Department of Obstetrics and Gynecology, Centre for Gynecologic Oncology Amsterdam, location VU, VU University Medical Centre, Amsterdam.
Int J Gynecol Cancer. 2012 Jan;22(1):107-14. doi: 10.1097/IGC.0b013e31822c273d.
This study aimed to investigate in a retrospective study the effect of laparoscopic surgery, introduced in our center in 1994 as part of the standard treatment of early stage cervical cancer, on surgical and disease outcomes.
A total of 169 women with cervical carcinoma stage IB1 (n = 150) or IB2 (n = 19) were included in the study. Seventy-six patients who underwent laparoscopic pelvic lymph node dissection (LPLND), followed either by open radical hysterectomy (n = 63) or, in case of positive lymph nodes, by primary chemoradiation (n = 13), were compared with an historic cohort of 93 patients who underwent a fully open, traditional Wertheim-Meigs procedure (WM). Recorded clinical characteristics of patients included age, International Federation of Gynecology and Obstetrics stage, histologic diagnosis, differentiation grade, tumor diameter, lymph node status, and adjuvant therapy. Operation time; lymph node yield; intraoperative, early, and late complications; site of recurrences; and disease-free and overall survival rates were analyzed and compared between groups.
Clinical characteristics did not differ between groups. Duration of total surgery time was longer in patients with LPLND followed by open radical hysterectomy compared with that in the WM group (P < 0.001). In patients with negative lymph nodes (n = 129), the number of resected nodes was higher (P = 0.002) in the LPLND (median, 26 nodes; range, 8-55 nodes) than in the WM group (median, 21 nodes; range, 7-50 nodes). In patients with positive lymph nodes (n = 40), no significant difference in the number of resected lymph nodes between the 2 groups (P = 0.904) was found. Intraoperative, early, and late complications did not differ between the 2 surgical procedures. The number of locoregional recurrences, but not of distant metastases, was significantly higher (P = 0.018) in the WM group compared with the LPLND group. No difference in disease-free or disease-specific survival was found between the LPLND and WM group, neither with nor without adjuvant or primary (chemo)radiation. A benefit in disease-free survival (P = 0.044), but not in disease-specific survival (P = 0.070), was found in the LPLND compared with the WM group in those patients who received adjuvant therapy or primary chemoradiation.
Introduction of a laparoscopic procedure in the surgical staging and treatment of cervical cancer patients did not have a detrimental effect on surgical or disease outcome, and this can be safely applied to the treatment of early stage cervical cancer.
本研究旨在回顾性研究腹腔镜手术对早期宫颈癌标准治疗的影响。
共纳入 169 例宫颈癌 IB1 期（n=150）或 IB2 期（n=19）患者。76 例患者接受腹腔镜盆腔淋巴结清扫术（LPLND），其中 63 例随后行开放性根治性子宫切除术，13 例因淋巴结阳性而行初始放化疗。将这 76 例患者与 93 例接受完全开放性传统 Wertheim-Meigs 手术（WM）的历史对照队列进行比较。记录患者的临床特征，包括年龄、国际妇产科联盟（FIGO）分期、组织学诊断、分化程度、肿瘤直径、淋巴结状态和辅助治疗。分析和比较两组之间的手术时间、淋巴结产量、术中、早期和晚期并发症、复发部位、无病生存率和总生存率。
两组患者的临床特征无差异。与 WM 组相比，LPLND 后行开放性根治性子宫切除术的患者总手术时间更长（P＜0.001）。在淋巴结阴性患者（n=129）中，LPLND 组（中位数，26 枚；范围，8-55 枚）切除的淋巴结数量高于 WM 组（中位数，21 枚；范围，7-50 枚）（P=0.002）。在淋巴结阳性患者（n=40）中，两组间切除的淋巴结数量无显著差异（P=0.904）。两种手术方法的术中、早期和晚期并发症无差异。WM 组局部区域复发的数量高于 LPLND 组（P=0.018），但远处转移的数量无差异。LPLND 组与 WM 组在无病生存率或疾病特异性生存率方面无差异，无论是否接受辅助或初始（化疗）放疗。在接受辅助治疗或初始放化疗的患者中，LPLND 组无病生存率（P=0.044）较 WM 组有获益，但疾病特异性生存率（P=0.070）无差异。
腹腔镜手术在宫颈癌患者的手术分期和治疗中的应用并未对手术或疾病结果产生不利影响，可安全应用于早期宫颈癌的治疗。
