Lymph Node Yield, Positivity Ratio, and Overall Survival in Laparoscopic Versus Open Radical Hysterectomy for Carcinoma Cervix: A Retrospective Analysis

Background:

Cervical cancer is the second most prevalent malignancy in India, following breast cancer. This study aims to compare lymph node yield and node positivity ratio between laparoscopic and open radical hysterectomy. In the LACC trial, minimally invasive radical hysterectomy showed lower rates of disease-free survival and overall survival compared to open abdominal radical hysterectomy for women with early stage cervical cancer. This decreased survival in minimally invasive procedures is attributed to the use of uterine manipulators and tumor seeding. In our institution, we employ enhanced laparoscopy skills, hold the round ligament during dissection, avoid uterine manipulators, and use custom-made Endo bags for node retrieval delivered via the vagina. We also use continuous suction to minimize the risk of tumor seeding into the peritoneum and vault during surgery.

Methods: Study Setting:

We collected data from patients treated at our Surgical Oncology department, a tertiary care cancer hospital in South India.

Study Period:

The data collection period spanned from November 2017 to August 2022.

Patient Population:

The study comprised individuals who underwent either laparoscopic or open radical hysterectomy with standard pelvic lymphadenectomy for cervical carcinoma. These procedures were performed in two scenarios:

1. As an initial treatment for early operable cases.

2. As a follow-up for residual disease after definitive chemoradiation, chemotherapy, or radiation in advanced cervical cancer.

Study Design:

This is a retrospective cohort design aimed at comparing the lymph node yield and positivity ratio between open and laparoscopic radical hysterectomy.

Follow-up and Analysis:

Survival analysis was conducted through patient follow-ups up to December 2023.

Findings and Conclusions:

Laparoscopic procedures yielded a slightly higher average node harvest (6.4 nodes) compared to open surgeries (5.1 nodes). However, laparoscopic radical hysterectomy demonstrated a more extensive overall node dissection in upfront cases (10.5 nodes) compared to post-treatment cases (5.04 nodes).

Node positivity rates varied among the approaches, with laparoscopy at 7.9%, lower in upfront cases (4.5%) than in post-Chemo/CRT cases (9%). Open procedures exhibited a higher overall node positivity rate of 11.8%, notably elevated in upfront cases (16.7%) compared to post-Chemo/CRT cases (10.7%).

In comparison with recent trials, our study demonstrates better survival with the laparoscopic arm. This improvement may be attributed to the lessons learned from LACC-like trials.