Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
Istituto Europeo di Oncologia, Milano, Italy.
Int J Gynecol Cancer. 2020 Sep;30(9):1269-1277. doi: 10.1136/ijgc-2020-001506. Epub 2020 Aug 11.
Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse.
We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group.
Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m (range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52).
Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.
最近的出版物表明，宫颈癌的微创手术结果不如开放手术。SUCCOR 研究是一项欧洲多中心回顾性观察队列研究，其主要目的是评估接受开腹与微创根治性子宫切除术的 IB1 期（FIGO 2009）宫颈癌患者的无病生存率。作为次要目标，我们旨在调查保护性手术操作与复发风险之间的关系。
我们从 2013 年 1 月至 2014 年 12 月期间接受开腹或微创根治性子宫切除术的 1272 例 IB1 期（FIGO 2009）宫颈癌患者中获取数据。在应用所有纳入和排除标准后，我们使用逆概率加权法构建了一个由 693 例患者组成的加权队列，以比较两种手术方式（微创手术与开腹手术）的结局。第一个终点是比较两组患者 4.5 年时的无病生存率。次要终点是比较各组之间的总生存率以及微创术中使用子宫操纵器和保护封闭肿瘤对肿瘤的影响。
患者的平均年龄为 48.3 岁（范围：23-83 岁），平均 BMI 为 25.7kg/m（范围：15-49）。微创手术组患者的复发风险是开腹手术组的两倍（HR，2.07；95%CI，1.35 至 3.15；P=0.001）。同样，死亡风险也比开腹手术组高 2.42 倍（HR，2.45；95%CI，1.30 至 4.60，P=0.005）。使用子宫操纵器的微创手术患者复发的危险度是未使用子宫操纵器患者的 2.76 倍（HR，2.76；95%CI，1.75 至 4.33；P<0.001），但无病生存率与开腹手术组相似（HR，1.58；95%CI，0.79 至 3.15；P=0.20）。此外，在微创术中进行阴道保护封闭的患者与开腹手术组的复发率相似（HR，0.63；95%CI，0.15 至 2.59；P<0.52）。
与开腹手术相比，宫颈癌微创手术增加了复发和死亡的风险。在这项研究中，避免使用子宫操纵器和在微创中使用避免肿瘤扩散的操作可以获得与开腹手术相似的结果。需要进一步的前瞻性研究。
