Clark Leslie H, Barber Emma L, Gehrig Paola A, Soper John T, Boggess John F, Kim Kenneth H
*University of North Carolina at Chapel Hill; and Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
Int J Gynecol Cancer. 2016 Oct;26(8):1485-9. doi: 10.1097/IGC.0000000000000775.
Open radical hysterectomy followed by adjuvant radiation for cervical cancer has been associated with significant rates of morbidity. Radical hysterectomy is now often performed robotically. We sought to examine if the robotic platform decreased the morbidity associated with radical hysterectomy followed by adjuvant radiation.
MATERIALS/METHODS: A retrospective cohort of patients with cervical cancer undergoing radical hysterectomy from 1995 to 2013 was evaluated. Complications were assessed using electronic record review and graded. χ tests and Student t tests were used for analysis.
Overall, 243 patients underwent radical hysterectomy for cervical cancer. Surgical approach was 43% open and 57% robotic. Eighty-three patients (34.2%) required adjuvant radiation. Overall, radical hysterectomy plus adjuvant radiation was associated with increased risk of complication (29%) compared to radical hysterectomy alone (7%) (P < 0.001). Complications included lymphedema (n = 18), bowel-associated complications (n = 10), and urinary complications (n = 7). There was no difference in time to initiation of radiation between open and robotic surgery (43 vs 47 days; P = 0.33). There was no difference in grade 2/3 complications in patients receiving adjuvant radiation between open and robotic surgery (27.5% vs 27.9%; P = 0.97). Patients undergoing open surgery followed by radiation experienced a trend toward increased adhesion-related complications, such as bowel obstruction and ureteral stricture (10% vs 2.3%; P = 0.19); whereas patients undergoing robotic surgery followed by radiation experienced a trend toward increased lymphedema (19% vs 8%; P = 0.20).
We found no difference in long-term complications between patients who underwent robotic surgery compared to open radical hysterectomy with adjuvant radiation. There may be fewer adhesion-related complications with robotic surgery. However, as many radiation-related complications occur at later time points, continued follow-up to evaluate for potential differences between the 2 groups is necessary.
宫颈癌根治性子宫切除术后辅助放疗与较高的发病率相关。根治性子宫切除术现在常通过机器人辅助进行。我们试图研究机器人平台是否能降低根治性子宫切除术后辅助放疗相关的发病率。
材料/方法：对1995年至2013年接受根治性子宫切除术的宫颈癌患者进行回顾性队列研究。通过电子病历回顾评估并发症并分级。采用χ检验和学生t检验进行分析。
总体而言，243例患者接受了宫颈癌根治性子宫切除术。手术方式为43%开腹手术和57%机器人辅助手术。83例患者（34.2%）需要辅助放疗。总体而言，与单纯根治性子宫切除术（7%）相比，根治性子宫切除术加辅助放疗的并发症风险增加（29%）（P < 0.001）。并发症包括淋巴水肿（n = 18）、肠道相关并发症（n = 10）和泌尿系统并发症（n = 7）。开腹手术和机器人辅助手术开始放疗的时间无差异（43天对47天；P = 0.33）。接受辅助放疗的患者中，开腹手术和机器人辅助手术的2/3级并发症无差异（27.5%对27.9%；P = 0.97）。接受开腹手术加放疗的患者出现粘连相关并发症（如肠梗阻和输尿管狭窄）有增加趋势（10%对2.3%；P = 0.19）；而接受机器人辅助手术加放疗的患者出现淋巴水肿有增加趋势（19%对8%；P = 0.20）。
我们发现，与接受开腹根治性子宫切除术加辅助放疗的患者相比，接受机器人辅助手术的患者在长期并发症方面没有差异。机器人辅助手术可能减少粘连相关并发症。然而，由于许多放疗相关并发症发生在较晚时间点，有必要持续随访以评估两组之间的潜在差异。
