Pulman Katherine J, Dason Ebernella S, Philp Lauren, Bernardini Marcus Q, Ferguson Sarah E, Laframboise Stéphane, Atenafu Eshetu G, May Taymaa
Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, University of Toronto, Toronto, ON, Canada.
Division of Gynecologic Oncology, Trillium Health Sciences Center, Toronto, ON, Canada.
Int J Gynaecol Obstet. 2017 Mar;136(3):315-319. doi: 10.1002/ijgo.12073. Epub 2017 Jan 12.
To compare laparotomy, laparoscopy, and robotic surgical approaches to lymphadenectomy for high-risk endometrial cancer staging.
A retrospective cohort study enrolled patients who underwent surgery for pathologic high-risk endometrial carcinoma at the University Health Network, Toronto, Canada, between January 1, 2005 and December 31, 2013. The primary outcome, the median number of nodes retrieved, was compared based on surgical technique. The secondary outcome was the detection of metastatic nodes.
A total of 176 patients who underwent surgery for high-risk endometrial cancer were included, of whom 147 (83.5%) had pelvic and 78 (44.3%) had para-aortic lymphadenectomy. Laparotomy, laparoscopy, and robotic approaches were applied for 69 (39.2%), 44 (25.0%), and 63 (35.8%) patients, respectively. Minimally-invasive staging was associated with an increased proportion of patients undergoing pelvic lymphadenectomy compared with laparotomy (P=0.005). The median number of nodes removed in the pelvis and para-aortic regions did not differ between surgical approaches. The detection of metastatic nodes was also similar between the groups. Increased blood loss (P<0.001) and longer hospital admission (P<0.001) were observed with laparotomy procedures.
All three techniques demonstrated adequate staging of high-risk endometrial carcinoma. Based on improved peri-operative outcomes, the use of minimally-invasive techniques is advocated where appropriate.
比较剖腹手术、腹腔镜手术和机器人手术用于高危子宫内膜癌分期淋巴结清扫的效果。
一项回顾性队列研究纳入了2005年1月1日至2013年12月31日期间在加拿大多伦多大学健康网络因病理高危子宫内膜癌接受手术的患者。根据手术技术比较主要结局指标（获取淋巴结的中位数）。次要结局指标是转移淋巴结的检出情况。
共纳入176例因高危子宫内膜癌接受手术的患者，其中147例（83.5%）接受了盆腔淋巴结清扫，78例（44.3%）接受了腹主动脉旁淋巴结清扫。剖腹手术、腹腔镜手术和机器人手术分别应用于69例（39.2%）、44例（25.0%）和63例（35.8%）患者。与剖腹手术相比，微创分期与接受盆腔淋巴结清扫患者的比例增加相关（P = 0.005）。不同手术方式在盆腔和腹主动脉旁区域切除淋巴结的中位数无差异。各组间转移淋巴结的检出情况也相似。剖腹手术观察到失血量增加（P < 0.001）和住院时间延长（P < 0.001）。
所有三种技术均能对高危子宫内膜癌进行充分分期。基于围手术期结局的改善，提倡在适当情况下使用微创技术。
