Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Obstetrics and gynecology, University of Insubria, Varese, Italy.
Int J Gynecol Cancer. 2020 Jul;30(7):987-992. doi: 10.1136/ijgc-2020-001381. Epub 2020 May 23.
Recent evidence has suggested that laparoscopic radical hysterectomy is associated with an increased risk of recurrence in comparison with open abdominal radical hysterectomy. The aim of our study was to identify patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer.
This a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery performed between January 1990 and December 2018. Inclusion criteria were: age ≥18 years old, radical hysterectomy (type B or type C), no recurrent disease, and clinical follow-up >30 days. The primary endpoint was to evaluate patterns of first recurrence following laparoscopic and open abdominal radical hysterectomy. The secondary endpoint was to estimate the effect of the primary surgical approach (laparoscopy and open surgery) in post-recurrence survival outcomes (event-free survival and overall survival). In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Survival outcomes were estimated using the Kaplan-Meier model.
A total of 1058 patients were included in the analysis (823 underwent open abdominal radical hysterectomy and 235 patients underwent laparoscopic radical hysterectomy). The study included 117 (14.2%) and 35 (14.9%) patients who developed recurrent cervical cancer after open or laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2), we reduced the population to 105 patients (35 vs 70 patients with recurrence after laparoscopic and open radical hysterectomy). Median follow-up time was 39.1 (range 4-221) months and 32.3 (range 4-124) months for patients undergoing open and laparoscopic surgery, respectively. Patients undergoing laparoscopic radical hysterectomy had shorter progression-free survival than patients undergoing open abdominal surgery (HR 1.98, 95% CI 1.32 to 2.97; p=0.005). Patients undergoing laparoscopic radical hysterectomy were more likely to develop intrapelvic recurrences (74% vs 34%; p<0.001) and peritoneal carcinomatosis (17% vs 1%; p=0.005) than patients undergoing open surgery.
Patients undergoing laparoscopic radical hysterectomy are at higher risk of developing intrapelvic recurrences and peritoneal carcinomatosis. Further evidence is needed in order to corroborate our findings.
最近的证据表明，与开腹根治性子宫切除术相比，腹腔镜根治性子宫切除术与复发风险增加相关。本研究的目的是确定宫颈癌患者接受腹腔镜和开腹根治性子宫切除术后的复发模式。
这是一项回顾性多机构研究，评估了 1990 年 1 月至 2018 年 12 月期间接受腹腔镜和开腹手术治疗的宫颈癌复发患者。纳入标准为：年龄≥18 岁，根治性子宫切除术（B 型或 C 型），无复发病灶，临床随访时间>30 天。主要终点是评估腹腔镜和开腹根治性子宫切除术后首次复发的模式。次要终点是估计主要手术方法（腹腔镜和开放手术）在复发后生存结局（无进展生存和总生存）中的作用。为了减少可能的混杂因素，我们应用了倾向匹配算法。使用 Kaplan-Meier 模型估计生存结局。
共纳入 1058 例患者进行分析（823 例行开腹根治性子宫切除术，235 例行腹腔镜根治性子宫切除术）。研究包括 117（14.2%）例和 35（14.9%）例接受开腹或腹腔镜手术后发生宫颈癌复发的患者。应用倾向匹配比较（1:2）后，我们将人群减少至 105 例（腹腔镜和开腹根治性子宫切除术后分别有 35 例和 70 例患者复发）。中位随访时间分别为开腹手术患者 39.1 个月（范围 4-221）和腹腔镜手术患者 32.3 个月（范围 4-124）。与接受开腹手术的患者相比，接受腹腔镜根治性子宫切除术的患者无进展生存率更短（HR 1.98，95%CI 1.32 至 2.97；p=0.005）。与接受开腹手术的患者相比，接受腹腔镜根治性子宫切除术的患者更易发生盆腔内复发（74% vs 34%；p<0.001）和腹膜癌病（17% vs 1%；p=0.005）。
接受腹腔镜根治性子宫切除术的患者发生盆腔内复发和腹膜癌病的风险更高。需要进一步的证据来证实我们的发现。
