Colpohystérectomie élargie par laparoscopie après curiethérapie préopératoire pour cancer du col utérin (stade 1B1): faisabilité et résultats

Background The aim of this study was to examine the feasibility and to report the results of laparoscopic radical hysterectomy (LRH) after initial uterovaginal brachytherapy (BT) for stage IB1 cervical cancer. Patients and methods We retrospectively reviewed in two Comprehensive Cancer Centers patients who had undergone initial BT followed 6 to 8 weeks later by LRH and lymph node dissection. Results Between 2003 and 2010, 162 patients had undergone LRH. The procedure was feasible using this approach in 160 (98.8%) cases (2 conversions to laparotomy). Eight peroperative complications had occurred. Nineteen patients had nodal involvement. Peri- or postoperative ureteral morbidity had occurred in 10 (6%) patients. Twenty-four (15%) patients had experienced postoperative dysuria. Histologically, only 9 patients had residual cervical disease > 5 mm and only 1 patient had parametrial lymphovascular space involvement (associated with nodal spread). No patient had vaginal disease or involved surgical margins. After a median follow-up of 39 months (range, 3-118), 9 patients had relapsed. Five-year overall survival was 95% (88.2%-97.9%). Conclusions Radical hysterectomy using a laparoscopic approach is feasible and reproducible after initial BT for stage IB1 cervical cancer and is associated with excellent survival. Morbidity is very close to that reported in patients treated using upfront surgery. In this large series, the morbidity associated with parametrial dissection and the fact that parametrial spread was observed in only 0.6% of the patients suggest that a simple extrafascial hysterectomy is perhaps sufficient in this context.