title: Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer.
abstract: OBJECTIVE
  This study investigates the pattern of disease recurrence and identifies the clinicopathologic prognostic factors for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB and IIA cervical carcinoma treated with laparoscopic/robotic radical hysterectomy (LRH/RRH).
  
  
  METHODS
  We conducted a retrospective analysis of 128 patients with FIGO stage IB and IIA cervical cancer. Preoperative examination did not uncover definitive evidence of parametrial invasion or lymph node metastasis in any of the patients; therefore, all patients underwent LRH/RRH with retroperitoneal lymphadenectomy between April 2006 and December 2013. Sites of disease recurrence and all possible clinicopathologic factors related to the risk of disease recurrence were determined.
  
  
  RESULTS
  Multivariate analysis demonstrated that laparoscopic intracorporeal colpotomy (P < 0.041, odds ratio 7.038, 95% confidence interval 1.059-15.183) represented a strong prognostic factor related to disease recurrence. We categorized the minimally invasive surgery group into LRH through vaginal colpotomy (LRH-VC; 79 patients) and LRH/RRH through intracorporeal colpotomy (LRH/RRH-IC; 49 patients) according to the colpotomic approaches. Disease recurrence was higher in the LRH/RRH-IC group than in the LRH-VC group (16.3% vs 5.1%, P = 0.057), with five patients in the LRH/RRH-IC group experiencing intraperitoneal spreads.
  
  
  CONCLUSIONS
  Total laparoscopic/robotic intracorporeal colpotomy under CO2 pneumoperitoneum may carry a risk of positive vaginal cuff margin, as well as intraperitoneal tumor spreads in patients with early-stage cervical cancer treated with LRH/RRH.
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Tae-Wook
authors.initials: TW
authors.lastname: Kong
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Suk-Joon
authors.initials: SJ
authors.lastname: Chang
authors.affiliation: Ajou University Graduate School of Medicine, Suwon, Korea.
authors.forename: Xianling
authors.initials: X
authors.lastname: Piao
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jiheum
authors.initials: J
authors.lastname: Paek
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Pathology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yonghee
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Mison
authors.initials: M
authors.lastname: Chun
authors.affiliation: Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.|Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hee-Sug
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D012371:Robotics; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Intracorporeal colpotomy; intraperitoneal spread; laparoscopic/robotic radical hysterectomy; vaginal colpotomy