Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Int J Gynecol Cancer. 2014 Feb;24(2):280-8. doi: 10.1097/IGC.0000000000000052.
There have been many comparative reports on laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. However, most of these studies included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 and small (tumor diameter ≤2 or 3 cm) IB1 disease. The purpose of this study was to compare the feasibility, morbidity, and recurrence rate of LRH and ARH for FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater.
We conducted a retrospective analysis of 88 patients with FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. All patients had no evidence of parametrial invasion and lymph node metastasis in preoperative gynecologic examination, pelvic magnetic resonance imaging, and positron emission tomography-computed tomography, and they all underwent LRH or ARH between February 2006 and March 2013.
Among 88 patients, 40 patients received LRH whereas 48 underwent ARH. The mean estimated blood loss was 588.0 mL for the ARH group compared with 449.1 mL for the LRH group (P < 0.001). The mean operating time was similar in both groups (246.0 minutes in the ARH vs 254.5 minutes in the LRH group, P = 0.589). Return of bowel motility was observed earlier after LRH (1.8 vs 2.2 days, P = 0.042). The mean hospital stay was significantly shorter for the LRH group (14.8 vs 18.0 days, P = 0.044). There were no differences in histopathologic characteristics between the 2 groups. The mean tumor diameter was 44.4 mm in the LRH and 45.3 mm in the ARH group. Disease-free survival rates were 97.9% in the ARH and 97.5% in the LRH group (P = 0.818).
Laparoscopic radical hysterectomy might be a feasible therapeutic procedure for the management of FIGO stage IB and IIA cervical cancer with tumor diameter of 3 cm or greater. Further randomized studies that could support this approach are necessary to evaluate long-term clinical outcome.
腹腔镜根治性子宫切除术（LRH）与腹式根治性子宫切除术（ARH）治疗早期宫颈癌已有许多比较报告。然而，这些研究大多包括国际妇产科联合会（FIGO）分期为 IA2 和小（肿瘤直径≤2 或 3cm）IB1 期的患者。本研究旨在比较 LRH 和 ARH 治疗肿瘤直径≥3cm 的 FIGO 分期 IB 和 IIA 宫颈癌的可行性、发病率和复发率。
我们对 88 例肿瘤直径≥3cm 的 FIGO 分期 IB 和 IIA 宫颈癌患者进行回顾性分析。所有患者术前妇科检查、盆腔磁共振成像和正电子发射断层扫描-计算机断层扫描均无宫旁侵犯和淋巴结转移证据，均于 2006 年 2 月至 2013 年 3 月行 LRH 或 ARH。
88 例患者中，40 例行 LRH，48 例行 ARH。ARH 组平均估计出血量为 588.0ml，LRH 组为 449.1ml（P<0.001）。两组平均手术时间相似（ARH 组 246.0 分钟，LRH 组 254.5 分钟，P=0.589）。LRH 术后肠蠕动恢复较早（1.8 天对 2.2 天，P=0.042）。LRH 组平均住院时间明显缩短（14.8 天对 18.0 天，P=0.044）。两组的组织病理学特征无差异。LRH 组平均肿瘤直径为 44.4mm，ARH 组为 45.3mm。ARH 组和 LRH 组无病生存率分别为 97.9%和 97.5%（P=0.818）。
腹腔镜根治性子宫切除术可能是治疗肿瘤直径≥3cm 的 FIGO 分期 IB 和 IIA 宫颈癌的一种可行治疗方法。需要进一步的随机研究来支持这一方法，以评估长期临床结果。
