Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Surg Oncol. 2013 Jul;108(1):63-9. doi: 10.1002/jso.23347. Epub 2013 Jun 5.
To compare survival and surgical outcomes of laparoscopic (LRH) and open radical hysterectomy (ORH) in patients with stage IB2 and IIA2 cervical cancer.
A retrospective analysis was performed on 303 patients with stage IB2 and IIA2 cervical cancer who underwent LRH (n = 115) or ORH (n = 188).
Two patients (1.7%) in the LRH group required conversion to laparotomy. There was no difference with respect to operating time, perioperative change in hemoglobin level, and need for transfusion. However, in the LRH group, estimated blood loss (P = 0.003) was significantly lower, time to recovery of bowel movement (P < 0.001) and length of postoperative hospital stay (P < 0.001) were significantly shorter, and postoperative complications were significantly less frequent (P = 0.036). The 5-year disease-free survival was 78% in the LRH group and 77% in the ORH group (P = 0.718), and 5-year overall survival was 83% in both groups (P = 0.746). There were no differences in pattern of recurrence (P = 0.225) and median time to recurrence (12 vs. 13 months; P = 0.240).
LRH has similar therapeutic efficacy to ORH in patients with bulky early-stage cervical cancer. However, LRH has more favorable surgical outcomes. Therefore, LRH is not only a reasonable alternative to ORH but also the preferred surgical procedure for these patients.
比较腹腔镜（LRH）与开腹根治性子宫切除术（ORH）治疗 IB2 期和 IIA2 期宫颈癌患者的生存和手术结局。
对 303 例 IB2 期和 IIA2 期宫颈癌患者进行回顾性分析，其中行 LRH 治疗者（n=115）和行 ORH 治疗者（n=188）。
LRH 组中有 2 例（1.7%）患者需要中转开腹。两组的手术时间、围手术期血红蛋白变化和输血需求均无差异。然而，LRH 组术中出血量（P=0.003）显著降低，术后肠蠕动恢复时间（P<0.001）和术后住院时间（P<0.001）显著缩短，术后并发症发生率（P=0.036）显著降低。LRH 组和 ORH 组的 5 年无病生存率分别为 78%和 77%（P=0.718），5 年总生存率均为 83%（P=0.746）。两组复发模式（P=0.225）和复发中位时间（12 个月比 13 个月；P=0.240）均无差异。
对于早期宫颈癌体积较大的患者，LRH 与 ORH 的治疗效果相似。但 LRH 具有更有利的手术结局。因此，LRH 不仅是 ORH 的合理替代方案，也是此类患者的首选手术方法。
