Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Sci Rep. 2021 Jan 12;11(1):615. doi: 10.1038/s41598-020-79886-8.
Minimally invasive surgery is the first-line management for endometrial cancer. The role of 2-port access laparoscopy (TPA) has been underestimated. Compared to conventional laparoscopic surgery (CL), TPA is associated with smaller total incision size and less postoperative pain. Compared to single-incision laparoscopic surgery, no specific instruments and surgical techniques are needed. This study primarily evaluated the surgical and pathologic outcomes of TPA with conventional instruments, and additionally evaluated the surgeon's learning curve. Consecutive patients who underwent TPA and CL for endometrial cancer between 2015 and 2019 were included. Baseline characteristics were recorded. In total, 148 patients (TPA, 89; CL, 59) were identified. The baseline characteristics were similar, except for a greater proportion of patients in the CL group receiving para-aortic lymph node dissection (5.62% vs. 35.59%, P < 0.01). The mean operation time was significantly less in the TPA group (152.09 vs. 187.15 min; P < 0.01). Both the groups had comparable 5-year progression-free survival (TPA, 86.68%) and 5-year overall survival rates (TPA, 93.24%). Analysis of the learning curve showed that the operation time decreased after 3-4 procedures. TPA using conventional laparoscopic instruments for endometrial cancer is feasible and is easily accessible to patients and surgeons.
微创手术是子宫内膜癌的一线治疗方法。2 端口腹腔镜（TPA）的作用被低估了。与传统腹腔镜手术（CL）相比，TPA 与更小的总切口大小和更少的术后疼痛相关。与单切口腹腔镜手术相比，不需要特殊的器械和手术技术。本研究主要评估了使用常规器械进行 TPA 的手术和病理结果，并额外评估了外科医生的学习曲线。连续纳入 2015 年至 2019 年间接受 TPA 和 CL 治疗子宫内膜癌的患者。记录基线特征。共纳入 148 例患者（TPA 组 89 例，CL 组 59 例）。除了 CL 组接受腹主动脉旁淋巴结清扫术的患者比例较大（5.62% vs. 35.59%，P < 0.01）外，两组的基线特征相似。TPA 组的平均手术时间明显更短（152.09 分钟 vs. 187.15 分钟；P < 0.01）。两组的 5 年无进展生存率（TPA 组为 86.68%）和 5 年总生存率（TPA 组为 93.24%）相似。学习曲线分析表明，手术时间在 3-4 次手术后下降。使用常规腹腔镜器械进行子宫内膜癌 TPA 是可行的，并且易于患者和外科医生接受。
