Diver Elisabeth, Hinchcliff Emily, Gockley Allison, Melamed Alexander, Contrino Leah, Feldman Sarah, Growdon Whitfield
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Integrated Residency Program in Obstetrics and Gynecology, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts.
J Minim Invasive Gynecol. 2017 Mar-Apr;24(3):402-406. doi: 10.1016/j.jmig.2016.12.005. Epub 2016 Dec 21.
To assess outcomes of women with cervical cancer undergoing upfront radical hysterectomy (RH) via a minimally invasive surgery (MIS) or a traditional laparotomy (XL) approach at 2 large US academic institutions to determine whether the mode of surgery affects patient outcomes.
Retrospective cohort study (Canadian Task Force classification II-1).
Two academic medical institutions in the United States.
Women undergoing upfront RH for cervical cancer between 2000 and 2013.
Minimally invasive techniques (laparoscopic and robotic) for RH compared with XL.
A total of 383 women met the eligibility requirements. Of these, 101 underwent an MIS (i.e., traditional laparoscopy, laparoendoscopic single site, or robotic) approach, and 282 underwent an XL approach. Overall survival (median not reached; p = .29) was not different between the 2 groups. Recurrence was rare and equivalent in the 2 groups, affecting 5.0% of patients in the MIS group and 6.4% of those in the XL group (p = .86). Pelvic lymph nodes were dissected in 98% of patients in the MIS group and 97% of those in the XL group (p > .99) and were found to be positive in 10.9% and 8.5% of those patients, respectively (p = .55). The mean number of pelvic lymph nodes retrieved was higher in the MIS group (19.4 vs 16.0; p < .001). There was no between-group difference in the rate of postoperative chemotherapy (p = .32) or radiation therapy (p = .28). Surgical margins were positive in 5.0% of specimens in the MIS group and in 4.6% of specimens in the XL group (p = .54). Although there was no difference in the overall rate of complications (15.1% and 17.2%, respectively; p = .87), laparotomy was associated with a higher median estimated blood loss (EBL) (50 cm vs 500 cm) and a higher rate of perioperative blood transfusion (3.0% vs 26.2%; p < .001). Length of perioperative hospital stay was significantly shorter in the MIS group (1.9 days vs 4.9 days; p < .001).
MIS RH does not compromise patient outcomes, including overall survival, rate of recurrence, and the frequency of pelvic lymph node dissection or positivity. Morbidity was decreased in the MIS group, including decreased EBL, fewer blood transfusions, and shorter hospital stay.
在美国两家大型学术机构评估接受初次根治性子宫切除术（RH）的宫颈癌女性患者，采用微创手术（MIS）或传统剖腹手术（XL）的治疗结果，以确定手术方式是否会影响患者的治疗结果。
回顾性队列研究（加拿大工作组分类II-1）。
美国的两家学术医疗机构。
2000年至2013年间接受初次宫颈癌RH手术的女性。
将RH的微创技术（腹腔镜和机器人手术）与XL进行比较。
共有383名女性符合入选标准。其中，101名接受了MIS（即传统腹腔镜手术、单孔腹腔镜手术或机器人手术），282名接受了XL手术。两组的总生存率（中位数未达到；p = 0.29）无差异。复发情况罕见且两组相当，MIS组有5.0%的患者复发，XL组有6.4%的患者复发（p = 0.86）。MIS组98%的患者和XL组97%的患者进行了盆腔淋巴结清扫（p > 0.99），清扫出的淋巴结阳性率分别为10.9%和8.5%（p = 0.55）。MIS组清扫出的盆腔淋巴结平均数量更多（19.4个对16.0个；p < 0.001）。术后化疗率（p = 0.32）或放疗率（p = 0.28）在两组间无差异。MIS组5.0%的标本手术切缘阳性，XL组4.6%的标本手术切缘阳性（p = 0.54）。虽然总体并发症发生率无差异（分别为15.1%和17.2%；p = 0.87），但剖腹手术的估计中位失血量（EBL）更高（500ml对50ml），围手术期输血率更高（3.0%对26.2%；p < 0.001）。MIS组围手术期住院时间明显更短（1.9天对4.9天；p < 0.001）。
MIS-RH不会影响患者的治疗结果，包括总生存率、复发率以及盆腔淋巴结清扫或阳性的频率。MIS组的发病率降低，包括EBL减少、输血次数减少和住院时间缩短。
