Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Eur J Surg Oncol. 2012 Mar;38(3):203-9. doi: 10.1016/j.ejso.2011.12.017. Epub 2012 Jan 14.
The standard treatment for stage IB-IIA cervical cancer over the past three decades has been the Piver-Rutledge type III radical hysterectomy. This surgery implies a high rate of urologic morbidity. The objective was to determine the role of class I radical hysterectomy compared to class III radical hysterectomy in terms of morbidity, overall survival, DFS and patterns of relapse in patients undergoing primary surgery.
125 patients with stage IB1 and IIA cervical cancer ≤ 4 cm were randomized between type I and type III hysterectomy. Clinical, pathologic and follow-up data were prospectively collected. Adjuvant radiotherapy was administered when indicated. Univariate and multivariate analyses were carried out.
Sixty-two patients were randomized to class I surgery and 63 to class III. No significant differences were observed regarding pathologic findings and adjuvant treatment. Morbidity rates were higher after class III surgery (84% versus 45%). Pelvic recurrences were equal in both groups (8 cases each one). Fifteen-year overall survival rate was 90 and 74% respectively (p = 0.11) and 76 and 80% when cervical size is ≤ 3 cm (p = 0.88).
There are no significant differences in terms of both recurrence rate and overall survival among patients with stage IB-IIA cervical cancer undergoing simple extrafascial hysterectomy (class I) or radical hysterectomy (class III). Morbidity is proportional to the extent of radicality. These data confirm the need of tailoring the extent of resection to the characteristics of the cervical neoplasia and open new interesting pathways to upcoming protocols for the conservative management of these tumors.
在过去三十年中，对于 IB 期-IIA 期宫颈癌的标准治疗一直是 Piver-Rutledge 三型根治性子宫切除术。这种手术会导致较高的泌尿系统发病率。本研究旨在确定 I 型根治性子宫切除术与 III 型根治性子宫切除术在发病率、总生存率、DFS 和患者接受原发性手术时的复发模式方面的作用。
125 名患有≤4cm 的 IB1 和 IIA 期宫颈癌的患者被随机分为 I 型和 III 型子宫切除术组。前瞻性收集临床、病理和随访数据。根据需要给予辅助放疗。进行单变量和多变量分析。
62 名患者被随机分配至 I 型手术组，63 名患者被随机分配至 III 型手术组。两组在病理发现和辅助治疗方面无显著差异。III 型手术后的发病率较高（84%对比 45%）。两组的盆腔复发率相等（各 8 例）。15 年总生存率分别为 90%和 74%（p=0.11），当宫颈大小≤3cm 时分别为 76%和 80%（p=0.88）。
对于接受单纯筋膜外子宫切除术（I 型）或根治性子宫切除术（III 型）的 IB-IIA 期宫颈癌患者，复发率和总生存率方面无显著差异。发病率与根治性程度成正比。这些数据证实了根据宫颈癌的特征来调整切除范围的必要性，并为这些肿瘤的保守管理即将出台的方案开辟了新的有趣途径。
