Radical hysterectomy for treatment of cervical cancer: a prospective study of two methods of closed-suction drainage

Evaluation of morbidity of suction drains after retroperitoneal lymphadenectomy in gynecological tumors: a systematic literature review

INTRODUCTION

The prophylactic use of closed suction drains after retroperitoneal lymphadenectomy in the management of gynecologic tumors has been widely used to prevent collections of clots or lymph and to avoid infections and postoperative fistulas. The improvement of newer surgical techniques, the use of antibiotic prophylaxis, and the nonclosure of the peritoneum led to the need to reevaluate the use of drains. Retrospective, prospective, and randomized studies did not find differences in the postoperative morbidity between the use and nonuse of drains. Some studies even suggested worse morbidity with the use of drains.

OBJECTIVES

To assess the morbidity of the use of drains compared with no drains in a systematic literature review with aggregate effect measure (meta-analysis).

MATERIALS AND METHODS

Between 1966 and August 2007, 3 independent reviewers analyzed all studies that assessed the use of drains or no drains through a comprehensive literature search of the MEDLINE, EMBASE, and Cochrane Central Databases. Statistical analysis was carried out through the RevMan software.

RESULTS

Of the 285 studies initially reviewed, 11 were selected. Only 4 were considered adequate for group analysis, totaling 571 patients. When assessing outcomes altogether, namely, fever morbidity, symptomatic lymphocysts, deep vein thrombosis, pelvic infection, and fistulas, the relative risk was 1.76 (95% confidence interval, 1.04-3.01) and number necessary to harm was 12.2 referring to the use of drains.

CONCLUSIONS

The prophylactic use of continuous suction drains after retroperitoneal lymphadenectomy in the management of gynecologic tumors should be avoided.

Radical abdominal hysterectomy

Radical abdominal hysterectomy and pelvic lymphadenectomy remain the gold standard procedures for the treatment of early cervical cancer. Over the years, the establishment of formal gynecologic oncology training programs, general medical advancements, and new surgical techniques have resulted in a satisfactory tumor resection, with improved overall therapeutic index and reliable cure rates. The role of neoadjuvant and adjuvant therapy continues to be defined as the results from randomized trials emerge.

Laparoscopic radical hysterectomy with pelvic lymphadenectomy for early, invasive cervical carcinoma

STUDY OBJECTIVE

To demonstrate the feasibility and evaluate the efficacy of laparoscopic radical hysterectomy with pelvic lymphadenectomy for early, invasive cervical cancer.

DESIGN

Prospective study (Canadian Task Force classification II-2).

SETTING

University-affiliated hospital.

PATIENTS

Eighteen women (age range 29-70 yrs) with early, invasive cervical cancer.

INTERVENTION

Laparoscopic radical hysterectomy with pelvic lymphadenectomy.

MEASUREMENTS AND MAIN RESULTS

Diagnoses were squamous cell carcinoma in15 patients and adenocarcinoma of the cervix in 3; these were graded microcarcinoma in 6 and stage Ib (<4 cm) in 12. Mean operating time was approximately 363 +/- 65 minutes (range 240-475 min). Blood loss averaged 619 +/- 297 ml (range 250-1000 ml). The average number of pelvic lymph nodes obtained was 22.0 +/- 8.5 (range 14-40). Specimen weight averaged 117 +/- 67 g (range 60-340 g). Surgical margins were clear in all patients. No procedure was converted to laparotomy. There were no major intraoperative complications involving injury to main blood vessels, nerves, bowel, bladder, or ureters.

CONCLUSION

In our experience, laparoscopic radical hysterectomy with pelvic lymphadenectomy is acceptable in accordance with the standards of gynecologic oncology. Despite the longer operating time than traditional abdominal radical hysterectomy, all patients recovered as quickly as they would after laparoscopic-assisted vaginal hysterectomy. We believe that this procedure could be an alternative to abdominal radical hysterectomy for selected women, especially those who have stage Ib1 cervical cancer.