Sentinel Lymph Node Identification and Radical Hysterectomy with Lymphadenectomy in Early Stage Cervical Cancer: Laparoscopy Versus Laparotomy

Abstract Study Objective To estimate the feasibility and results of sentinel lymph node identification and radical hysterectomy with pelvic lymphadenectomy entirely completed by laparoscopy versus laparotomy in early stage cervical cancer. Design Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). Setting Acute care, teaching hospital. Patients From September 2000 through January 2005, 50 consecutive patients with International Federation of Gynecology and Obstetrics stage IA 2 , IB 1 , and IIA disease less than 4 cm underwent radical hysterectomy and lymphadenectomy with intraoperative sentinel lymph node biopsy. Interventions The operation was performed entirely by laparoscopy in 20 patients and using the conventional abdominal approach in 30. Feasibility of sentinel lymph node identification, surgical morbidity, overall survival, and recurrence rate–free survival in both groups were compared. Measurements and Main Results The overall detection rate of the sentinel lymph node was 100% (false negative 0%). A mean of 2.50 sentinel nodes/patient was detected in the laparotomy group compared with a mean of 2.55 nodes in the laparoscopic group (p = .874). Bifurcation of the right common iliac artery was the most frequent nodal location. Blood loss and length of stay were significantly lower in the laparoscopic group, but surgical time was significantly longer. The median follow-up was 35 months (range 5–57) in the laparotomy group and 22.5 (range 2–52) in the laparoscopic group. Differences in overall survival and disease-free survival were not observed. Conclusion Sentinel lymph node identification and radical hysterectomy in the initial treatment of early stage cervical cancer can be performed safely by laparoscopy with lower morbidity and overall survival and recurrence-free survival similar to standard laparotomy.