Mettler L, Meinhold-Heerlein I
Kiel School of Gynecological Endoscopy, Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany.
Minerva Ginecol. 2009 Aug;61(4):319-37.
The laparoscopic management of gynecologic cancers has been discussed controversely since decades. Much progress has been achieved technically enabling an experienced endoscopic surgeon to perform most of the gynecologic oncologic procedures such as hysterectomy, omentectomy, pelvic and paraaortic lymph node dissection. Although the value of laparoscopy with respect to oncological safety and patient's outcome has not been shown in prospective randomized clinical trials, many studies with altogether thousands of patients have revealed the feasibility and also similar oncologic results of laparoscopy when compared to laparotomy. Therefore, the laparoscopic approach has become well accepted for certain oncological indications, especially when early stage cancer cases are treated. These indications are also subject to ongoing Phase III trials: The LACC001 trial compares Total Laparoscopic Radical Hysterectomy (TLRH) or total robotic radical hysterectomy with total abdominal radical hysterectomy (TARH) for the treatment of early stage cervical cancer. The GOG LAP 2 and also the LACE001 trial compare total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) for the treatment of early stage endometrial cancer, whereby bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node dissection is performed according to tumor stage and grade. This review summarizes the current status of laparoscopy in gynecologic oncology based on the literature to date, the ongoing clinical trials, and the recommendations of the German Gynecologic Oncology Group (AGO).
几十年来，关于妇科癌症的腹腔镜治疗一直存在争议。在技术上已经取得了很大进展，使经验丰富的内镜外科医生能够实施大多数妇科肿瘤手术，如子宫切除术、大网膜切除术、盆腔及腹主动脉旁淋巴结清扫术。尽管腹腔镜在肿瘤学安全性和患者预后方面的价值尚未在前瞻性随机临床试验中得到证实，但许多涉及总共数千名患者的研究表明，与开腹手术相比，腹腔镜手术具有可行性，并且肿瘤学结果相似。因此，腹腔镜手术方法已被某些肿瘤学适应症广泛接受，尤其是在治疗早期癌症病例时。这些适应症也正在进行III期试验：LACC001试验比较全腹腔镜根治性子宫切除术（TLRH）或全机器人根治性子宫切除术与经腹根治性子宫切除术（TARH）治疗早期宫颈癌的效果。GOG LAP 2以及LACE001试验比较全腹腔镜子宫切除术（TLH）与经腹子宫切除术（TAH）治疗早期子宫内膜癌的效果，其中根据肿瘤分期和分级进行双侧输卵管卵巢切除术、盆腔及腹主动脉旁淋巴结清扫术。本综述基于迄今为止的文献、正在进行的临床试验以及德国妇科肿瘤学组（AGO）的建议，总结了腹腔镜在妇科肿瘤学中的现状。
