1A1期和1A2期宫颈癌女性的微创手术与开放手术：一项回顾性数据库队列研究。
Minimally invasive versus open surgery for women with stage 1A1 and stage 1A2 cervical cancer: A retrospective database cohort study.
作者信息
Hayek Judy, Mowzoon Mia, Demissie Saleshi, Palileo Albert, Serur Eli, Goldberg Gary L, Alagkiozidis Ioannis
机构信息
Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital, USA.
Department of Biostatistics, Feinstein Institutes for Medical Research, Staten Island University Hospital, Northwell Health, USA.
出版信息
Ann Med Surg (Lond). 2022 Apr 7;77:103507. doi: 10.1016/j.amsu.2022.103507. eCollection 2022 May.
BACKGROUND
Recent studies comparing minimally invasive versus open radical hysterectomy in patients with early-stage cervical cancer have reported a worse overall survival with minimally invasive surgery (MIS). However, in the patients with microscopic disease, there was no survival difference and the optimal surgical approach for microscopic cervical cancer remains unclear.
METHODS
Using the National Cancer Database, we identified a cohort of women who underwent hysterectomy as the primary treatment for stage IA1/IA2 cervical cancer between January 2010 and December 2016. Using multivariable logistic regression, our primary outcome was to compare overall survival between the open and MIS groups. The data was stratified for simple and radical hysterectomies. Secondary endpoint was comparison of readmission rates and length of stay (LOS).
RESULTS
We identified 6230 patients with stage IA1 and IA2 cervical cancer that underwent hysterectomy as primary treatment. 4054 of these women (65%) underwent MIS. There was no difference in age, lympho-vascular invasion, number of lymph nodes retrieved and histology between the two groups. In the overall cohort, there was no difference in survival between the open and the MIS group (Hazard ratio for the open group 1.23; CI 0.92-1.63). Post-operative radiation therapy was more common in the open group (5.24% vs 4.09%, p value < 0.02). The mean LOS (1.35 days vs 3.08 days) was shorter in MIS group ( value < 0.0001). No difference was found in the readmission rates (60% for the MIS group vs 55% for the open group; value 0.14).
CONCLUSIONS
Our data suggest that MIS is associated with similar overall survival and shorter length of hospital stay compared to the open hysterectomy in women with stage IA cervical cancer. Based on this large data set, MIS appears to be a safe and effective surgical approach for women with stage IA1/IA2 cervical cancer.
背景
近期比较早期宫颈癌患者微创与开放根治性子宫切除术的研究报告称，微创手术（MIS）的总生存率更差。然而，在微小病灶患者中，生存率并无差异，微小宫颈癌的最佳手术方式仍不明确。
方法
利用国家癌症数据库，我们确定了一组在2010年1月至2016年12月期间接受子宫切除术作为IA1/IA2期宫颈癌主要治疗方法的女性队列。使用多变量逻辑回归，我们的主要结果是比较开放手术组和MIS组之间的总生存率。数据按单纯子宫切除术和根治性子宫切除术进行分层。次要终点是比较再入院率和住院时间（LOS）。
结果
我们确定了6230例IA1期和IA2期宫颈癌患者，她们接受了子宫切除术作为主要治疗方法。其中4054名女性（65%）接受了MIS。两组在年龄、淋巴管浸润、切除淋巴结数量和组织学方面无差异。在整个队列中，开放手术组和MIS组的生存率无差异（开放手术组的风险比为1.23；CI为0.92-1.63）。开放手术组术后放疗更为常见（5.24%对4.09%，p值<0.02）。MIS组的平均住院时间较短（1.35天对3.08天，p值<0.0001）。再入院率无差异（MIS组为60%，开放手术组为55%；p值为0.14）。
结论
我们的数据表明，与IA期宫颈癌女性的开放子宫切除术相比，MIS的总生存率相似且住院时间更短。基于这个大数据集，MIS似乎是IA1/IA2期宫颈癌女性的一种安全有效的手术方法。
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