title: [Comparison of safety and efficacy of laparoscopic versus abdominal radical hysterectomy in the treatment of patients with stage I a2-II b cervical cancer].
abstract: OBJECTIVE
  To compare the safety and efficacy after laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in the treatment of patients with stage I a2-II b cervical cancer.
  
  
  METHODS
  In a retrospective study, data were analyzed from patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ia2-II b cervical cancer underwent LRH or ARH at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; First Affiliated Hospital, School of Medicine, Shihezi University; and the Guizhou Provincial People's Hospital between 2000 and 2015. Perioperative outcomes and survival analysis were compared.
  
  
  RESULTS
  (1) The FIGO stages, histotypes, metastasis of lymph nodes, lymph vascular space invasion and neoadjuvant chemotherapy significantly differed between the LRH group and the ARH group (all P<0.05). In order to eliminate the effects by the unbalanced data, stratified analysis was conducted based on FIGO stage. There were 861 patients in stage I a2-I b1 group, including 663 patients in LRH group and 198 patients in ARH group. And there were 668 patients in stage I b2-IIb group, including 389 patients in LRH group and 279 patients in ARH group. (2) In the patients with stage I a2- I b1 and I b2- II b tumor, there were no significant difference in age, histotype, differentiation degree, parametrial invasion, lymphvasular invasion space and neoadjvant chemotherapy between the LRH group and the ARH group (all P>0.05). For patients with stage I a2- I b1, the operation time in the LRH group was longer than that in the ARH group (P=0.027), and it showed less blood loss and lower blood transfusion rate in the LRH group than those in the ARH group (all P=0.000). The findings were similar in the patients with stage I b2-II b (all P=0.000). (3) There were no significant difference in intraoperative complications and postoperative complications between the LRH and the ARH group in the patients with stage I a2-I b1 and I b2-IIb, respectively (all P>0.05). (4) The median follow- up time was 24 months (range: 1 to 177 months), the recurrence rate was 3.6% (38/1 052) in LRH group and 3.1% (15/477) in ARH group,there was not significant difference (P>0.05). The estimated 3- year overall survival (OS) and the free-progression survival time (PFS) were respectively 92.4% and 91.5% in LRH group, and 91.8% and 91.5% in ARH group. There was no significant difference in the overall survival (P=0.738) or progress free survival (P=0.990) by log-rank test. Moreover, there were no significant difference in OS or PFS between the LRH group and the ARH group in patients with stage I a2- I b1 and I b2- II b, respectively (all P>0.05).
  
  
  CONCLUSIONS
  LRH is safe and effective, and it could be used a routine way for the treatment of patients with stage I a2-IIb cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital，School of Medicine, Shihezi University, Shihezi 832008, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang 550002, China.
authors.forename: Donglin
authors.initials: D
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Cai
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
authors.forename: Weihong
authors.initials: W
authors.lastname: Dong
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhoufang
authors.initials: Z
authors.lastname: Xiong
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Min
authors.forename: Hongbo
authors.initials: H
authors.lastname: Wang
authors.forename: Yinghong
authors.initials: Y
authors.lastname: Wang
authors.forename: Wentong
authors.initials: W
authors.lastname: Liang
authors.affiliation: Email: zehuawang@163.net.
authors.forename: Zehua
authors.initials: Z
authors.lastname: Wang
mesh_terms: D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*