Annals of Surgical Oncology

, Volume 15, Issue 10, pp 2847–2855 | Cite as

The Outcome of Laparoscopic Radical Hysterectomy and Lymphadenectomy for Cervical Cancer: A Prospective Analysis of 295 Patients

  • Yong Chen
  • Huichen Xu
  • Yuyan Li
  • Dan Wang
  • Junnan Li
  • Jizhao Yuan
  • Zhiqing Liang
Gynecologic Oncology



Cervical carcinoma is likely to become one of the most important indications for laparoscopic radical surgery. The laparoscopic technique combines the benefits of a minimally invasive approach with established surgical principles. In our institution, the laparoscopic radical hysterectomy and transperitoneal approach for lymphadenectomy have become the standard techniques for invasive cervical cancer. We report the indications, techniques, results, and oncological outcome in a single center experience.


Between February 2001 and June 2007 we performed laparoscopic radical hysterectomies for cervical cancer in 295 patients. Their initial techniques, operation data, complications, postoperative course, oncological outcome, and survival were evaluated.


Out of 295 procedures, 290 were successful. Para-aortic lymphadenectomy was performed in 156 patients (52.9%), and pelvic lymphadenectomy was performed in all 295 patients. The median blood loss was 230 mL (range, 50–1200 mL). The mean operation time was 162 min (range, 110–350), which included the learning curves of 3 surgeons. In 5 cases (1.7%), conversion to open surgery was necessary due to bleeding (3 cases), bowel injury (1 case), and hypercapnia (1 case). Other major intraoperative injuries occurred in 12 patients (4.1%). Positive lymph nodes were detected in 80 cases (27.1%), lymphovascular space invasion in 54 cases (18.3%), and surgical margins were negative for tumor in all patients. The mean hospital stay was 10.3 days. Postoperative complications occurred in 10.8% patients, ureterovaginal fistula in 5 cases, vesicovaginal fistula in 4, ureterostenosis in 3 cases, deep venous thrombosis in 9 cases, lymphocyst in 4 cases, lymphedema in 5 cases, and 1 case with trocar insertion site metastasis. Other medical problems included 47 cases (15.9%) of bladder dysfunction and 62 cases (21.0%) of rectum dysfunction or constipation. The median follow-up was 36.45 months (range, 8–76 months). Recurrences or metastasis occurred in 48 patients (16.3%). Of these patients, 43 (14.6%) have died of their disease, and 5 (1.7%) are alive with disease. The overall disease-free survival was 95.2% for Ia, 96.2% for Ib, 84.5% for IIa, 79.4% for IIb, 66.7% for IIIa, and 60.0% for IIIb.


Laparoscopic radical hysterectomy is a routine, effective treatment for patients with Ia2–IIb cervical carcinoma. With more experience it is envisaged that IIb stage patients can be managed safely offering all the benefits of minimal surgery to the patients. Although no long-term follow-up is available, our follow-up data for up to 76 months confirm the effectiveness of laparoscopic radical hysterectomy in terms of surgical principles and oncological outcome.


Cervical cancer Laparoscopy Radical hysterectomy 



This study was supported by Southwest Hospital Clinical Creative Grant to Dr. Liang (SWH2005010B). We would like to acknowledge Dr. Sooranna, PhD, Lecturer, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, University College London for reviewing and editing the manuscript.


  1. 1.
    Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol 1992; 166:864–5PubMedGoogle Scholar
  2. 2.
    Dargent D, Mathevet P. Radical laparoscopic vaginal hysterectomy. J Gynecol Obstet Biol Reprod (Paris) 1992; 21:709–10Google Scholar
  3. 3.
    Lee CL, Huang KG, Wang CJ, et al. Laparoscopic radical hysterectomy using pulsed bipolar system: comparison with conventional bipolar electrosurgery. Gynecol Oncol. 2007; 105:620–4PubMedCrossRefGoogle Scholar
  4. 4.
    Pomel C, Atallah D, Le Bouedec G, et al. Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study. Gynecol Oncol 2003; 91:534–9PubMedCrossRefGoogle Scholar
  5. 5.
    Ramirez PT, Slomovitz BM, Soliman PT, et al. Total laparoscopic radical hysterectomy and lymphadenectomy: the M. D. Anderson Cancer Center experience. Gynecol Oncol 2006; 102:252–5PubMedCrossRefGoogle Scholar
  6. 6.
    Jobling T, Wood C. Laparoscopic modified radical hysterectomy and lymphadenectomy simulating open operation for stage 1A2 cervical carcinoma. Aust N Z J Obstet Gynaecol 1993; 33:400–3PubMedCrossRefGoogle Scholar
  7. 7.
    Canis M, Mage G, Pouly JL, et al. Laparoscopic radical hysterectomy for cervical cancer. Baillieres Clin Obstet Gynaecol 1995; 9:675–89PubMedCrossRefGoogle Scholar
  8. 8.
    Spirtos NM, Schlaerth JB, Kimball RE, et al. Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy. Am J Obstet Gynecol 1996; 174:1763–7; discussion 7–8PubMedCrossRefGoogle Scholar
  9. 9.
    Malzoni M, Malzoni C, Perone C, et al. Total laparoscopic radical hysterectomy (type III) and pelvic lymphadenectomy. Eur J Gynaecol Oncol 2004; 25:525–7PubMedGoogle Scholar
  10. 10.
    Schlaerth AC, Abu-Rustum NR. Role of minimally invasive surgery in gynecologic cancers. Oncologist 2006; 11:895–901PubMedCrossRefGoogle Scholar
  11. 11.
    Zakashansky K, Chuang L, Gretz H, et al. A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program. Int J Gynecol Cancer 2007; 17:1075–82PubMedCrossRefGoogle Scholar
  12. 12.
    Morgan DJ, Hunter DC, McCracken G, et al. Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up. Bjog 2007; 114:537–42PubMedGoogle Scholar
  13. 13.
    Jackson KS, Das N, Naik R, et al. Laparoscopically assisted radical vaginal hysterectomy vs. radical abdominal hysterectomy for cervical cancer: a match controlled study. Gynecol Oncol 2004; 95:655–61PubMedCrossRefGoogle Scholar
  14. 14.
    Steed H, Rosen B, Murphy J, et al. A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. Gynecol Oncol 2004; 93:588–93PubMedCrossRefGoogle Scholar
  15. 15.
    Malur S, Possover M, Schneider A. Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer. Surg Endosc 2001; 15:289–92PubMedCrossRefGoogle Scholar
  16. 16.
    Liang ZQ, Xu HC, Xiong GW, et al. Clinical evaluation of laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy in patients with cervical cancer. Zhonghua Fu Chan Ke Za Zhi 2003; 38:409–11PubMedGoogle Scholar
  17. 17.
    Xu H, Chen Y, Li Y, et al. Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 procedures. Surg Endosc 2007; 21:960–4PubMedCrossRefGoogle Scholar
  18. 18.
    Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 1974; 44:265–72PubMedGoogle Scholar
  19. 19.
    Abu-Rustum NR, Hoskins WJ. Radical abdominal hysterectomy. Surg Clin North Am 2001; 81:815–28PubMedCrossRefGoogle Scholar
  20. 20.
    Puntambekar SP, Palep RJ, Puntambekar SS, et al. Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases. J Minim Invasive Gynecol 2007; 14:682–9PubMedCrossRefGoogle Scholar
  21. 21.
    Malzoni M, Tinelli R, Cosentino F, et al. Feasibility, morbidity, and safety of total laparoscopic radical hysterectomy with lymphadenectomy: our experience. J Minim Invasive Gynecol 2007; 14:584–90PubMedCrossRefGoogle Scholar
  22. 22.
    Li G, Yan X, Shang H, et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer. Gynecol Oncol 2007; 105:176–80PubMedCrossRefGoogle Scholar
  23. 23.
    Sharma R, Bailey J, Anderson R, et al. Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta): a comparison with open Wertheim/Meigs hysterectomy. Int J Gynecol Cancer 2006; 16:1927–32PubMedCrossRefGoogle Scholar
  24. 24.
    Gil-Moreno A, Puig O, Perez-Benavente MA, et al. Total laparoscopic radical hysterectomy (type II-III) with pelvic lymphadenectomy in early invasive cervical cancer. J Minim Invasive Gynecol 2005; 12:113–20PubMedCrossRefGoogle Scholar
  25. 25.
    Nam JH, Kim JH, Kim DY, et al. Comparative study of laparoscopico-vaginal radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer. Gynecol Oncol 2004; 92:277–83PubMedCrossRefGoogle Scholar
  26. 26.
    Kohler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol 2004; 95:52–61PubMedCrossRefGoogle Scholar
  27. 27.
    Hertel H, Kohler C, Michels W, et al. Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecol Oncol 2003; 90:505–11PubMedCrossRefGoogle Scholar
  28. 28.
    Spirtos NM, Eisenkop SM, Schlaerth JB, et al. Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. Am J Obstet Gynecol. 2002; 187:340–8PubMedCrossRefGoogle Scholar
  29. 29.
    Lee CL, Huang KG, Jain S, et al. Comparison of laparoscopic and conventional surgery in the treatment of early cervical cancer. J Am Assoc Gynecol Laparosc 2002; 9:481–7PubMedCrossRefGoogle Scholar
  30. 30.
    Dargent D, Mathevet P. Schauta’s vaginal hysterectomy combined with laparoscopic lymphadenectomy. Baillieres Clin Obstet Gynaecol 1995; 9:691–705PubMedCrossRefGoogle Scholar
  31. 31.
    Lecuru F, Taurelle R. Transperitoneal laparoscopic pelvic lymphadenectomy for gynecologic malignancies (II). Indications. Surg Endosc 1998; 12:97–100PubMedCrossRefGoogle Scholar
  32. 32.
    Querleu D, Leblanc E, Ferron G, et al. Laparoscopic surgery and gynaecological cancers. Bull Cancer 2007; 94:1063–71PubMedGoogle Scholar
  33. 33.
    Renaud MC, Plante M, Roy M. Combined laparoscopic and vaginal radical surgery in cervical cancer. Gynecol Oncol 2000; 79:59–63PubMedCrossRefGoogle Scholar
  34. 34.
    Ghezzi F, Cromi A, Ciravolo G, et al. Surgicopathologic outcome of laparoscopic versus open radical hysterectomy. Gynecol Oncol 2007; 106:502–6PubMedCrossRefGoogle Scholar
  35. 35.
    Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol 2006; 103:859–64PubMedCrossRefGoogle Scholar
  36. 36.
    Schlaerth JB, Spirtos NM, Carson LF, et al. Laparoscopic retroperitoneal lymphadenectomy followed by immediate laparotomy in women with cervical cancer: a gynecologic oncology group study. Gynecol Oncol 2002; 85:81–8PubMedCrossRefGoogle Scholar
  37. 37.
    Uccella S, Laterza R, Ciravolo G, et al. A comparison of urinary complications following total laparoscopic radical hysterectomy and laparoscopic pelvic lymphadenectomy to open abdominal surgery. Gynecol Oncol 2007; 107:S147–9PubMedCrossRefGoogle Scholar
  38. 38.
    Raatz D, Borner P. Laparoscopy assisted radical vaginal hysterectomy (LAVRH) for cervical carcinoma—perioperative parameters and complications. Zentralbl Gynakol 2001; 123:136–42PubMedCrossRefGoogle Scholar
  39. 39.
    Dargent D, Enria R. Laparoscopic assessment of the sentinel lymph nodes in early cervical cancer. Technique—preliminary results and future developments. Crit Rev Oncol Hematol 2003; 48:305–10PubMedCrossRefGoogle Scholar
  40. 40.
    Landoni F, Maneo A, Cormio G, et al. Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol 2001; 80:3–12PubMedCrossRefGoogle Scholar
  41. 41.
    Landoni F, Maneo A, Colombo A, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350:535–40PubMedCrossRefGoogle Scholar
  42. 42.
    Sardi J, Vidaurreta J, Bermudez A, et al. Laparoscopically assisted Schauta operation: learning experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital. Gynecol Oncol 1999; 75:361–5PubMedCrossRefGoogle Scholar
  43. 43.
    Marchiole P, Buenerd A, Benchaib M, et al. Clinical significance of lympho vascular space involvement and lymph node micrometastases in early-stage cervical cancer: a retrospective case-control surgico-pathological study. Gynecol Oncol 2005; 97:727–32PubMedCrossRefGoogle Scholar
  44. 44.
    Kodama J, Seki N, Ojima Y, et al. Prognostic factors in node-positive patients with stage IB-IIB cervical cancer treated by radical hysterectomy and pelvic lymphadenectomy. Int J Gynaecol Obstet 2006; 93:130–5PubMedCrossRefGoogle Scholar
  45. 45.
    Kamelle SA, Rutledge TL, Tillmanns TD, et al. Surgical-pathological predictors of disease-free survival and risk groupings for IB2 cervical cancer: do the traditional models still apply? Gynecol Oncol 2004; 94:249–55PubMedCrossRefGoogle Scholar
  46. 46.
    Charoenkwan K, Pranpanas S. Prevalence and characteristics of late postoperative voiding dysfunction in early-stage cervical cancer patients treated with radical hysterectomy. Asian Pac J Cancer Prev 2007; 8:387–9PubMedGoogle Scholar
  47. 47.
    Benedetti-Panici P, Zullo MA, Plotti F, et al. Long-term bladder function in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy and type 3–4 radical hysterectomy. Cancer 2004; 100:2110–7PubMedCrossRefGoogle Scholar
  48. 48.
    Ayhan A, Tuncer ZS, Yarali H. Complications of radical hysterectomy in women with early stage cervical cancer: clinical analysis of 270 cases. Eur J Surg Oncol 1991; 17:492–4PubMedGoogle Scholar
  49. 49.
    Ralph G, Tamussino K, Lichtenegger W. Urological complications after radical abdominal hysterectomy for cervical cancer. Baillieres Clin Obstet Gynaecol 1988; 2:943–52PubMedCrossRefGoogle Scholar
  50. 50.
    Sood AK, Nygaard I, Shahin MS, et al. Anorectal dysfunction after surgical treatment for cervical cancer. J Am Coll Surg 2002; 195:513–9PubMedCrossRefGoogle Scholar
  51. 51.
    Ralph G, Winter R, Michelitsch L, et al. Radicality of parametrial resection and dysfunction of the lower urinary tract after radical hysterectomy. Eur J Gynaecol Oncol 1991; 12:27–30PubMedGoogle Scholar
  52. 52.
    Possover M. Technical modification of the nerve-sparing laparoscopy-assisted vaginal radical hysterectomy type 3 for better reproducibility of this procedure. Gynecol Oncol 2003; 90:245–7PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Yong Chen
    • 1
  • Huichen Xu
    • 1
  • Yuyan Li
    • 1
  • Dan Wang
    • 1
  • Junnan Li
    • 1
  • Jizhao Yuan
    • 1
  • Zhiqing Liang
    • 1
  1. 1.Department of Obstetrics and GynecologySouthwest Hospital, Third Military Medical UniversityChongqingP.R. China

Personalised recommendations