Feasibility and Safety of Laparoscopic Total Mesometrial Resection in Early-stage Cervical Cancer

Aim: In this study we aimed to analyze the safety and feasibility of total mesometrial resection (TMMR) using the laparoscopic approach. Patients and Methods: Laparoscopic TMMR and pelvic lymphadenectomy (LNE) was carried out in 34 patients with cervical cancer FIGO IA-IIB from April 2012-April 2016 at our tertiary center. Para-aortic LNE was performed when indicated. The main outcomes included surgical margins, a number of retrieved lymph node, intra-and post-operative complications, and recurrence rates. Results: Complete microscopic tumor resection was confirmed in 33/34 (97%) patients. No conversion to open surgery was necessary. Mean intraoperative blood loss was only 65.2 ml with no blood transfusions required. Intra-operative complications occurred in 4/34 (11.8%) cases (2 bladder injuries and 2 ureteric injuries). Post-operative complications were observed in 10/35 (29.4%) cases. Only one complication occurred after 30 days (vesico-vaginal fistula). There was a loco-regional recurrence within a mean follow-up time of 25.9 months. Conclusion: Laparoscopic TMMR appears to be feasible and safe in the treatment of early-stage cervical cancer. Further large-scale studies are required.