Comparison of radical abdominal hysterectomy with laparoscopic-assisted radical vaginal hysterectomy for treatment of early cervical cancer

The objective of this report is to determine the significance of differences in peri- and postoperative morbidity in patients with cervical cancer treated with radical abdominal hysterectomy (RAH) versus laparoscopic- assisted radical vaginal hysterectomy (LRVH) in a single institution. In this nonrandomized case series, the records of 30 patients (median age, 42) with International Federation of Gynecology and Obstetrics (FIGO) stage I or II cervical cancer who underwent primary RAH with pelvic and paraaortic lymphadenectomy and 37 patients (median age, 41) who underwent LRVH and lymphadenectomy were reviewed. The 2 groups were compared with respect to the demographic data, incidence of short- and long-term morbidity, duration of operation, blood loss, and transfusion rate. We used the analysis of variance (ANOVA) test to express statistical significance. Twenty-one out of 30 (70%) patients in the RAH group had stage IB, 7 had stage IA2, and 2 had stage IIA. Thirty-three out of 37 (89%) patients in the LRVH group had stage IB, 3 had stage IA2, and 1 had stage IIA. Mean operative time in patients who underwent an abdominal operation was 193 minutes compared with 225 minutes in patients with a laparoscopic vaginal procedure (P < .01). Estimated blood loss in the LRVH group was significantly reduced (525 mL) when compared with the RAH (1,115 mL) (P < .0001). Twelve out of 30 (40%) RAH patients needed a blood transfusion while 4/37 (11%) required blood transfusion in the LRVH group (P < .0001). The mean hospital stay for the RAH was 5.2 days compared with 3 days for the LRVH group (P < .0001). We encountered 1 ureterovaginal fistula in the abdominal approach, while in the vaginal technique we had 2 bladder injuries, 2 ureterovaginal fistulas, and 1 large bowel injury. This study shows that LRVH reduces blood loss and shortens hospital stay. We believe that with the surgeon's experience the urinary complications can be reduced. Comparison of survival data for both procedures is necessary to confirm the adequacy of the LRVH approach.