| Popis: |
This study compared results obtained with laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) to determine the applicability of LRH as an alternative for treatment of early stage cervical cancer. A class III LRH technique is described. Between January 1994 and November 1996, 49 radical hysterectomies were performed at Notre-Dame Hospital for Stage IA 2 and IB 1 cervical cancer. Three patients were excluded from the study because LRH was offered as an alternative only when the Quetelet Index (QI) was equal to or less than 33. Twenty-three patients were scheduled for LRH and 23 for ARH. Both groups were comparable for age, QI, stage, tumour diameter and histology. The mean operating time was 390 minutes for LRH and 240 minutes for ARH (p = 0.0001 ). Blood loss was less in the LRH group (475 cc versus 1,060 cc, p=0.0001). One LRH patient required an immediate laparotomy to secure haemostasis. In the LRH group, one eventration occurred as well as two unusual neurological complications. The post-operative stay was shorter for LRH (p = 0.0265). The numbers of para-aortic and pelvic nodes obtained were comparable. There were three recurrences, one in the LRH group and two in the ARH group. The average follow-up was 49 months in both groups. With experience, the mean operating time, complication rate, need for analgesia and length of hospital stay decreased considerably with the LRH procedure. Cosmetic results were superior. This procedure remains time consuming and difficult to perform, limiting its applicability as an alternative to ARH for the treatment of early stage cervical cancer. Ongoing research is suggested. |
