Feasibility and Safety of Laparoscopic Total Mesometrial Resection in Early-stage Cervical Cancer

In this study we aimed to analyze the safety and feasibility of total mesometrial resection (TMMR) using the laparoscopic approach. Laparoscopic TMMR and pelvic lymphadenectomy (LNE) was carried out in 34 patients with cervical cancer FIGO IA-IIB from April 2012-April 2016 at our tertiary center. Para-aortic LNE was performed when indicated. The main outcomes included surgical margins, a number of retrieved lymph node, intra- and post-operative complications, and recurrence rates. Complete microscopic tumor resection was confirmed in 33/34 (97%) patients. No conversion to open surgery was necessary. Mean intra-operative blood loss was only 65.2 ml with no blood transfusions required. Intra-operative complications occurred in 4/34 (11.8%) cases (2 bladder injuries and 2 ureteric injuries). Post-operative complications were observed in 10/35 (29.4%) cases. Only one complication occurred after 30 days (vesico-vaginal fistula). There was a loco-regional recurrence within a mean follow-up time of 25.9 months. Laparoscopic TMMR appears to be feasible and safe in the treatment of early-stage cervical cancer. Further large-scale studies are required.