Röseler Jona, Wolff Robert, Bauerschlag Dirk O, Maass Nicolai, Hillemanns Peter, Ferreira Helder, Debrouwere Marie, Scheibler Fülöp, Geiger Friedemann, Elessawy Mohamed
Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
Kleijnen Systematic Reviews Ltd., Escrick, York YO19 6FD, UK.
J Clin Med. 2021 Aug 24;10(17):3761. doi: 10.3390/jcm10173761.
The aim of the study was to perform a systematic assessment of disease-free survival (DFS), overall survival, and morbidity rates after open radical hysterectomy (ORH) and minimally invasive surgery (MIS) for early-stage cervical cancer and discuss with experts the consequences of the LACC trial (published by Ramirez et al. in 2018) on clinical routine.
A total of 5428 records were retrieved. After exclusion based on text screening, four records were identified for inclusion. Five experts from three independent large-volume medical centers in Europe were interviewed for their interpretation of the LACC trial.
The LACC trial showed a significantly higher risk of disease progression with MIS compared to ORH (HR 3.74, 95% CI 1.63 to 8.58). This was not seen in one epidemiological study and was contradicted by one prospective cohort study reported by Greggi et al. A systematic review by Zhang et al. mentioned a similar DFS for robot-assisted radical hysterectomy (RRH) and LRH. Recurrence rates were significantly higher with MIS compared to ORH in the LACC trial (HR 4.26, 95% CI 1.44 to 12.60). In contrast, four studies presented by Greggi reported no significant difference in recurrence rates between LRH/RRH and ORH, which concurred with the systematic reviews of Zhang and Zhao. The experts mentioned various limitations of the LACC trial and stated that clinicians were obliged to provide patients with detailed information and ensure a shared decision-making process.
The surgical treatment of early-stage cervical cancer remains a debated issue. More randomized controlled trials (RCT) will be needed to establish the most suitable treatment for this condition.
本研究旨在对早期宫颈癌行开放性根治性子宫切除术（ORH）和微创手术（MIS）后的无病生存期（DFS）、总生存期和发病率进行系统评估，并与专家讨论LACC试验（由Ramirez等人于2018年发表）对临床常规的影响。
共检索到5428条记录。经文本筛选排除后，确定4条记录纳入研究。对来自欧洲三个独立的大容量医疗中心的五名专家进行访谈，以了解他们对LACC试验的解读。
LACC试验显示，与ORH相比，MIS的疾病进展风险显著更高（HR 3.74，95%CI 1.63至8.58）。一项流行病学研究未发现此情况，Greggi等人报告的一项前瞻性队列研究与之矛盾。Zhang等人的一项系统评价提到机器人辅助根治性子宫切除术（RRH）和腹腔镜根治性子宫切除术（LRH）的DFS相似。在LACC试验中，MIS的复发率显著高于ORH（HR 4.26，95%CI 1.44至12.60）。相比之下，Greggi提出的四项研究报告称，LRH/RRH与ORH之间的复发率无显著差异，这与Zhang和Zhao的系统评价一致。专家们提到了LACC试验的各种局限性，并表示临床医生有义务向患者提供详细信息，并确保共同决策过程。
早期宫颈癌的手术治疗仍是一个有争议的问题。需要更多的随机对照试验（RCT）来确定最适合这种情况的治疗方法。
