Learning Curve of Laparoscopic Radical Hysterectomy With Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer Comparison of the First 50 and Second 50 Cases

Background: To compare the surgical and oncological outcomes and morbidity of the first 50 cases treated by laparoscopic radical hysterectomy with those of the second 50 cases. Methods: Between October 1994 and January 2004, we retrospectively reviewed the charts of 100 consecutive patients (International Federation of Gynecology and Obstetrics stages IA2 [n = 12], IB1 [n = 56], IB2 [n = 15], IIA [n = 15], and 1113 [n = 2]) who underwent laparoscopic radical hysterectomy with pelvic and/or para-aortic lymphadenectomy. One hundred patients were divided into the first 50 cases (group 1) and second 50 cases (group 2). Results: Operating time, length of hospital stay, time to normal residual urine, and transfusion rate significantly decreased, and the acquired number of pelvic nodes significantly increased when comparing group I with group 2. The intraoperative and postoperative complication rates profoundly decreased in group 2 as compared with group 1. After a median follow-up of 66.5 months, 10 patients had a recurrence, 9 of whom died. The 5-year overall survival rates were 96% in group I and 90% in group 2, and 5-year disease-free survival rates were 92% in group I and 90% in group 2. Conclusions: Laparoscopic radical hysterectomy is a feasible and safe treatment modality in early and even locally advanced cervical cancer without decreasing survival. Surgical outcome was improved with experience, and the complication rate related to operation of group I was higher than that of group 2. There was no significant difference in survival between the 2 groups.