早期宫颈癌患者的生育期女性行子宫颈切除术：微创手术与剖腹手术。
Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY.
出版信息
Am J Obstet Gynecol. 2019 May;220(5):469.e1-469.e13. doi: 10.1016/j.ajog.2019.02.038. Epub 2019 Feb 22.
BACKGROUND
A recent trial demonstrated decreased survival in women with early-stage cervical cancer who underwent radical hysterectomy via minimally invasive surgery compared with laparotomy; however, outcomes following trachelectomy have yet to be studied.
OBJECTIVE
To examine trends, characteristics, and survival of reproductive-aged women with early-stage cervical cancer who underwent minimally invasive trachelectomy.
STUDY DESIGN
This is a retrospective study examining the National Cancer Database between 2010 and 2015. Women aged <50 years who underwent trachelectomy for stage IA2-IB cervical cancer were grouped by mode of surgery. Clinicopathologic characteristics and outcomes were compared between minimally invasive surgery and laparotomy groups.
RESULTS
A total of 246 women were included, 144 (58.5%, 95% confidence interval, 52.4%-64.7%) of whom had trachelectomy with a minimally invasive surgery approach. Median age was similar between the minimally invasive surgery and laparotomy groups (median, 31 vs 29 years, P = .20). There was a significant increase in the use of minimally invasive surgery from 29.3% in 2010 to 75.0% in 2015 (P < .001). Specifically, minimally invasive surgery became the dominant approach for trachelectomy by year 2011 (54.8%). Hospitals registered in the West (75.0% vs 25.0%) were more likely, whereas those registered in the Midwest (46.9% vs 53.1%) were less likely, to perform minimally invasive surgery (P = .02). Median follow-up was 37 months (interquartile range, 23-51) for the minimally invasive surgery group and 40 months (interquartile range, 26-67) for the laparotomy group. During follow-up, there were 11 (5.3%) deaths, 4 (3.5%) in the minimally invasive surgery group and 7 (7.6%) in the laparotomy group (P = .25).
CONCLUSION
Minimally invasive surgery has become the dominant modality for trachelectomy in reproductive-aged women with stage IA2-IB cervical cancer after year 2011. Survival of women with stage IA2-IB cervical cancer who underwent trachelectomy is generally good regardless of surgical modality. Although our study showed no difference in survival between the minimally invasive surgery and laparotomy approaches, effects of MIS on survival remain unknown and further study is warranted.
背景
最近的一项试验表明，与开腹手术相比，接受微创根治性子宫切除术的早期宫颈癌女性生存率降低；然而，经宫颈切除术的结果尚未研究。
目的
检查接受微创经宫颈切除术的早期宫颈癌育龄妇女的趋势、特征和生存率。
研究设计
这是一项回顾性研究，对 2010 年至 2015 年期间的国家癌症数据库进行了研究。将年龄<50 岁、接受 IA2-IB 期宫颈癌经宫颈切除术的患者按手术方式分组。比较微创手术组和开腹手术组的临床病理特征和结局。
结果
共纳入 246 例患者，其中 144 例（58.5%，95%置信区间，52.4%-64.7%）接受微创经宫颈切除术。微创手术组和开腹手术组的中位年龄相似（中位数，31 岁比 29 岁，P=0.20）。微创手术的使用率从 2010 年的 29.3%显著增加到 2015 年的 75.0%（P<0.001）。具体而言，微创手术在 2011 年成为经宫颈切除术的主要方法（54.8%）。在西部（75.0%比 25.0%）登记的医院更有可能进行微创手术，而在中西部（46.9%比 53.1%）登记的医院不太可能进行微创手术（P=0.02）。微创手术组的中位随访时间为 37 个月（四分位距，23-51），开腹手术组为 40 个月（四分位距，26-67）。随访期间，共有 11 例（5.3%）死亡，微创手术组 4 例（3.5%），开腹手术组 7 例（7.6%）（P=0.25）。
结论
2011 年后，微创经宫颈切除术已成为 IA2-IB 期宫颈癌育龄妇女经宫颈切除术的主要方法。接受经宫颈切除术的 IA2-IB 期宫颈癌妇女的生存率通常较好，与手术方式无关。尽管我们的研究表明微创手术和开腹手术在生存率方面没有差异，但微创手术对生存率的影响仍不清楚，需要进一步研究。
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