Gynecologic Oncology Unit, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
Ann Surg Oncol. 2013 Jun;20(6):2007-15. doi: 10.1245/s10434-012-2777-5. Epub 2012 Dec 6.
Despite the lack of conclusive evidence supporting this treatment modality, neoadjuvant chemotherapy (NACT) prior to radical surgery is a commonly accepted strategy to manage locally advanced cervical cancer. Radical hysterectomy in chemotherapy-treated patients can be technically challenging due to large volume of residual disease, desmoplastic reaction, and loss of normal tissue planes as a result of the cytotoxic treatment. We sought to assess whether surgical outcomes of laparoscopic radical hysterectomy (LRH) and its open counterpart are equivalent in the setting of NACT.
Prospectively maintained databases of five gynecologic oncology services were searched for stage IB2-IIB cervical cancer patients undergoing surgery after NACT. LRH and open radical hysterectomy (RAH) patients were compared with respect to perioperative outcomes and mid-term survival. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching.
LRH cases (n = 68) were associated with lower-stage, lower-grade tumors compared with RAH group (n = 273). When patients were grouped by stage at presentation (IB2-IIA and IIB), complication rates and perioperative outcomes were equivalent between LRH and RAH groups. LRH offered less blood loss, lower transfusion rate, and shorter hospitalization. These differences remained significant after PS matching. In the PS-matched cohort, Cox proportional hazards model including tumor stage, grade, histotype, nodal status, institution, and time period of surgery showed that laparoscopic approach was not associated with impaired survival.
Laparoscopic approach seems a valuable alternative to open surgery for patients with locally advanced cervical carcinoma who have received NACT.
尽管没有确凿的证据支持这种治疗方式，但新辅助化疗（NACT）前的根治性手术是治疗局部晚期宫颈癌的常用策略。由于大量残留疾病、纤维变性反应以及细胞毒性治疗导致正常组织平面丢失，接受化疗的患者进行根治性子宫切除术在技术上具有挑战性。我们旨在评估在 NACT 环境下，腹腔镜根治性子宫切除术（LRH）及其开放对照的手术结果是否相当。
五个妇科肿瘤服务的前瞻性维护数据库被搜索用于接受 NACT 后手术的 IB2-IIB 期宫颈癌患者。LRH 和开放根治性子宫切除术（RAH）患者在围手术期结果和中期生存方面进行了比较。通过倾向评分（PS）匹配来调整手术方法的潜在选择偏倚。
LRH 病例（n=68）与 RAH 组（n=273）相比，肿瘤分期较低，分级较低。当按就诊时的分期（IB2-IIA 和 IIB）对患者进行分组时，LRH 和 RAH 组之间的并发症发生率和围手术期结果相当。LRH 出血量较少、输血率较低且住院时间较短。这些差异在 PS 匹配后仍然显著。在 PS 匹配队列中，包括肿瘤分期、分级、组织类型、淋巴结状态、机构和手术时间段的 Cox 比例风险模型显示，腹腔镜方法与生存受损无关。
对于接受 NACT 的局部晚期宫颈癌患者，腹腔镜方法似乎是开放手术的一种有价值的替代方法。
