Yang Weihong, Chen Rong, Li Caixia, Li Li, Luo Ning, Cheng Zhongping
Department of Gynecology and Obstetrics, Tenth People's Hospital, China.
Gynecologic Minimally Invasive Surgery Research Center, Tongji University School of Medicine, University in Shanghai, China.
Gynecol Minim Invasive Ther. 2020 Oct 15;9(4):220-226. doi: 10.4103/GMIT.GMIT_75_20. eCollection 2020 Oct-Dec.
To evaluate the clinical outcomes of standardized and region-specific excision in laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer (ECC).
This is a retrospective case-controlled study from 2011 to December 2016. A total of 328 women with ECC (IA1, IA2, IB1, or IIA1) underwent primary surgery by laparoscopy or laparotomy in our institute. Women diagnosed as stage IB1 or IIA1 were treated with radical hysterectomy (RH) by open or laparoscopic route. The total parametrium excision in the process of RH was measured and highlighted in the study.
A total of 186 patients underwent open surgery and 142 ones were treated with laparoscopic surgery. Laparoscopic surgery was associated with less blood loss (194.43 ± 84.40 ml vs. 362.68 ± 253.36 ml, < 0.01), shorter hospital stay (11 vs. 14 days, < 0.01), and lower risk of blood transfusion (2.8% vs. 18.8%, < 0.01). There was no significant difference in the postoperative complications between two groups (18/142, 12.7% vs. 21/186, 11.3%; > 0.05). The rate of 5-year overall survival (OS) was 92.8% in laparoscopy group, similar to that of 94.4% in the open group ( = 0.762). Disease-free survival (DFS) rate at 3 years in laparoscopy group was decreased when compared to open group (91.8% vs. 95.0%, = 0.030), but there was no significant difference in 3-year DFS among the women with tumor size <2 cm (100% vs. 97.0%, = 0.818).
Laparoscopic surgery was associated with better surgical outcomes compared to open surgery in ECC. 5-Year OS was comparable between the groups and cases with tumor size <2 cm showed no difference in 3-year DFS. LRH may be a better fit for women with tumor size <2 cm. Standardized region-specific RH helps to optimize the clinical outcomes of LRH in ECC.
评估早期宫颈癌（ECC）腹腔镜根治性子宫切除术（LRH）中标准化和区域特异性切除术的临床效果。
这是一项2011年至2016年12月的回顾性病例对照研究。共有328例ECC（IA1、IA2、IB1或IIA1期）女性在我院接受了腹腔镜或开腹的初次手术。诊断为IB1或IIA1期的女性通过开放或腹腔镜途径行根治性子宫切除术（RH）。本研究测量并强调了RH过程中的全宫旁组织切除术。
共有186例患者接受了开放手术，142例接受了腹腔镜手术。腹腔镜手术的术中出血量较少（194.43±84.40 ml对362.68±253.36 ml，<0.01），住院时间较短（11天对14天，<0.01），输血风险较低（2.8%对18.8%，<0.01）。两组术后并发症无显著差异（142例中有18例，12.7%对186例中有21例，11.3%；>0.05）。腹腔镜组5年总生存率（OS）为92.8%，与开放组的94.4%相似（=0.762）。与开放组相比，腹腔镜组3年无病生存率（DFS）有所下降（91.8%对95.0%，=0.030），但肿瘤大小<2 cm的女性3年DFS无显著差异（100%对97.0%，=0.818）。
与开放手术相比，腹腔镜手术在ECC中的手术效果更好。两组5年OS相当，肿瘤大小<2 cm的病例3年DFS无差异。LRH可能更适合肿瘤大小<2 cm的女性。标准化的区域特异性RH有助于优化ECC中LRH的临床效果。
