Gynecologic Oncology Unit, National Cancer Institute, Milan, Italy.
Gynecologic Oncology Unit, National Cancer Institute, Milan, Italy.
Eur J Surg Oncol. 2015 Jan;41(1):34-9. doi: 10.1016/j.ejso.2014.10.058. Epub 2014 Nov 6.
To investigate the safety, feasibility and effectiveness of laparoscopic approach in the management patients undergoing modified radical hysterectomy for early stage cervical cancer.
Consecutive data of 157 women who had class II radical hysterectomy, for stage IA2 and stage IB1 <2 cm cervical cancer, were prospectively collected. Data of patients undergoing surgery via laparoscopy (LRH) were compared with those undergoing open surgical operations (RAH). A propensity-matched comparison (1:1) was carried out to minimize as possible selection biases. Post-operative complications were graded per the Clavien-Dindo classification. Five-year survival outcomes were assessed using Kaplan-Meier model.
After the exclusion of 37 (23.5%) patients on the basis of propensity-matching, 60 patients undergoing LRH were compared with 60 patients undergoing RAH. No between-group differences in baseline, disease and pathological variables were observed (p > 0.05). Patients undergoing surgery via laparoscopy experienced longer operative time than patients undergoing RAH; while LRH correlated whit shorter length of hospitalization and lower blood loss in comparison to RAH. Intra- and post-operative complication rate was similar between groups (p = 1.00). The execution of LRH or RAH did not influence site of recurrence (p > 0.2) as well as survival outcomes, in term of 5-year disease-free (p = 0.29, log-rank test) and overall survivals (p = 0.50, log-rank test).
Laparoscopic approach is a safe procedure, upholds the results of RAH, reducing invasiveness of open surgical operations. Further large prospective investigations are warranted.
探讨腹腔镜手术治疗早期宫颈癌改良根治性子宫切除术的安全性、可行性和有效性。
前瞻性收集了 157 例接受 II 类根治性子宫切除术的患者（IA2 期和 IB1<2cm 宫颈癌）的连续数据。比较了经腹腔镜（LRH）手术和经开放性手术（RAH）手术患者的数据。采用倾向评分匹配（1:1）尽可能减少选择偏倚。术后并发症按 Clavien-Dindo 分类分级。采用 Kaplan-Meier 模型评估 5 年生存结局。
基于倾向匹配排除 37 例（23.5%）患者后，将 60 例接受 LRH 的患者与 60 例接受 RAH 的患者进行比较。两组患者在基线、疾病和病理变量方面无差异（p>0.05）。腹腔镜手术组的手术时间长于开放性手术组；而与 RAH 相比，LRH 与较短的住院时间和较低的出血量相关。两组患者的术中及术后并发症发生率相似（p=1.00）。LRH 或 RAH 的实施不影响复发部位（p>0.2），也不影响 5 年无病生存率（p=0.29，log-rank 检验）和总生存率（p=0.50，log-rank 检验）。
腹腔镜手术是一种安全的手术方法，可保持开放性手术的效果，降低手术的侵袭性。需要进一步进行大型前瞻性研究。
