Department of Obstetrics and Gynecology 791, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Gynecol Oncol. 2011 Mar;120(3):334-9. doi: 10.1016/j.ygyno.2010.12.342. Epub 2011 Jan 13.
The aim of this study was to review current literature on total laparoscopic (TLRH) and robot-assisted radical hysterectomy (RRH) with pelvic lymphadenectomy in the treatment of early stage cervical cancer by analyzing data published in individual case series in order to compare surgical and oncological outcomes.
Up to January 2010, 27 studies were identified that met the inclusion criteria, together with our own unpublished data of patients, accounted for 342 RRH patients and 914 TLRH patients.
There was no statistical difference between the methods in terms of age, BMI or prior abdominal surgery. Estimated mean operative time, blood loss and number of lymph nodes retrieved did not statistically differ between the RRH and TLRH method. Less blood transfusions were needed in patients treated by RRH (5.4%) versus TLRH (9.7%, p<0.05). Both methods were similar in respect to adjuvant chemo- or (chemo)radiation and recurrence rate. When complications were prioritized to severity, major post-operative complications where more frequent in RRH patients (9.6%) than in TLRH patients (5.5%, p<0.05). The length of hospital stay was significantly shorter in RRH compared to TLRH treatment (3.3 versus 6.2days respectively; p:0.04).
Robot-assisted and total laparoscopic radical hysterectomy appears to be equally adequate and feasible. RRH studies had small patient populations and further experience beyond the learning curve phase may improve operative time and complication rate. Both minimal invasive techniques should be investigated in a randomized manner.
本研究旨在通过分析单独病例系列研究中发表的数据，回顾经腹腔镜（TLRH）和机器人辅助根治性子宫切除术（RRH）联合盆腔淋巴结清扫术治疗早期宫颈癌的现有文献，以比较手术和肿瘤学结果。
截至 2010 年 1 月，共确定了 27 项符合纳入标准的研究，加上我们自己未发表的患者数据，共包括 342 例 RRH 患者和 914 例 TLRH 患者。
RRH 和 TLRH 方法在年龄、BMI 或既往腹部手术方面无统计学差异。RRH 和 TLRH 方法的估计平均手术时间、出血量和淋巴结检出数无统计学差异。RRH 组（5.4%）比 TLRH 组（9.7%）需要输血的患者较少（p<0.05）。RRH 和 TLRH 两种方法在辅助化疗或（放）化疗和复发率方面相似。当按严重程度对并发症进行优先排序时，RRH 患者的术后严重并发症更为常见（9.6%），而 TLRH 患者（5.5%）较少（p<0.05）。RRH 组的住院时间明显短于 TLRH 组（分别为 3.3 天和 6.2 天；p：0.04）。
机器人辅助和完全腹腔镜根治性子宫切除术似乎同样合适且可行。RRH 研究的患者人群较小，在学习曲线阶段之外进一步积累经验可能会改善手术时间和并发症发生率。这两种微创技术都应在随机研究中进行研究。
