00024: SURGICOPATHOLOGIC OUTCOME OF LAPAROSCOPIC VERSUS OPEN RADICAL HYSTERECTOMY

Objective: To compare the surgicopathologic outcome of total laparoscopic radical hysterectomy (LRH) with that of abdominal radical hysterectomy (ARH) for the treatment of early-stage cervical cancer (Ib-IIa = 4 cm). Methods: Radical hysterectomy (type 2 and 3 of Piver) specimens of sequential patients undergoing LRH (N=50) were compared with those of historical controls selected from consecutive women who have had conventional ARH (N=48), and who met the same criteria for eligibility as the cases. To evaluate the extent of parametrial resection, parametrial tissues were systematically measured at their widest dimensions before tissue processing. Results: No difference was found in demographics, hystologic type, tumor stage and grade between the two groups. Operating time, intraoperative and postoperative complications did not significantly differ between groups. Median estimated blood loss was 180 (range, 50–1000) mL and 450 (200–2500) mL in laparoscopy and laparotomy group, respectively (p , 0.0001). No patient in LRH and 4 (8.3%) in ARH group received blood transfusions (p=0.05). Median hospital stay was 6 (3–14) days for LHR vs 10 (4–32) days for ARH, respectively (p , 0.0001). The parametrial width was similar between LRH and ARH in both type II (right parametrium: 2.4 cm (1–3) vs. 2.3 (1.8-4.0), p=0.28; left parametrium: 2.3 cm (1.8-4) vs 2.2 (1.23.0), p=0.54) and type III radical hysterectomy (right parametrium: 3.8 cm (2.3-6.5) vs 3.4 (1.7-7.0), p=0.59; left parametrium: 3.6 cm (26) vs 3.5 (1.5-6.5), p=0.82). There were no significant differences between the two groups with regard to lymph nodes yield and likelihood of identifying positive margins or metastatic disease. Conclusions: Our results suggest that laparoscopically managed patients with cervical cancer undergo a similar extent of surgery as those treated with the traditional ARH, as judged by objective pathologic criteria. Lower blood loss and shorter hospital stay are associated with laparoscopic procedure.