Eltabbakh Gamal H
Division of Gynecologic Oncology, University of Vermont College of Medicine, Burlington, USA.
Cancer. 2002 Nov 1;95(9):1894-901. doi: 10.1002/cncr.10928.
The effect of the laparoscopic surgical approach on the survival of women with endometrial carcinoma remains unclear. The objectives of the current study were to assess the effect of laparoscopic surgery on the survival of women with early-stage endometrial carcinoma and to analyze the factors that affect such survival.
A retrospective review of women presenting with clinical stage I endometrial carcinoma (according to the 1988 International Federation of Gynecology and Obstetrics Staging System) was performed. Women treated with laparoscopy were compared with those treated with laparotomy with regard to their characteristics, surgical procedure, treatment, surgical stage, histology, tumor grade, and recurrence-free and overall survival. Factors affecting survival (surgical approach, histology, grade, and surgical stage) were evaluated using multivariate analysis and survival curves were constructed using Kaplan-Meier analyses.
One hundred women underwent laparoscopy and 86 underwent laparotomy. Both groups were similar with regard to age, parity, menopausal status, lymphadenectomy, surgical stage, tumor grade, histology, and postoperative radiation therapy. Women who underwent laparoscopy and those who underwent laparotomy had similar 2-year and 5-year estimated recurrence-free survival rates (93% vs. 94% and 90% vs. 92%, respectively), as well as similar 2-year and 5-year overall survival rates (98% vs. 96% and 92% vs. 92%, respectively). There was no apparent difference with regard to the sites of recurrence between both groups. In univariate and multivariate analyses, surgical stage, tumor grade, and histology (but not the surgical approach) were found to have a significant effect on survival.
Although longer follow-up is needed, the survival of women with early-stage endometrial carcinoma does not appear to be worsened by laparoscopy. Surgical stage, tumor histology, and tumor grade were found to significantly affect survival regardless of the surgical approach used.
腹腔镜手术方式对子宫内膜癌女性患者生存率的影响仍不明确。本研究的目的是评估腹腔镜手术对早期子宫内膜癌女性患者生存率的影响，并分析影响该生存率的因素。
对临床分期为I期子宫内膜癌（根据1988年国际妇产科联盟分期系统）的女性患者进行回顾性研究。比较接受腹腔镜手术的女性与接受开腹手术的女性在特征、手术过程、治疗、手术分期、组织学、肿瘤分级以及无复发生存率和总生存率方面的情况。使用多因素分析评估影响生存率的因素（手术方式、组织学、分级和手术分期），并使用Kaplan-Meier分析构建生存曲线。
100名女性接受了腹腔镜手术，86名接受了开腹手术。两组在年龄、产次、绝经状态、淋巴结清扫、手术分期、肿瘤分级、组织学和术后放疗方面相似。接受腹腔镜手术和开腹手术的女性2年和5年的估计无复发生存率相似（分别为93%对94%和90%对92%），2年和5年的总生存率也相似（分别为98%对96%和92%对92%）。两组之间在复发部位方面没有明显差异。在单因素和多因素分析中，发现手术分期、肿瘤分级和组织学（而非手术方式）对生存率有显著影响。
尽管需要更长时间的随访，但早期子宫内膜癌女性患者的生存率似乎不会因腹腔镜手术而恶化。无论采用何种手术方式，手术分期、肿瘤组织学和肿瘤分级均被发现对生存率有显著影响。
