unit, Fondation A de Rothschild, Paris, France. Electronic address: sbaffert@fo-rothschild.fr.
authors.forename: S
authors.initials: S
authors.lastname: Baffert
authors.affiliation: Surgical Department, Institut Curie, Paris, France. Electronic address: severine.alran@curie.fr.
authors.forename: S
authors.initials: S
authors.lastname: Alran
authors.affiliation: Surgical Department, Institut Curie, Paris, France. Electronic address: virginie.fourchotte@curie.fr.
authors.forename: V
authors.initials: V
authors.lastname: Fourchotte
authors.affiliation: Department of Health Technology Assessment, Health Economic Unit, Fondation A de Rothschild, Paris, France. Electronic address: marie-angele.traore@curie.fr.
authors.forename: M A
authors.initials: MA
authors.lastname: Traore
authors.affiliation: Clinical Research Department, Trial Management Unit, Institut Curie, Paris, France. Electronic address: cecile.simondi@curie.fr.
authors.forename: C
authors.initials: C
authors.lastname: Simondi
authors.affiliation: Surgical Department, CHU Lyon, France. Electronic address: Patrice.Mathevet@chuv.ch.
authors.forename: P
authors.initials: P
authors.lastname: Mathevet
authors.affiliation: Surgical Department, Centre GF Leclerc, Dijon, France. Electronic address: cloustalot@cgfl.fr.
authors.forename: C
authors.initials: C
authors.lastname: Loustalot
authors.affiliation: Surgical Department, Clinique mutualiste Jules Verne, Nantes, France. Electronic address: christophe.binelli@mla.fr.
authors.forename: C
authors.initials: C
authors.lastname: Binelli
authors.affiliation: Surgical Department, Institut de Cancerologie de l'Ouest, Center Gauducheau, Nantes, France. Electronic address: isabelle.jaffre@ico.unicancer.fr.
authors.forename: I
authors.initials: I
authors.lastname: Jaffre
authors.affiliation: Surgical Department, Hôpital Lariboisière, AP-HP, Paris, France. Electronic address: Emmanuel.BARRANGER@nice.unicancer.fr.
authors.forename: E
authors.initials: E
authors.lastname: Barranger
authors.affiliation: Surgical Department, CHU Brest, Brest, France. Electronic address: pierre-francois.dupre@chu-brest.fr.
authors.forename: P F
authors.initials: PF
authors.lastname: Dupre
authors.affiliation: Surgical Department, Institut Claudius Regaud, Toulouse, France. Electronic address: ferron.gwenael@claudiusregaud.fr.
authors.forename: G
authors.initials: G
authors.lastname: Ferron
authors.affiliation: Surgical Department, Institut Paoli Calmettes, Marseille, France. Electronic address: houvenag@ipc.unicancer.fr.
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Surgical Department, CHU Rennes Sud, Rennes, France. Electronic address: jean.leveque@chu-rennes.fr.
authors.forename: J
authors.initials: J
authors.lastname: Leveque
authors.affiliation: Surgical Department, CHU, Angers, France. Electronic address: phdescamps@chu-angers.fr.
authors.forename: P
authors.initials: P
authors.lastname: Descamps
authors.affiliation: Surgical Department, CHU, Tours, France. Electronic address: body@med.univ-tours.fr.
authors.forename: G
authors.initials: G
authors.lastname: Body
authors.affiliation: Surgical Department, CHU Lyon Sud, Lyon, France. Electronic address: daniel.raudrant@chu-lyon.fr.
authors.forename: D
authors.initials: D
authors.lastname: Raudrant
authors.affiliation: Surgical Department, Institut de Cancerologie de l'Ouest, Center Gauducheau, Nantes, France. Electronic address: jean-marc.classe@ico.unicancer.fr.
authors.forename: J M
authors.initials: JM
authors.lastname: Classe
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D059248:Chemoradiotherapy / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000523:psychology; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010865:Pilot Projects; D011183:Postoperative Complications / Q000191:economics / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
keywords: Advanced cervical cancer; Cost comparison; Laparoscopic hysterectomy; Laparoscopy; Laparotomy; Quality of life