比较微创与开放手术治疗子宫内膜癌肉瘤。
Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma.
机构信息
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
出版信息
Int J Gynecol Cancer. 2020 Aug;30(8):1162-1168. doi: 10.1136/ijgc-2020-001573. Epub 2020 Jul 20.
OBJECTIVE
The aim of this study was to compare perioperative and oncologic outcomes between minimally invasive and open surgery in the treatment of endometrial carcinosarcoma.
METHODS
We retrospectively identified all patients with newly diagnosed endometrial carcinosarcoma who underwent primary surgery via any approach at our institution from January 2009 to January 2018. Patients with known bulky disease identified on preoperative imaging were excluded. The χ and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. Kaplan-Meier curves were used to estimate survival, and compared using the log rank test.
RESULTS
We identified 147 eligible patients, of whom 37 (25%) underwent an open approach and 110 (75%) underwent minimally invasive surgery. Within the minimally invasive group, 92 (84%) of 110 patients underwent a robotic procedure and 14 (13%) underwent a laparoscopic procedure. Four minimally invasive cases (4%) were converted to open procedures. Median age, body mass index, operative time, stage, complication grade, and use of adjuvant treatment were clinically and statistically similar between groups. Median length of hospital stay in the open group was 4 days (range 3-21) compared with 1 day (range 0-6) in the minimally invasive group (p<0.001). The rates of any 30-day complication were 46% in the open and 8% in the minimally invasive group (p<0.001). The rates of grade 3 or higher complications were 5.4% and 1.8%, respectively (p=0.53). Median follow-up for the entire cohort was 30 months (range 0.4-121). Two-year progression-free survival rates were 52.8% (SE±8.4) in the open group and 58.5% (SE±5.1) in the minimally invasive group (p=0.7). Two-year disease-specific survival rates were 66.1% (SE±8.0) and 81.4% (SE±4.1), respectively (p=0.8).
CONCLUSIONS
In patients with clinical stage I endometrial carcinosarcoma, minimally invasive compared with open surgery was not associated with poor oncologic outcomes, but with a shorter length of hospital stay and a lower rate of overall complications.
目的
本研究旨在比较微创与开放手术治疗子宫内膜癌肉瘤的围手术期和肿瘤学结果。
方法
我们回顾性地确定了 2009 年 1 月至 2018 年 1 月期间在我院接受任何方式初始手术治疗的新诊断为子宫内膜癌肉瘤的所有患者。排除术前影像学检查发现已知大块疾病的患者。使用卡方检验和曼-惠特尼 U 检验分别比较分类变量和连续变量。使用 Kaplan-Meier 曲线估计生存率，并使用对数秩检验进行比较。
结果
我们确定了 147 例符合条件的患者，其中 37 例（25%）接受了开放手术，110 例（75%）接受了微创手术。在微创手术组中，92 例（84%）患者接受了机器人手术，14 例（13%）接受了腹腔镜手术。4 例微创手术（4%）转为开放手术。两组间的中位年龄、体重指数、手术时间、分期、并发症分级和辅助治疗的使用均具有临床和统计学相似性。开放组的中位住院时间为 4 天（范围 3-21），微创手术组为 1 天（范围 0-6）（p<0.001）。开放组的任何 30 天并发症发生率为 46%，微创手术组为 8%（p<0.001）。3 级或更高级别的并发症发生率分别为 5.4%和 1.8%（p=0.53）。整个队列的中位随访时间为 30 个月（范围 0.4-121）。开放组的 2 年无进展生存率为 52.8%（SE±8.4），微创手术组为 58.5%（SE±5.1）（p=0.7）。开放组和微创手术组的 2 年疾病特异性生存率分别为 66.1%（SE±8.0）和 81.4%（SE±4.1）（p=0.8）。
结论
在临床分期为 I 期的子宫内膜癌肉瘤患者中，与开放手术相比，微创手术并不与较差的肿瘤学结果相关，而是与较短的住院时间和较低的总并发症发生率相关。
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