Skip to main content

Advertisement

SpringerLink
Log in

Comparison between laparoscopic and abdominal radical hysterectomy for low-risk cervical cancer: a multicentre retrospective study

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare oncological outcomes of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for low-risk cervical cancer.

Method

We retrospectively compared the 3-year overall survival (OS) and 3-year disease-free survival (DFS) of 1269 low-risk cervical cancer patients with FIGO 2009 stage IA2, IB1 and IIA1 with a tumour size < 2 cm, no lymphovascular space invasion (LVSI), superficial stromal invasion and no lymph node involvement on imaging, and who received LRH (n = 672) and ARH (n = 597) between 2009 and 2018 at 47 hospitals.

Results

In the total study population, LRH and ARH showed similar 3-year OS (98.6% vs. 98.9%, P = 0.850) and DFS rates (95.7% vs. 96.4%, P = 0.285). LRH was not associated with worse 3-year OS (HR 0.897, 95% CI 0.287–2.808, P = 0.852) or DFS (HR 0.692, 95% CI 0.379–1.263, P = 0.230) as determined by multivariable analysis. After propensity score matching in 1269 patients, LRH (n = 551) and ARH (n = 551) still showed similar 3-year OS (98.4% vs. 98.8%, P = 0.704) and DFS rates (95.5% vs. 96.3%, P = 0.249). LRH was still not associated with worse 3-year OS (HR 0.816, 95% CI 0.262–2.541, P = 0.725) or DFS (HR 0.694, 95% CI 0.371–1.296, P = 0.251).

Conclusion

Among patients with low-risk cervical cancers < 2 cm, no LVSI, superficial stromal invasion, and no lymph node involvement on imaging, no significant differences were observed in 3-year OS or DFS rates between LRH and ARH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Koh W-J, Abu-Rustum NR, Bean S et al (2019) Cervical cancer, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 17:64–84. https://doi.org/10.6004/jnccn.2019.0001

    Article  CAS  Google Scholar 

  2. Nezhat CR, Burrell MO, Nezhat FR et al (1992) Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol 166:864–865. https://doi.org/10.1016/0002-9378(92)91351-a

    Article  CAS  PubMed  Google Scholar 

  3. Malzoni M, Tinelli R, Cosentino F et al (2009) Total laparoscopic radical hysterectomy versus abdominal radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our experience. Ann Surg Oncol 16:1316–1323. https://doi.org/10.1245/s10434-009-0342-7

    Article  PubMed  Google Scholar 

  4. Lee EJ, Kang H, Kim DH (2011) A comparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for early-stage cervical cancer: a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol 156:83–86. https://doi.org/10.1016/j.ejogrb.2010.12.016

    Article  PubMed  Google Scholar 

  5. Ditto A, Martinelli F, Bogani G et al (2015) Implementation of laparoscopic approach for type B radical hysterectomy: a comparison with open surgical operations. Eur J Surg Oncol 41:34–39. https://doi.org/10.1016/j.ejso.2014.10.058

    Article  PubMed  Google Scholar 

  6. Diver E, Hinchcliff E, Gockley A et al (2017) Minimally invasive radical hysterectomy for cervical cancer is associated with reduced morbidity and similar survival outcomes compared with laparotomy. J Minim Invasive Gynecol 24:402–406

    Article  Google Scholar 

  7. Mendivil AA, Rettenmaier MA, Abaid LN et al (2016) Survival rate comparisons amongst cervical cancer patients treated with an open, robotic-assisted or laparoscopic radical hysterectomy: a five year experience. Surg Oncol 25:66–71

    Article  Google Scholar 

  8. Guo J, Yang L, Cai J et al (2018) Laparoscopic procedure compared with open radical hysterectomy with pelvic lymphadenectomy in early cervical cancer: a retrospective study. Onco Targets Ther 11:5903–5908. https://doi.org/10.2147/OTT.S156064

    Article  PubMed  PubMed Central  Google Scholar 

  9. Melamed A, Rauh-Hain JA, Ramirez PT (2019) Minimally invasive radical hysterectomy for cervical cancer: when adoption of a novel treatment precedes prospective, randomized evidence. J Clin Oncol 37:3069–3074. https://doi.org/10.1200/JCO.19.01164

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nam J-H, Park J-Y, Kim D-Y et al (2012) Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol 23:903–911. https://doi.org/10.1093/annonc/mdr360

    Article  PubMed  Google Scholar 

  11. Bogani G, Cromi A, Uccella S et al (2014) Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched analysis. J Minim Invasive Gynecol 21:857–862. https://doi.org/10.1016/j.jmig.2014.03.018

    Article  PubMed  Google Scholar 

  12. Sobiczewski P, Bidzinski M, Derlatka P et al (2009) Early cervical cancer managed by laparoscopy and conventional surgery comparison of treatment results. Int J Gynecol Cancer 19:1390–1395. https://doi.org/10.1111/IGC.0b013e3181ba5e88

    Article  PubMed  Google Scholar 

  13. Kim JHJW, Kim KK, Park SJ et al (2019) Comparative effectiveness of abdominal versus laparoscopic radical hysterectomy for cervical cancer in the postdissemination era. Cancer Res Treat 51:788–796. https://doi.org/10.4143/crt.2018.120

    Article  PubMed  Google Scholar 

  14. Uppal S, Rebecca Liu J, Kevin Reynolds R et al (2019) Trends and comparative effectiveness of inpatient radical hysterectomy for cervical cancer in the United States (2012–2015). Gynecol Oncol 152:133–138. https://doi.org/10.1016/j.ygyno.2018.09.027

    Article  PubMed  Google Scholar 

  15. dos Reis R, Andrade CEMC, Frumovitz M et al (2018) Radical hysterectomy and age: outcomes comparison based on a minimally invasive vs an open approach. J Minim Invasive Gynecol 25:1224–1230. https://doi.org/10.1016/j.jmig.2018.03.002

    Article  PubMed  Google Scholar 

  16. Yuan Z, Cao D, Yang JJ et al (2019) Laparoscopic vs. open abdominal radical hysterectomy for cervical cancer: a single-institution, propensity score matching study in China. Front Oncol 9:1107. https://doi.org/10.3389/fonc.2019.01107

    Article  PubMed  PubMed Central  Google Scholar 

  17. Obermair A, Asher R, Pareja R et al (2020) Incidence of adverse events in minimally invasive vs open radical hysterectomy in early cervical cancer: results of a randomized controlled trial. Am J Obstet Gynecol 222:249.e1-249.e10

    Article  Google Scholar 

  18. Ramirez PT, Frumovitz M, Pareja R et al (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379:1895–1904. https://doi.org/10.1056/NEJMoa1806395

    Article  PubMed  Google Scholar 

  19. Melamed A, Margul DJ, Chen L et al (2018) Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 379:1905–1914. https://doi.org/10.1056/NEJMoa1804923

    Article  PubMed  PubMed Central  Google Scholar 

  20. Paik ES, Lim MC, Kim MH et al (2019) Comparison of laparoscopic and abdominal radical hysterectomy in early stage cervical cancer patients without adjuvant treatment: ancillary analysis of a korean gynecologic oncology group study (KGOG 1028). Gynecol Oncol 154:547–553. https://doi.org/10.1016/j.ygyno.2019.06.023

    Article  PubMed  Google Scholar 

  21. Kim SI, Cho JH, Seol A et al (2019) Comparison of survival outcomes between minimally invasive surgery and conventional open surgery for radical hysterectomy as primary treatment in patients with stage IB1–IIA2 cervical cancer. Gynecol Oncol 153:3–12. https://doi.org/10.1016/j.ygyno.2019.01.008

    Article  PubMed  Google Scholar 

  22. Kim SI, Lee M, Lee S et al (2019) Impact of laparoscopic radical hysterectomy on survival outcome in patients with FIGO stage IB cervical cancer: a matching study of two institutional hospitals in Korea. Gynecol Oncol 155:75–82. https://doi.org/10.1016/j.ygyno.2019.07.019

    Article  PubMed  Google Scholar 

  23. Li Z, Chen C, Liu P, Duan H, Liu M, Xu Y, Li P, Zhang W, Jiang H, Bin X, Lang J (2021) Comparison of oncological outcomes and major complications between laparoscopic radical hysterectomy and abdominal radical hysterectomy for stage IB1 cervical cancer with a tumour size less than 2 cm. Eur J Surg Oncol 47(8):2125–2133. https://doi.org/10.1016/j.ejso.2021.03.238

    Article  PubMed  Google Scholar 

  24. Zhang X-R, Li Z-Q, Sun L-X, Liu P, Li Z-H, Li P-F, Zhao H-W, Chen B-L, Ji M, Wang L, Kang S, Lang J-H, Mao C, Chen C-L (2021) Cohort profile: Chinese cervical cancer clinical study. Front Oncol 11:690275. https://doi.org/10.3389/fonc.2021.690275

    Article  PubMed  PubMed Central  Google Scholar 

  25. Li W, Liu P, Zhao W et al (2020) Effects of preoperative radiotherapy or chemoradiotherapy on postoperative pathological outcome of cervical cancer—from the large database of 46,313 cases of cervical cancer in China. Eur J Surg Oncol 46:148–154. https://doi.org/10.1016/j.ejso.2019.09.188

    Article  PubMed  Google Scholar 

  26. Chen B, Ji M, Li P et al (2020) Comparison between robot-assisted radical hysterectomy and abdominal radical hysterectomy for cervical cancer: a multicentre retrospective study. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2020.02.019

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chen C, Wang W, Liu P et al (2019) Survival after abdominal Q-M type B versus C2 radical hysterectomy for early-stage cervical cancer. Cancer Manag Res 11:10909–10919. https://doi.org/10.2147/CMAR.S220212

    Article  PubMed  PubMed Central  Google Scholar 

  28. Liang C, Liu P, Cui Z et al (2020) Effect of laparoscopic versus abdominal radical hysterectomy on major surgical complications in women with stage IA-IIB cervical cancer in China, 2004–2015. Gynecol Oncol 156:115–123. https://doi.org/10.1016/j.ygyno.2019.10.032

    Article  PubMed  Google Scholar 

  29. Kong T-W, Chang S-J, Piao X et al (2016) Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer. J Obstet Gynaecol Res 42:77–86. https://doi.org/10.1111/jog.12840

    Article  PubMed  Google Scholar 

  30. Lin F, Pan L, Li L et al (2014) Effects of a simulated CO2 pneumoperitoneum environment on the proliferation, apoptosis, and metastasis of cervical cancer cells in vitro. Med Sci Monit 20:2497–2503. https://doi.org/10.12659/MSM.891179

    Article  PubMed  PubMed Central  Google Scholar 

  31. Selman TJ, Mann C, Zamora J et al (2008) Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis. CMAJ 178:855–862. https://doi.org/10.1503/cmaj.071124

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Min Hao (The Second Hospital of ShanXi Medical University), Bin Ling (China-Japan Friendship Hospital), Lixin Sun and Hongwei Zhao (Shanxi Cancer Hospital), Jihong Liu and Lizhi Liang (Sun Yat-sen University Cancer Center), Lihong Lin and Yu Guo (Anyang Tumor Hospital), Li Wang (The Affiliated Tumor Hospital of Zhengzhou University), Weidong Zhao (Anhui Provincial Cancer Hospital), Yan Ni (The Yuncheng Central Hospital of Shanxi Province), Wentong Liang and Donglin Li (Guizhou Provincial People`s Hospital), Xuemei Zhan and Mingwei Li (Jiangmen Central Hospital), Weifeng Zhang (Ningbo Women & Children’s Hospital), Peiyan Du (The Affiliated Cancer Hospital and Institute of Guangzhou Medical University), Ziyu Fang (Liuzhou Workers’ Hospital), Rui Yang (Shenzhen Hospital of Peking University), Long Chen (Qingdao Municipal Hospital), Encheng Dai and Ruilei Liu (Linyi People’s Hospital), Yuanli He and Mubiao Liu (Zhujiang Hospital, Southern Medical University), Jilong Yao and Zhihua Liu (Shenzhen Maternity & Child Health Hospital), Xueqin Wang (The Fifth Affiliated Hospital of Southern Medical University), Anwei Lu (Maternal and Child Health Hospital of Guiyang Province), Shuangling Jin (Peace Hospital affiliated to Changzhi Medical College), Ben Ma (Guangzhou First People’s Hospital), Zhonghai Wang (Shenzhen Nanshan People’s Hospital), Lin Zhu (The Second Hospital of Shandong University), Hongxin Pan (The Third Affiliated Hospital of Shenzhen University), Qianyong Zhu (No. 153. Center Hospital of Liberation Army/Hospital No. 988 of the Chinese People’s Liberation Army Joint Support Force), Dingyuan Zeng and Zhong Lin (Maternal and Child Health Care Hospital of Liuzhou), Xiaohong Wang (Laiwu People’s Hospital/Jinan City People’s Hospital), and Bin Zhu (The Affiliated Yiwu Women and Children Hospital of Hangzhou Medical College) for their contribution during the data collection.

Funding

This study received funding from the National Science and Technology Support Program of China (2014BAI05B03), the National Natural Science Fund of Guangdong (2015A030311024), and the Science and Technology Plan of Guangzhou (158100075).

Author information

Author notes

  1. Zhiqiang Li, Chunlin Chen, Ping Liu, and Anwei Lu contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, China

    Zhiqiang Li, Chunlin Chen, Ping Liu, Hui Duan, Pengfei Li, Haixia Jiang & Jinghe Lang

  2. Department of Obstetrics and Gynecology, Shenzhen Hospital, Southern Medical University, Shenzhen, 518000, China

    Anwei Lu

  3. Department of Gynecologic Oncology, Shanxi Provincial Cancer Hospital, Taiyuan, 030013, China

    Hongwei Zhao

  4. Department of Obstetrics and Gynecology, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, 529000, China

    Xuemei Zhan

  5. Department of Gynecology, Anhui Cancer Hospital, Hefei, 230001, China

    Weidong Zhao

  6. Shenzhen Maternal and Child Health Hospital, Shenzhen, 518028, China

    Jilong Yao

  7. Department of Obstetrics and Gynecology, Guizhou People’s Hospital, Guiyang, 550002, China

    Donglin Li

  8. Department of Obstetrics and Gynecology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 51008, China

    Mubiao Liu

  9. Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, 511436, China

    Xiaonong Bin

  10. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China

    Jinghe Lang

Authors
  1. Zhiqiang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chunlin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anwei Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hongwei Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xuemei Zhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hui Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pengfei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Weidong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jilong Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Donglin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Haixia Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Mubiao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Xiaonong Bin
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jinghe Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors approved the final version of the study. ZL, CC, PL and AL contributed equally to the work. ZL: data management, manuscript writing, data analysis. CC: project development, data management, data analysis. PL: project development, manuscript editing. AL: data collection, manuscript editing. HZ: data collection, figure production. XZ: data collection, figure production. HD: data collection, table production. PL: data collection, table production. WZ: data collection, validation. JY: data collection, validation. DL: data collection, validation. HJ: data collection, interpretation. ML: data collection, interpretation. XB: data analysis. JL: project development, data management.

Corresponding authors

Correspondence to Chunlin Chen or Jinghe Lang.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

This study has been approved by the Ethics Committee of Nanfang Hospital affiliated with Southern Medical University (Guangzhou, China) (ethical number: NFEC-2017–135, clinical research registration number: CHiCTR1800017778; International Clinical Trials Registry Platform Search Port, http://apps.who.int/trialsearch/). The ethical committee decided that no consent for participation was necessary, because the study was retrospective.

Informed consent

All procedures in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Z., Chen, C., Liu, P. et al. Comparison between laparoscopic and abdominal radical hysterectomy for low-risk cervical cancer: a multicentre retrospective study. Arch Gynecol Obstet 305, 449–458 (2022). https://doi.org/10.1007/s00404-021-06185-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-021-06185-6

Keywords

Search

Navigation