Pellegrino Antonio, Villa Annalisa, Fruscio Robert, Signorelli Mauro, Meroni Mario G, Iedà Nicoletta, Vitobello Domenico
UO Obstetrics and Gynecology, Casa di Cura Abano Terme, Abano Terme (PD), Italy.
Surg Laparosc Endosc Percutan Tech. 2008 Oct;18(5):474-8. doi: 10.1097/SLE.0b013e31817e797b.
The aim of the study was to evaluate the adequacy, morbidity, and survival outcome of laparoscopic type II radical hysterectomy and pelvic lymphadenectomy in patients with early invasive cervical cancer.
Between February 2003 and December 2005, 57 patients underwent total laparoscopic radical hysterectomy (TLRH) with pelvic lymphadenectomy. Eligibility criteria were good general condition, tumor size < 3 cm, no evidence of lymph node metastases in imaging study (magnetic resonance imaging and/or computed tomography and/or positron emission tomography) and body mass index < or = 35.
TLRH was completed in 56 patients; in 1 patient, surgery was converted to laparotomy because of positive nodal status at the frozen section. Median age was 43 years and median body mass index was 21.5 kg/m2. The majority of patients (86%) had FIGO stage Ib1 cervical cancer, and the predominant histotype was squamous (59%). Median operating time was 310 minutes and median blood loss 200 mL. No patient required hemotransfusion. Median number of resected lymph nodes was 24, and 6 patients had microscopic node metastasis. Margins were positive in one patient. The only intraoperative complication was a 1-cm cystotomy repaired laparoscopically during the intervention. Four patients required a second surgery, 2 for ureteral stenosis and 2 for the reparation of vaginal cuff diastasis. After a median follow-up of 13 months, 4 patients had a relapse; all 56 patients are alive at present.
TLRH with pelvic lymphadenectomy is an adequate and feasible surgical option in treating early invasive cervical cancer; however a longer follow-up is required to evaluate the oncologic outcome of these patients.
本研究旨在评估早期浸润性宫颈癌患者行腹腔镜II型根治性子宫切除术及盆腔淋巴结清扫术的充分性、发病率及生存结局。
2003年2月至2005年12月期间，57例患者接受了全腹腔镜根治性子宫切除术（TLRH）及盆腔淋巴结清扫术。入选标准为一般状况良好、肿瘤大小<3 cm、影像学检查（磁共振成像和/或计算机断层扫描和/或正电子发射断层扫描）无淋巴结转移证据且体重指数≤35。
56例患者完成了TLRH；1例患者因冰冻切片显示淋巴结阳性而中转开腹手术。中位年龄为43岁，中位体重指数为21.5 kg/m²。大多数患者（86%）为国际妇产科联盟（FIGO）Ib1期宫颈癌，主要组织学类型为鳞状细胞癌（59%）。中位手术时间为310分钟，中位失血量为200 mL。无患者需要输血。切除淋巴结的中位数量为24个，6例患者有微小淋巴结转移。1例患者切缘阳性。唯一的术中并发症是术中腹腔镜修补1 cm膀胱切开术。4例患者需要二次手术，2例因输尿管狭窄，2例因阴道断端裂开修补。中位随访13个月后，4例患者复发；目前所有56例患者均存活。
TLRH及盆腔淋巴结清扫术是治疗早期浸润性宫颈癌的一种充分且可行的手术选择；然而，需要更长时间的随访来评估这些患者的肿瘤学结局。
