Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Int J Gynecol Cancer. 2021 Aug;31(8):1099-1103. doi: 10.1136/ijgc-2021-002543. Epub 2021 May 6.
To evaluate the outcomes of minimally invasive surgery for patients with stage IA cervical carcinoma undergoing hysterectomy.
Patients with pathological stage IA (IA1, IA2, IA not otherwise specified) squamous, adenocarcinoma, adenosquamous carcinoma of the cervix, no history of another tumor, who underwent radical or simple hysterectomy with known mode of surgery, diagnosed between 2010 and 2015 with at least 1 month of follow-up, were drawn from the National Cancer Database. Comparisons of demographic and clinicopathologic characteristics were made with the χ test. The impact of minimally invasive surgery (robotic-assisted or traditional laparoscopic) on overall survival was assessed with the log-rank test following generation of Kaplan-Meier curves. A Cox model was constructed to control for confounders.
A total of 1930 patients were identified; the majority (73.3%, 1414 patients) had stage IA1 disease, while 458 (23.7%) patients had stage IA2, and 58 (3%) patients had stage IA not otherwise specified. In the present cohort, 685 patients (35.5%) had open, 438 patients (22.7%) had laparoscopic, and 807 patients (41.8%) had robotic-assisted laparoscopic hysterectomy. Patients who had an open approach were more likely to undergo lymphadenectomy (58.1% vs 52.7%, p=0.021) and have radical hysterectomy (42% vs 32.4%, p<0.001). Patients who had minimally invasive surgery had a shorter hospital stay (median 1 vs 3 days, p<0.001). There was no difference in overall survival between patients who had open and minimally invasive hysterectomy (p=0.87); 4-year overall survival rates were 97.7% and 98.6%, respectively. There was no difference in overall survival between the open and minimally invasive surgery groups for patients who had simple (p=0.61; 4-year overall survival rates 97.6% and 98.7%, respectively) or radical hysterectomy (p=0.70; 4-year overall survival rates 97.8% and 98.4%, respectively). After controlling for patient age, tumor histology, and presence of lymphovascular invasion, minimally invasive hysterectomy was not associated with worse survival (HR 0.94, 95% CI 0.49 to 1.81). In a sensitivity analysis, based on 3048 patients with clinical stage IA after controlling for confounders, minimally invasive surgery was not associated with worse survival than laparotomy (HR 1.06, 95% CI 0.65 to 1.72).
In a large cohort of patients with stage IA cervical carcinoma, performance of minimally invasive hysterectomy was not associated with a detrimental effect on overall survival.
评估行根治性或单纯子宫切除术的ⅠA 期宫颈癌患者行微创手术的结局。
从国家癌症数据库中抽取 2010 年至 2015 年间经病理证实为ⅠA 期（IA1、IA2、IA 未特指）鳞癌、腺癌、腺鳞癌、无其他肿瘤病史、已知手术方式且至少有 1 个月随访的患者。比较两组患者的人口统计学和临床病理学特征，采用卡方检验。通过生成 Kaplan-Meier 曲线后对数秩检验来评估微创手术（机器人辅助或传统腹腔镜）对总生存率的影响。采用 Cox 模型来控制混杂因素。
共纳入 1930 例患者，大多数（73.3%，1414 例）为 IA1 期疾病，458 例（23.7%）为 IA2 期，58 例（3%）为 IA 未特指。本队列中，685 例（35.5%）患者行开腹手术，438 例（22.7%）行腹腔镜手术，807 例（41.8%）行机器人辅助腹腔镜子宫切除术。行开腹手术的患者更倾向于行淋巴结切除术（58.1%比 52.7%，p=0.021）和行根治性子宫切除术（42%比 32.4%，p<0.001）。微创手术患者的住院时间更短（中位数 1 比 3 天，p<0.001）。开腹和微创手术患者的总生存率无差异（p=0.87）；4 年总生存率分别为 97.7%和 98.6%。对于行单纯性子宫切除术（p=0.61；4 年总生存率分别为 97.6%和 98.7%）或根治性子宫切除术（p=0.70；4 年总生存率分别为 97.8%和 98.4%）的患者，开腹手术与微创手术患者的总生存率无差异。在校正患者年龄、肿瘤组织学和脉管侵犯后，微创手术与较差的生存率无关（HR 0.94，95%CI 0.49 至 1.81）。在一项基于 3048 例临床ⅠA 期患者的敏感性分析中，在校正混杂因素后，微创手术与开腹手术相比，与生存率下降无关（HR 1.06，95%CI 0.65 至 1.72）。
在ⅠA 期宫颈癌患者的大样本队列中，行微创手术并不影响总生存率。
