Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
Gynecol Oncol. 2021 Apr;161(1):39-45. doi: 10.1016/j.ygyno.2020.12.036. Epub 2021 Jan 3.
To examine characteristics and short-term perioperative outcomes related to minimally invasive pelvic exenteration for gynecologic malignancy.
This comparative effectiveness study is a retrospective population-based analysis of the National Inpatient Sample from 10/2008-9/2015. Women with cervical, uterine, vaginal, and vulvar malignancies who underwent pelvic exenteration were evaluated based on the use of laparoscopic or robotic-assisted surgery. Patient demographics and intraoperative/postoperative complications related to a minimally invasive surgical approach were assessed.
Among 1376 women who underwent pelvic exenteration, 49 (3.6%) had the procedure performed via a minimally invasive approach. The majority of minimally invasive cases were robotic-assisted (51.0%). Women in the minimally invasive group were more likely to be old, white, have cervical/uterine cancers, and receive urinary diversion, but less frequently received vaginal reconstruction or colostomy when compared to those in the open surgery group (P < 0.05). Overall perioperative complication rates were similar between the minimally invasive and open surgery groups (79.6% versus 77.7%, P = 0.862), but the minimally invasive group had a decreased risk of high-risk complications compared to the open surgery group (adjusted-odds ratio 0.19, 95% confidence interval 0.07-0.51). Specifically, a minimally invasive approach was associated with decreased incidence of sepsis and thromboembolism compared to an open approach (P < 0.05). The minimally invasive group had a shorter length of stay (median, 9 versus 14 days) and lower total charge (median, $127,875 versus $208,591) compared to the open surgery group (P < 0.05).
Laparotomy remains the main surgical approach for pelvic exenteration for gynecologic malignancy and minimally invasive surgery was infrequently utilized during the study period in the United States. Before widely adopting this surgical approach, the utility and role of minimally invasive pelvic exenteration requires further investigation.
研究与妇科恶性肿瘤的微创盆腔廓清术相关的特征和短期围手术期结局。
本项基于人群的回顾性比较有效性研究，利用了 2008 年 10 月至 2015 年 9 月间国家住院患者样本数据库。评估了接受盆腔廓清术的宫颈癌、子宫癌、阴道癌和外阴癌患者中腹腔镜或机器人辅助手术的应用情况。评估了微创手术方法相关的患者人口统计学特征和围手术期/术后并发症。
在 1376 例行盆腔廓清术的患者中，有 49 例（3.6%）采用微创方法。大多数微创病例为机器人辅助手术（51.0%）。与开放手术组相比，微创组的患者年龄更大、更可能为白人、患有宫颈癌/子宫癌，且接受尿路改道，但更不可能进行阴道重建或结肠造口术（P < 0.05）。微创组和开放手术组的总体围手术期并发症发生率相似（79.6%比 77.7%，P = 0.862），但微创组发生高危并发症的风险低于开放手术组（调整后优势比 0.19，95%置信区间 0.07-0.51）。具体而言，与开放手术相比，微创方法与降低脓毒症和血栓栓塞发生率相关（P < 0.05）。与开放手术组相比，微创组的住院时间更短（中位数 9 天比 14 天），总费用更低（中位数 127875 美元比 208591 美元）（P < 0.05）。
剖腹手术仍然是妇科恶性肿瘤盆腔廓清术的主要手术方法，在研究期间美国微创手术的应用并不常见。在广泛采用这种手术方法之前，微创盆腔廓清术的实用性和作用需要进一步研究。
