University of Oklahoma, Oklahoma City, OK 73190, USA.
J Clin Oncol. 2009 Nov 10;27(32):5331-6. doi: 10.1200/JCO.2009.22.3248. Epub 2009 Oct 5.
The objective was to compare laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer.
Patients with clinical stage I to IIA uterine cancer were randomly assigned to laparoscopy (n = 1,696) or open laparotomy (n = 920), including hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The main study end points were 6-week morbidity and mortality, hospital length of stay, conversion from laparoscopy to laparotomy, recurrence-free survival, site of recurrence, and patient-reported quality-of-life outcomes.
Laparoscopy was initiated in 1,682 patients and completed without conversion in 1,248 patients (74.2%). Conversion from laparoscopy to laparotomy was secondary to poor visibility in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), bleeding in 49 patients (2.9%), and other cause in 70 patients (4.2%). Laparoscopy had fewer moderate to severe postoperative adverse events than laparotomy (14% v 21%, respectively; P < .0001) but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 204 v 130 minutes, respectively; P < .001). Hospitalization of more than 2 days was significantly lower in laparoscopy versus laparotomy patients (52% v 94%, respectively; P < .0001). Pelvic and para-aortic nodes were not removed in 8% of laparoscopy patients and 4% of laparotomy patients (P < .0001). No difference in overall detection of advanced stage (stage IIIA, IIIC, or IVB) was seen (17% of laparoscopy patients v 17% of laparotomy patients; P = .841).
Laparoscopic surgical staging for uterine cancer is feasible and safe in terms of short-term outcomes and results in fewer complications and shorter hospital stay. Follow-up of these patients will determine whether surgical technique impacts pattern of recurrence or disease-free survival.
比较腹腔镜与开腹手术用于子宫癌全面外科分期的效果。
将临床Ⅰ期至ⅡA 期子宫癌患者随机分配至腹腔镜组（n=1696）或开腹组（n=920），包括子宫切除术、输卵管卵巢切除术、盆腔细胞学检查以及盆腔和腹主动脉旁淋巴结切除术。主要研究终点为 6 周内发病率和死亡率、住院时间、腹腔镜转为开腹术、无复发生存率、复发部位和患者报告的生活质量结果。
1682 例患者开始接受腹腔镜手术，其中 1248 例（74.2%）无中转开腹。246 例（14.6%）因可视度差、69 例（4.1%）因转移性癌症、49 例（2.9%）因出血、70 例（4.2%）因其他原因而中转开腹。腹腔镜组术后中重度不良事件少于开腹组（分别为 14%和 21%，P<0.0001），但术中并发症发生率相似，尽管腹腔镜手术时间明显更长（中位数分别为 204 分钟和 130 分钟，P<0.001）。腹腔镜组住院时间超过 2 天的患者比例明显低于开腹组（分别为 52%和 94%，P<0.0001）。8%的腹腔镜组患者和 4%的开腹组患者未行盆腔和腹主动脉旁淋巴结切除术（P<0.0001）。腹腔镜组和开腹组总体晚期阶段（ⅢA 期、ⅡIC 期或 IVB 期）检出率无差异（分别为 17%和 17%，P=0.841）。
腹腔镜用于子宫癌外科分期在短期结果方面是可行和安全的，可减少并发症并缩短住院时间。对这些患者的随访将确定手术技术是否会影响复发模式或无病生存率。
