Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):492-500. doi: 10.1016/j.jmig.2018.06.007. Epub 2018 Jun 13.
To analyze the effect that the introduction of minimally invasive procedures has had on surgical and oncologic outcomes when compared with conventional open radical hysterectomy (ORH) in a national reference cancer after 17 years of experience in radical hysterectomy.
A prospective controlled study (Canadian Task Force classification II-2).
A university teaching hospital.
All patients who underwent radical hysterectomy as primary treatment for cervical cancer in our institution between May 1999 and June 2016, with a total of 188 patients.
Patients underwent ORH or minimally invasive surgery (MIS) (i.e., laparoscopic or robotically assisted radical hysterectomy).
Seventy-six patients underwent ORH, 90 laparoscopic radical hysterectomy, and 22 robotically assisted radical hysterectomy. Blood loss and hospital stay were inferior in the MIS group (p <.0001). The laparotomic group presented shorter operation times (p = .0001). With a median follow-up of 112.4 months, a total of 156 patients (83%) were alive and free of disease at the time of the data analysis. Overall survival was higher in the MIS group when compared with the ORH group (91 vs 78.9, p = .026). There were no differences regarding recurrence rates between the surgical approaches.
With 1 of the largest follow-up periods in the literature, this study provides added evidence that MIS could become the preferable surgical approach for early-stage cervical cancer since it appears to reduce morbidity without affecting oncologic results.
分析微创术式引入后对手术和肿瘤学结果的影响，该研究纳入了 17 年根治性子宫切除术经验的国家参考癌症中心的病例，并与传统开腹根治性子宫切除术（ORH）进行比较。
前瞻性对照研究（加拿大任务组分类 II-2）。
一所大学教学医院。
1999 年 5 月至 2016 年 6 月期间在我院接受根治性子宫切除术作为宫颈癌初始治疗的所有患者，共计 188 例。
患者接受 ORH 或微创手术（MIS）（即腹腔镜或机器人辅助根治性子宫切除术）。
76 例患者接受 ORH，90 例腹腔镜根治性子宫切除术，22 例机器人辅助根治性子宫切除术。MIS 组的出血量和住院时间明显更少（p<0.0001）。剖腹组的手术时间更短（p=0.0001）。中位随访 112.4 个月，数据分析时共有 156 例（83%）患者存活且无疾病。MIS 组的总体生存率明显高于 ORH 组（91 比 78.9，p=0.026）。两种手术方法的复发率无差异。
本研究随访时间为文献中最长之一，进一步证明了微创术式可成为早期宫颈癌的首选手术方法，因为它似乎在不影响肿瘤学结果的情况下降低了发病率。
