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 Jul;162(1):43-49. doi: 10.1016/j.ygyno.2021.05.005. Epub 2021 May 13.
To examine the influence of the first level I evidence (Laparoscopic Approach to Cervical Cancer [LACC] trial) on minimally invasive hysterectomy use and perioperative complications for cervical cancer surgery.
This was population-based retrospective observational study, querying National Inpatient Sample. Women with cervical cancer who underwent hysterectomy and lymphadenectomy from 10/2015-12/2018 were examined. A quasi-experimental analysis with interrupted-time series was performed to assess the influence of the LACC trial report on minimally invasive hysterectomy use and perioperative complication rates.
5120 women in the pre-LACC period and 1645 women in the post-LACC period were compared. Following the LACC trial report on 3/2018, the minimally invasive hysterectomy use dropped by 19.7 percent points in one month (55.2% in 3/2018 to 35.5% in 4/2018), followed by a continued decline of 8.0% (95% confidence interval 0.1-15.3) monthly. By 12/2018, minimally invasive hysterectomy was used in 17.9% of cases, which was 38.8 percent points lower than the expected rate per the pre-LACC period projection. In multivariable analysis, women in the post-LACC period were 63% less likely to undergo minimally invasive hysterectomy (adjusted-odds ratio 0.37, 95% confidence interval 0.33-0.42) but 23% more likely to have a perioperative complication (38.6% versus 29.1%, adjusted-odds ratio 1.23, 95% confidence interval 1.08-1.40) compared to those in the pre-LACC period. Women in the post-LACC group were more likely to have a longer hospital stay compared to those in the pre-LACC group (median, 3 versus 2 days, P < 0.001).
Following the LACC trial results, U.S. surgeons rapidly shifted from minimally invasive to open hysterectomy for cervical cancer. Decreasing utilization of minimally invasive surgery was associated with an increase in perioperative complications and longer hospital admissions.
探讨一级证据（腹腔镜治疗宫颈癌试验[LACC]）对宫颈癌手术微创子宫切除术应用和围手术期并发症的影响。
这是一项基于人群的回顾性观察性研究，查询国家住院患者样本。2015 年 10 月至 2018 年 12 月期间接受子宫切除术和淋巴结切除术的宫颈癌女性患者纳入研究。采用准实验分析的时间序列中断法评估 LACC 试验报告对微创子宫切除术应用和围手术期并发症发生率的影响。
在 LACC 前时期，共比较了 5120 名女性，在 LACC 后时期，共比较了 1645 名女性。LACC 试验报告于 2018 年 3 月发布后，一个月内微创子宫切除术使用率下降了 19.7 个百分点（2018 年 3 月为 55.2%，2018 年 4 月为 35.5%），随后每月持续下降 8.0%（95%置信区间为 0.1-15.3）。到 2018 年 12 月，微创子宫切除术的使用率为 17.9%，比 LACC 前时期预测的预期使用率低 38.8 个百分点。多变量分析显示，LACC 后时期的女性接受微创子宫切除术的可能性降低了 63%（调整后优势比 0.37，95%置信区间 0.33-0.42），但发生围手术期并发症的可能性增加了 23%（38.6%对 29.1%，调整后优势比 1.23，95%置信区间 1.08-1.40）。与 LACC 前时期相比，LACC 后时期的女性住院时间更长（中位数为 3 天对 2 天，P<0.001）。
LACC 试验结果公布后，美国外科医生迅速从微创子宫切除术转为开腹子宫切除术治疗宫颈癌。微创手术使用率下降与围手术期并发症增加和住院时间延长有关。
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