Malzoni Mario, Tinelli Raffaele, Cosentino Francesco, Fusco Annarita, Malzoni Carmine
Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
Ann Surg Oncol. 2009 May;16(5):1316-23. doi: 10.1245/s10434-009-0342-7. Epub 2009 Feb 18.
The aim of this study was to retrospectively compare, in a series of 127 consecutive women, the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and abdominal radical hysterectomy with lymphadenectomy (ARH) for early cervical carcinoma.
A total of 127 consecutive patients with International Federation of Gynecology and Obstetrics stage Ia1 (lymphvascular space involvement), Ia2, and Ib1 early cervical cancer, 65 of whom underwent TLRH and 62 of whom underwent ARH with pelvic lymph node dissection, comprised the study population. The para-aortic lymphadenectomy with the superior border of the dissection being the inferior mesenteric artery was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation.
The median blood loss in the ARH group (145 ml; range, 60-225 ml) was significantly greater than TLRH group (55 ml; range, 30-80 ml) (P < .01). The median length of hospital stay was significantly greater in the ARH group (7 days; range, 5-9 days) than TLRH group (4 days; range, 3-7 days) (P < .01). The median operating time was 196 min in the TLRH group (range, 182-240 min) compared with 152 min in the ARH group (range, 161-240 min) (P < .01). No statistically significant difference was found between the two groups when the recurrence rate was compared.
Total laparoscopic radical hysterectomy is a safe and effective therapeutic procedure for management of early-stage cervical cancer with a far lower morbidity than reported for the open approach and is characterized by far less blood loss and shorter postoperative hospitalization time, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.
本研究旨在回顾性比较127例连续女性患者中，全腹腔镜根治性子宫切除术（TLRH）加淋巴结清扫术与腹式根治性子宫切除术（ARH）加淋巴结清扫术治疗早期宫颈癌的安全性、发病率及复发率。
共有127例国际妇产科联盟（FIGO）分期为Ia1期（伴脉管间隙浸润）、Ia2期和Ib1期的早期宫颈癌患者纳入研究人群，其中65例行TLRH，62例行ARH加盆腔淋巴结清扫术。所有在术中冰冻切片评估发现盆腔淋巴结阳性的病例均行腹主动脉旁淋巴结清扫术，清扫上界为肠系膜下动脉。
ARH组的术中中位失血量（145 ml；范围60 - 225 ml）显著多于TLRH组（55 ml；范围30 - 80 ml）（P <.01）。ARH组的中位住院时间（7天；范围5 - 9天）显著长于TLRH组（4天；范围3 - 7天）（P <.01）。TLRH组的中位手术时间为196分钟（范围182 - 240分钟），而ARH组为152分钟（范围161 - 240分钟）（P <.01）。比较两组复发率时未发现统计学显著差异。
全腹腔镜根治性子宫切除术是治疗早期宫颈癌的一种安全有效的治疗方法，其发病率远低于开放手术，且具有失血量少、术后住院时间短的特点，尽管需要多中心、长期随访的随机临床试验来评估该手术的总体肿瘤学结局。
