比较肿瘤学结果和主要并发症在腹腔镜根治性子宫切除术和腹部根治性子宫切除术之间为阶段 IB1 宫颈癌与肿瘤大小小于 2 厘米。

Comparison of oncological outcomes and major complications between laparoscopic radical hysterectomy and abdominal radical hysterectomy for stage IB1 cervical cancer with a tumour size less than 2 cm.

机构信息

Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.

出版信息

Eur J Surg Oncol. 2021 Aug;47(8):2125-2133. doi: 10.1016/j.ejso.2021.03.238. Epub 2021 Mar 22.

DOI:10.1016/j.ejso.2021.03.238

PMID:33781626

Abstract

OBJECTIVE

To compare the oncological outcomes and major complications of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IB1 cervical cancer (FIGO 2009) with a tumour size less than 2 cm.

METHODS

We retrospectively compared the oncological outcomes and major complications of 1207 stage IB1 cervical cancer patients with a tumour size less than 2 cm who received LRH (n = 546) or ARH (n = 661) in 37 hospitals.

RESULTS

(1) There was no significant difference in 3-year overall survival (OS; 97.3% vs. 98.5%, P = 0.288) or 3-year disease-free survival (DFS; 95.1% vs. 95.4%, P = 0.792) between LRH (n = 546) and ARH (n = 661).(2) The rate of any 1 complication refers to the incidence of one or more complications in a patient, which was higher with LRH than ARH (OR = 4.047, 95% CI = 2.035-8.048, P < 0.001). Additionally, intraoperative complications occurred with LRH (OR = 12.313, 95% confidence intervals [CI] = 1.571-96.493, P = 0.017), and postoperative complications (OR = 3.652, 95% CI = 1.763-7.562, P < 0.001) were higher with LRH than ARH. The ureteral injury rate was higher with LRH than with ARH (1.50% vs. 0.20%, OR = 9.814, 95% CI = 1.224-78.712, P = 0.032). The ureterovaginal fistula rate was higher with LRH than ARH. The rates of obturator nerve injury, bladder injury, vesicovaginal fistula, rectovaginal fistula, venous thromboembolism, bowel obstruction, chylous leakage, pelvic haematoma, and haemorrhage were similar between the groups.

CONCLUSIONS

The oncological outcomes of LRH and ARH for stage IB1 cervical cancer patients with a tumour size less than 2 cm do not differ significantly. However, incidences of any 1 complication, intraoperative complications, and postoperative complications were higher with LRH than ARH, with complications manifesting mainly as ureteral injury and uterovaginal fistula.

摘要

目的

比较肿瘤大小<2 cm 的 IB1 期宫颈癌（FIGO 2009）患者行腹腔镜根治性子宫切除术（LRH）与开腹根治性子宫切除术（ARH）的肿瘤学结局和主要并发症。

方法

我们回顾性比较了 37 家医院的 1207 例肿瘤大小<2 cm 的 IB1 期宫颈癌患者的肿瘤学结局和主要并发症，这些患者接受了 LRH（n=546）或 ARH（n=661）治疗。

结果

（1）LRH（n=546）和 ARH（n=661）组 3 年总生存率（OS；97.3% vs. 98.5%，P=0.288）和 3 年无病生存率（DFS；95.1% vs. 95.4%，P=0.792）无显著差异。（2）LRH 组的任何 1 种并发症发生率（OR=4.047，95%CI=2.035-8.048，P<0.001）高于 ARH 组。此外，LRH 组术中并发症（OR=12.313，95%置信区间[CI]为 1.571-96.493，P=0.017）和术后并发症（OR=3.652，95%CI=1.763-7.562，P<0.001）发生率均高于 ARH 组。LRH 组输尿管损伤发生率高于 ARH 组（1.50% vs. 0.20%，OR=9.814，95%CI=1.224-78.712，P=0.032）。LRH 组输尿管阴道瘘发生率高于 ARH 组。闭孔神经损伤、膀胱损伤、尿瘘、直肠阴道瘘、静脉血栓栓塞、肠梗阻、乳糜漏、盆腔血肿和出血的发生率在两组间相似。