Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
Gynecol Oncol. 2012 Oct;127(1):102-6. doi: 10.1016/j.ygyno.2012.06.003. Epub 2012 Jun 7.
To determine if laparoscopic radical hysterectomy (LRH) can be substituted for radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA cervical cancer.
We retrospectively reviewed the medical records of cervical cancer patients who underwent LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) from March 2003 to December 2011.
Of 118 enrolled patients, six were in FIGO stage IA2, 66 were in IB1, 41 were in IB2, one was in IIA1, and four were in IIA2. The median operating time, perioperative hemoglobin change, the number of harvested pelvic and para-aortic lymph nodes were 270 min (range, 120-495), 1.7 g/dL (range, 0.1-5), 26 (range, 9-55), and 7 (range, 1-39), respectively. There was no unplanned conversion to laparotomy. Intra- and postoperative complications occurred in 16 (13.5%) and 8 (6.7%) patients, respectively. In a median follow-up of 31 months (range, 1-89), 5-year recurrence-free and overall survival rates were 90% and 89%, respectively. Univariate analysis showed that cervical stromal invasion (P=0.023) and lymph node metastasis (P=0.018) affected survival rate. Cox-proportional hazards regression analysis showed that lymph node metastasis was the only independent factor for poor prognosis (hazard ratio=7.0, P=0.022).
LRH with LPL and/or LPAL in women with stage IA2-IIA cervical cancer is safe and feasible in terms of survival and morbidity. Our data suggest the need for larger prospective trials which could support this approach as a new standard of care for stage IA2-IIA cervical cancer.
确定腹腔镜根治性子宫切除术（LRH）是否可替代国际妇产科联合会（FIGO）分期为 IA2-IIA 期宫颈癌的根治性腹部子宫切除术。
我们回顾性分析了 2003 年 3 月至 2011 年 12 月期间接受 LRH 加腹腔镜盆腔淋巴结切除术（LPL）和/或腹腔镜腹主动脉旁淋巴结切除术（LPAL）的宫颈癌患者的病历。
118 例入组患者中，6 例为 FIGO 分期 IA2，66 例为 IB1，41 例为 IB2，1 例为 IIA1，4 例为 IIA2。中位手术时间、围手术期血红蛋白变化、盆腔和腹主动脉旁淋巴结采集数分别为 270 分钟（范围 120-495 分钟）、1.7 g/dL（范围 0.1-5 g/dL）、26 枚（范围 9-55 枚）和 7 枚（范围 1-39 枚）。无计划中转开腹。术中及术后并发症分别发生在 16 例（13.5%）和 8 例（6.7%）患者中。中位随访 31 个月（范围 1-89 个月）后，5 年无复发生存率和总生存率分别为 90%和 89%。单因素分析显示，宫颈间质浸润（P=0.023）和淋巴结转移（P=0.018）影响生存率。Cox 比例风险回归分析显示，淋巴结转移是预后不良的唯一独立因素（风险比=7.0，P=0.022）。
对于 FIGO 分期为 IA2-IIA 期的宫颈癌患者，LRH 联合 LPL 和/或 LPAL 治疗在生存和发病率方面是安全可行的。我们的数据表明，需要更大规模的前瞻性试验来支持这种方法作为 IA2-IIA 期宫颈癌的新治疗标准。
