Although laparoscopic pelvic lymphadenectomy has several potential advantages for patients with early-stage cervical cancer, laparotomy still is viewed as the standard approach because laparoscopic surgery may not remove a sufficient number of diseased lymph nodes. This randomized study compared three surgical approaches in 168 consecutive patients proved to have invasive cervical carcinoma, all of whom were scheduled for radical hysterectomy and systematic pelvic lymphadenectomy. The participants, aged 70 or younger, had stage IB1 or stage IB2-IIB disease and had responded objectively to neoadjuvant chemotherapy. The methods evaluated were transperitoneal (TPL), extraperitoneal (EPL), and laparoscopic pelvic lymphadenectomy (LPL). Conventional radical hysterectomy was performed in all cases, and patients were evaluated 15 days and 1 and 2 months after surgery. The final study population numbered 161 patients.
Both TPL and EPL removed an adequate number of pelvic lymph nodes in all instances, but LPL failed to do so in three instances. Overall feasibility, estimated on an intention-to-treat basis, exceeded 90% for all three procedures. Operating times for lymphadenectomy were longest for LPL, averaging 75 minutes, and least (averaging 54 minutes) for EPL. Average times in hospital ranged from 3.1 days for LPL to 5.6 days for TPL. Considering the entire operation, comparable proportions of patients in all three groups—approximating one in five—required blood transfusion. Lymphocysts were identified in 11% of all patients. A few patients in each group had mild paresthesias that responded to physiatric therapy.
The investigators conclude that, because laparoscopic radical hysterectomy is not yet a standardized procedure, the best approach to treating cervical cancer, once radical surgery is decided on, consists of EPL plus radical hysterectomy. Like LPL, EPL can shorten the time in hospital compared to TPL.