Chang Wei-Fu, Luo Ai-Jing, Yuan Yi-Feng, Chen Yang, Xin Zi-Rui, Xu Shuai-Shuai
Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China.
The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan, People's Republic of China.
Cancer Manag Res. 2020 Jun 12;12:4483-4492. doi: 10.2147/CMAR.S243986. eCollection 2020.
To evaluate the perioperative complications of patients with cervical cancer who are treated with robot-assisted radical hysterectomy (RRH) and to further evaluate the safety of patients undergoing NACT.
A total of 805 consecutive cervical cancer patients undergoing RRH were involved in this report. Their clinical characteristics were retrieved from hospital medical records. Perioperative complications were subdivided into intraoperative and postoperative complications, which were graded according to the Clavien-Dindo classification (CDC), and the complications of grade III and above were defined as severe complications. Furthermore, the two-level logistic regression model was used to estimate the risk factors of perioperative and severe complications and to further confirm the relationship between NACT and perioperative and severe complications.
The perioperative complication rate and severe complications were 45.09% and 7.83%, respectively. Poorly differentiated tumor and NACT were identified as independent risk factors for perioperative complications by multifactor analysis. Furthermore, we concentrated on the relations between NACT and complications. The risk of perioperative complications of the group with NACT (OR = 11.08, 95% CI: 5.70-21.54) was significantly higher than the group without NACT, especially in postoperative complications (OR=17.65, 95% CI: 8.63-36.08), even after adjusting confounding factors. However, there was no statistically significant difference in terms of severe complications (OR=1.68, 95% CI: 0.64-4.41) and intraoperative complications (OR=0.51, 95% CI: 0.18-1.41). Moreover, as the times of NACT increase, the impact on perioperative complications is more pronounced. A similar trend was observed in postoperative complications, while this statistical difference was still not observed in intraoperative and severe complications.
This result demonstrates the feasibility and safety of RRH of cervical carcinoma after NACT in generally, since it only causes mild complications, not severe complications.
评估接受机器人辅助根治性子宫切除术（RRH）治疗的宫颈癌患者的围手术期并发症，并进一步评估接受新辅助化疗（NACT）患者的安全性。
本报告纳入了805例连续接受RRH治疗的宫颈癌患者。从医院病历中获取他们的临床特征。围手术期并发症分为术中并发症和术后并发症，根据Clavien-Dindo分类（CDC）进行分级，III级及以上并发症定义为严重并发症。此外，采用二级逻辑回归模型估计围手术期和严重并发症的危险因素，并进一步确认NACT与围手术期和严重并发症之间的关系。
围手术期并发症发生率和严重并发症发生率分别为45.09%和7.83%。多因素分析确定低分化肿瘤和NACT为围手术期并发症的独立危险因素。此外，我们重点关注了NACT与并发症之间的关系。接受NACT组的围手术期并发症风险（OR = 11.08，95%CI：5.70 - 21.54）显著高于未接受NACT组，尤其是术后并发症（OR = 17.65，95%CI：8.63 - 36.08），即使在调整混杂因素后也是如此。然而，在严重并发症（OR = 1.68，95%CI：0.64 - 4.41）和术中并发症（OR = 0.51，95%CI：0.18 - 1.41）方面没有统计学显著差异。此外，随着NACT次数的增加，对围手术期并发症的影响更为明显。术后并发症也观察到类似趋势，而在术中并发症和严重并发症中仍未观察到这种统计学差异。
该结果总体上证明了NACT后宫颈癌RRH的可行性和安全性，因为它仅引起轻度并发症，而非严重并发症。
