Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, AZ, USA; Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China.
Department of Research Biostatistics, Mayo Clinic, Phoenix, AZ, USA.
Gynecol Oncol. 2020 Nov;159(2):373-380. doi: 10.1016/j.ygyno.2020.08.031. Epub 2020 Sep 3.
To compare the survival outcomes and surgical radicality between women who underwent open versus robotic radical hysterectomy (RH) for early cervical cancer.
In this institutional retrospective study, patients with clinical stage IA2- IIA (FIGO 2009) squamous cell, adenocarcinoma and adenosquamous carcinoma of the cervix who underwent either open or robotic RH between 2000 and 2017 were identified. Parametrial width and vaginal length were re-measured from pathology slides. An inverse propensity score weighting model was used to adjust selection bias.
A total of 333 patients were included (181 open, 152 robotic). The median follow-up time was 130 months for the open group and 53 months for the robotic group. There were 31 (17.1%) recurrences in the open and 21 (13.8%) in the robotic group. The 5-year progression-free survival (PFS) for the robotic and open group were 79.0% and 90.5%, respectively (HR 2.37, 95% CI 1.40-4.02). Five-year overall survival (OS) were 85.8% and 95.3%, respectively (HR 3.17, 95% CI 1.76-5.70). The mean parametrial width was similar between the open and robotic groups (2.5 vs 2.4 cm, p = 0.99). Unique recurrences (38.1%, 8/21) were noted in the robotic group: 2 port-site, 4 peritoneal, and 2 carcinomatosis. The time to vaginal recurrence was shorter in the robotic group than the open group (p = 0.001).
Patients who underwent robotic RH had inferior PFS and OS compared to open surgery. Surgical radicality according to pathology measurements was similar between the two approaches.
比较早期宫颈癌患者接受开腹与机器人根治性子宫切除术（RH）的生存结局和手术根治性。
本研究为回顾性单中心研究，纳入了 2000 年至 2017 年期间接受开腹或机器人 RH 的临床分期为 IA2- IIA（FIGO 2009）的宫颈鳞癌、腺癌和腺鳞癌患者。对病理切片重新测量宫旁宽度和阴道长度。采用逆概率评分加权模型调整选择偏倚。
共纳入 333 例患者（开腹组 181 例，机器人组 152 例）。开腹组中位随访时间为 130 个月，机器人组为 53 个月。开腹组和机器人组的复发率分别为 31 例（17.1%）和 21 例（13.8%）。机器人组和开腹组的 5 年无进展生存率（PFS）分别为 79.0%和 90.5%（HR 2.37，95%CI 1.40-4.02）。5 年总生存率（OS）分别为 85.8%和 95.3%（HR 3.17，95%CI 1.76-5.70）。开腹组和机器人组的宫旁宽度平均值相似（2.5 厘米比 2.4 厘米，p=0.99）。机器人组中出现了独特的复发（38.1%，8/21）：2 例为切口部位，4 例为腹膜，2 例为癌转移。机器人组阴道复发的时间短于开腹组（p=0.001）。
与开腹手术相比，机器人 RH 患者的 PFS 和 OS 较差。两种方法的病理测量手术根治性相似。
