Department of Obstetrics and Gynecology, Cukurova University Faculty of Medicine, Adana, Turkey.
Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey.
J Gynecol Oncol. 2019 Mar;30(2):e24. doi: 10.3802/jgo.2019.30.e24. Epub 2018 Nov 16.
The aim of the present study was to compare the long-term outcomes of the laparotomy (LT) and laparoscopic surgery and to evaluate the results according to low, intermediate, and high-risk groups of endometrial cancer (EC).
We identified 801 patients with EC and these patients were classified as group 1, who underwent LT (n=515); and group 2, who underwent laparoscopy (LS) (n=286). Patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion, myometrial invasion, lymph node involvement, and risk groups, peri- and post-operative outcomes, and survival outcomes were compared between the groups according to risk classification. Survival outcomes were assessed using Kaplan-Meier method.
The demographic characteristics of both groups were similar except age. Shorter hospital stay and fewer complications were observed in group 2. The overall survival (OS) were similar in the low, low-intermediate, high-intermediate and high-risk groups (p=0.269, 0.476, 0.078, and 0.085; respectively) for LS compared to LT. The covariate analysis revealed that the death and recurrence risks were approximately twice higher in the LT group than in the LS group (odds ratio [OR]=1.9; 95% confidence interval [CI]=1.2-3.1 for OS; OR=2.0; 95% CI=1.2-3.3 for disease-free survival).
The results of our study support the well-known positive aspects of LS as well as safe and effective use in cases of intermediate and high-risk EC.
本研究旨在比较开腹手术（LT）和腹腔镜手术的长期结果，并根据子宫内膜癌（EC）的低、中、高危组评估结果。
我们确定了 801 例 EC 患者，这些患者被分为 1 组，接受 LT（n=515）；2 组，接受腹腔镜手术（LS）（n=286）。比较两组患者的人口统计学特征、临床特征（如分期、分级、组织病理学类型、脉管间隙浸润、肌层浸润、淋巴结受累和风险组）、围手术期和术后结局以及生存结局。根据风险分类评估生存结局。使用 Kaplan-Meier 方法评估生存结果。
两组患者的人口统计学特征相似，但年龄不同。2 组的住院时间更短，并发症更少。低、低中、高中和高危组 LS 的总生存率（OS）与 LT 相比差异无统计学意义（p=0.269、0.476、0.078 和 0.085）。多变量分析显示，LT 组的死亡和复发风险比 LS 组高约 2 倍（OS 的比值比 [OR]=1.9；95%置信区间 [CI]=1.2-3.1；无病生存率的 OR=2.0；95%CI=1.2-3.3）。
本研究结果支持 LS 众所周知的积极方面，以及在中高危 EC 病例中安全有效的应用。
