Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China.
World J Surg Oncol. 2022 Dec 12;20(1):392. doi: 10.1186/s12957-022-02866-x.
Since the release of the LACC trial results in 2018, the safety of laparoscopic radical hysterectomy (LRH) for cervical cancer has received huge attention and heated discussion. We developed modified laparoscopic radical hysterectomy (MLRH) incorporating a series of measures to prevent tumor spillage, which has been performed in our center since 2015.
Present study retrospectively analyzed relevant indicators of MLRH and evaluated disease-free survival (DFS) primarily in the treatment of early cervical cancer compared with open surgery.
Patients with 2014 International Federation of Gynecology and Obstetrics clinical stages 1B1 and 2A1 cervical cancer who underwent radical hysterectomy in the gynecological department of our hospital from October 2015 to June 2018 were enrolled retrospectively in this study. Patients were divided into two groups based on the surgical procedure: open radical hysterectomy (ORH) group (n = 336) and MLRH group (n = 302). Clinical characteristics, surgical indices, and survival prognosis were analyzed, including 2.5-year overall survival (OS) rate, 2.5-year DFS rate, recurrence rate, and recurrence pattern.
Compared to the ORH group, the MLRH group exhibited a longer operative time, longer normal bladder function recovery time, less intraoperative blood loss volume, and more harvested pelvic lymph nodes (P < 0.05). No significant differences were observed in postoperative complications, the 2.5-year OS, 2.5-year DFS, and recurrence rate between the two groups (P > 0.05); however, the recurrence pattern was significantly different (P < 0.05). The MLRH group mainly exhibited local single metastasis (7/11), whereas the ORH group mainly exhibited distant multiple metastases (14/16). Stratified analysis revealed that overall survival rate was higher in the MLRH group than in the ORH group in patients with stage 1B1 and middle invasion (P < 0.05).
MLRH does not show a survival disadvantage in the treatment of early-stage cervical cancer when compared with open surgery. In addition, MLRH shows a survival advantage in patients with stage 1B1 and middle 1/3 invasion. Considering this is a retrospective study, further prospective study is necessary for more sufficient data support.
Present research is a retrospective study. The study had retrospectively registered on Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), and the registered number is ChiCTR1900026306.
自 2018 年 LACC 试验结果发布以来，腹腔镜根治性子宫切除术（LRH）治疗宫颈癌的安全性受到了广泛关注和热烈讨论。自 2015 年以来，我们中心一直在实施改良腹腔镜根治性子宫切除术（MLRH），该手术结合了一系列防止肿瘤外溢的措施。
本研究回顾性分析了 MLRH 的相关指标，并主要评估了其与开腹手术治疗早期宫颈癌的无病生存率（DFS）。
回顾性分析 2015 年 10 月至 2018 年 6 月在我院妇科接受根治性子宫切除术的国际妇产科联合会临床分期为 1B1 和 2A1 期宫颈癌患者的相关资料。根据手术方式将患者分为两组：开腹根治性子宫切除术（ORH）组（n=336）和 MLRH 组（n=302）。分析两组的临床特征、手术指标和生存预后，包括 2.5 年总生存率（OS）、2.5 年 DFS 率、复发率和复发模式。
与 ORH 组相比，MLRH 组的手术时间更长，正常膀胱功能恢复时间更长，术中出血量更少，盆腔淋巴结清扫数量更多（P<0.05）。两组术后并发症、2.5 年 OS、2.5 年 DFS 和复发率无统计学差异（P>0.05）；然而，复发模式存在显著差异（P<0.05）。MLRH 组主要表现为局部单发转移（7/11），而 ORH 组主要表现为远处多发转移（14/16）。分层分析显示，MLRH 组患者的总生存率高于 ORH 组，尤其是在 1B1 期和中侵润的患者中（P<0.05）。
与开腹手术相比，MLRH 治疗早期宫颈癌并不显示生存劣势。此外，MLRH 对 1B1 期和中 1/3 侵润的患者具有生存优势。考虑到这是一项回顾性研究，需要进一步的前瞻性研究以获得更充分的数据支持。
本研究为回顾性研究。研究已在中国临床试验注册中心（http://www.chictr.org.cn/）进行了回顾性注册，注册号为 ChiCTR1900026306。
