Fusegi Atsushi, Kanao Hiroyuki
Department of Gynecologic Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan.
Surg J (N Y). 2021 Oct 12;7(Suppl 2):S77-S83. doi: 10.1055/s-0041-1736178. eCollection 2021 Dec.
Radical hysterectomy is a standard operation for patients with early-stage cervical cancer. Over the recent decades, laparoscopic radical hysterectomy has been considered an alternative treatment. In 2018, the results of the laparoscopic approach to cervical cancer trial suggested that women with early-stage cervical cancer who underwent minimally invasive surgery for radical hysterectomy had poorer prognosis than those who underwent open surgery. This finding was unexpected, and direct evidence supporting poor prognosis related to minimally invasive radical hysterectomy was not available because the trial was not designed to evaluate the cause of the inferior outcomes. Tumor spillage caused by surgeon-related factors, including squeezing of the uterine cervix and tumor exposure to circulating CO gas, is considered to be associated with the poor prognosis of patients who underwent minimally invasive radical hysterectomy. We believe that protective maneuver to avoid tumor spillage is the key to improve oncologic outcomes of cervical cancer. Here, we present a procedure of total laparoscopic nerve-sparing radical hysterectomy for early-stage cervical cancer in which techniques, such as the "no-look no-touch technique," were used to prevent tumor spillage.
根治性子宫切除术是早期宫颈癌患者的标准手术。在最近几十年里，腹腔镜根治性子宫切除术被认为是一种替代治疗方法。2018年，宫颈癌腹腔镜手术试验结果表明，接受微创根治性子宫切除术的早期宫颈癌女性患者的预后比接受开放手术的患者差。这一发现出乎意料，而且由于该试验并非旨在评估预后较差的原因，因此没有支持微创根治性子宫切除术与预后不良相关的直接证据。由外科医生相关因素导致的肿瘤播散，包括挤压子宫颈和肿瘤暴露于循环的二氧化碳气体中，被认为与接受微创根治性子宫切除术患者的预后不良有关。我们认为，避免肿瘤播散的保护性操作是改善宫颈癌肿瘤学结局的关键。在此，我们介绍一种用于早期宫颈癌的全腹腔镜保留神经根治性子宫切除术的手术方法，其中采用了“不直视不触摸技术”等技术来防止肿瘤播散。
