Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Curr Opin Obstet Gynecol. 2020 Feb;32(1):22-27. doi: 10.1097/GCO.0000000000000598.
The aim of the article is to review recent studies that compare the oncologic efficacy of minimally invasive radical hysterectomy with that of open radical hysterectomy.
The Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized study design to test the hypothesis that minimally invasive radical hysterectomy is not inferior to open radical hysterectomy, was stopped early by the data and safety monitoring committee after enrolling 631 of a planned 740 patients. The disease-free survival rate at 4.5 years was 86% among women assigned to minimally invasive surgery and 96.5% in those who underwent open surgery (hazard ratio [HR] 3.74; 95% confidence interval [CI] 1.63-8.58). Minimally invasive surgery was also associated with inferior overall survival (HR 6.00; 95% CI 1.44-12.7). Recent well designed, adequately powered observational studies mostly corroborate the findings of the LACC trial.
After a decade of widespread acceptance and increasing popularity, the preponderance of evidence now suggests that minimally invasive radical hysterectomy for cervical cancer confers an excess risk of recurrence and death compared with open abdominal radical hysterectomy.
本文旨在回顾近期比较微创根治性子宫切除术与开腹根治性子宫切除术在肿瘤学疗效方面的研究。
腹腔镜宫颈癌根治术（LACC）试验是一项随机研究设计，旨在检验微创根治性子宫切除术不劣于开腹根治性子宫切除术的假设，在计划入组 740 例患者中入组 631 例后，即被数据和安全监测委员会提前终止。接受微创手术的患者在 4.5 年时无疾病生存率为 86%，而接受开腹手术的患者为 96.5%（风险比[HR]3.74；95%置信区间[CI]1.63-8.58）。微创手术与总生存率降低相关（HR 6.00；95%CI 1.44-12.7）。近期设计良好、充分有力的观察性研究大多证实了 LACC 试验的发现。
在广泛接受和日益普及微创根治性子宫切除术治疗宫颈癌 10 年后，目前大量证据表明，与开腹根治性子宫切除术相比，微创根治性子宫切除术增加了复发和死亡的风险。
