Gasimli Khayal, Wilhelm Lisa, Becker Sven, De Wilde Rudy Leon, Tahmasbi Rad Morva
Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Frankfurt Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Department of Gynecology, Carl-von-Ossietzky University, 26129 Oldenburg, Germany.
J Clin Med. 2022 Aug 22;11(16):4919. doi: 10.3390/jcm11164919.
The ideal management of early-stage cervical cancer has become the subject of a global controversy following the publication of a prospective study in 2018 that reported a worse oncologic outcome when comparing the minimally invasive approach to the laparotomy approach. The discussion involves both prospective and retrospective data and general and theoretical considerations. We wanted to look at the data available today and review the different opinions, offering an impartial assessment of the ongoing controversy.
The available literature was reviewed, focusing on articles arguing for and against minimally invasive surgery in cervical cancer. We tried to avoid any fundamental bias, as is often evident in the available reviews on the subject. Literature both before and after the 2018 publication was taken into consideration.
As is usual in discussions of concepts, the literature that is now available provides arguments for both sides of this challenging issue, depending on one's standpoint. Science-related writing is not immune to trends. There is a curious shift in opinion seen before and after 2018. One must question whether there was a prejudice in favor of minimally invasive surgery prior to the publication of the NEJM articles and a bias against it afterward.
Whether further minimally invasive surgery for cervical cancer is invariable is tied to the more pressing question of how this surgery will have to be centralized in the future. Unless these questions are linked, no satisfactory solution can be found.
2018年一项前瞻性研究发表后，早期宫颈癌的理想治疗方法成为全球争议的话题。该研究报告称，将微创方法与开腹手术方法相比较时，肿瘤学结局更差。讨论涉及前瞻性和回顾性数据以及一般和理论考量。我们希望查看当前可用的数据并审视不同观点，对这场持续的争议提供公正的评估。
对现有文献进行了综述，重点关注支持和反对宫颈癌微创手术的文章。我们尽量避免任何根本性的偏见，而这在关于该主题的现有综述中往往很明显。考虑了2018年发表前后的文献。
正如概念讨论中常见的那样，根据个人立场，现有文献为这个具有挑战性的问题的双方都提供了论据。与科学相关的著述也不能免受潮流影响。2018年前后出现了一种奇怪的观点转变。人们必须质疑，在《新英格兰医学杂志》的文章发表之前是否存在对微创手术的偏爱，而之后是否存在对它的偏见。
宫颈癌进一步的微创手术是否一成不变，与未来这种手术将如何集中进行这个更紧迫的问题相关。除非将这些问题联系起来，否则无法找到令人满意的解决方案。
