Gynecology, Clinica Universitaria de Navarra, Madrid, Spain.
Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain.
Int J Gynecol Cancer. 2024 Feb 5;34(2):203-208. doi: 10.1136/ijgc-2023-004657.
The aim of this study was to compare the incidence of intra-operative and post-operative complications in open and minimally invasive radical hysterectomy for patients with early-stage cervical cancer.
Data were collected from the SUCCOR database of 1272 patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO), 2009) who underwent radical hysterectomy in Europe between January 2013 and December 2014. We reviewed the duration of the surgeries, estimated blood loss, length of hospital stay, intra-operative and post-operative complications. The inclusion criteria were age ≥18 years and histologic type (squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma). Pelvic MRI confirming a tumor diameter ≤4 cm with no parametrial invasion and a pre-operative CT scan, MRI, or positron emission tomography CT demonstrating no extra-cervical metastatic disease were mandatory. Outcomes of interest were any grade >3 adverse events, intra-operative adverse events, post-operative adverse events, length of hospital stay, length of operation, and blood loss.
The study included 1156 patients, 633 (54%) in the open surgery group and 523 (46%) in the minimally invasive surgery group. Median age was 46 years (range 18-82), median body mass index 25 kg/m (range 15-68), and 1022 (88.3%) patients were considered to have an optimal performance status (ECOG Performance Status 0). The most common histologic tumor type was squamous carcinoma (n=794, 68.7%) and the most frequent FIGO staging was IB1 (n=510, 44.1%). In the minimally invasive surgery group the median duration of surgery was longer (240 vs 187 min, p<0.01), median estimated blood loss was lower (100 vs 300 mL, p<0.01), and median length of hospital stay was shorter (4 vs 7 days, p<0.01) compared with the abdominal surgery group. There was no difference in the overall incidence of intra-operative and post-operative complications between the two groups. Regarding grade I complications, the incidence of vaginal bleeding (2.9% vs 0.6%, p<0.01) and vaginal cuff dehiscence was higher in the minimally invasive surgery group than in the open group (3.3% vs 0.5%, p<0.01). Regarding grade III post-operative complications, bladder dysfunction (1.3% vs 0.2%, p=0.046) and abdominal wall infection (1.1% vs 0%, p=0.018) were more common in the open surgery group than in the minimally invasive surgery group. Ureteral fistula was more frequent in the minimally invasive group than in the open surgery group (1.7% vs 0.5%, p=0.037).
Our study showed that there was no significant difference in the overall incidence of intra-operative and post-operative complications between minimally invasive radical hysterectomy and the open approach.
本研究旨在比较早期宫颈癌患者行开放性和微创根治性子宫切除术的术中及术后并发症发生率。
我们从欧洲 2013 年 1 月至 2014 年 12 月期间 1272 例接受根治性子宫切除术的国际妇产科联合会（FIGO）2009 年分期为 IB1 期宫颈癌患者的 SUCCOR 数据库中收集数据。我们回顾了手术持续时间、估计失血量、住院时间、术中及术后并发症。纳入标准为年龄≥18 岁且组织学类型（鳞癌、腺癌或腺鳞癌）。盆腔 MRI 确认肿瘤直径≤4cm 且无宫旁侵犯，术前 CT、MRI 或正电子发射断层扫描（PET-CT）证实无宫颈外转移疾病。主要研究结局为任何 3 级以上不良事件、术中不良事件、术后不良事件、住院时间、手术时间和失血量。
本研究共纳入 1156 例患者，其中 633 例（54%）接受开放性手术，523 例（46%）接受微创手术。中位年龄为 46 岁（范围 18-82 岁），中位体重指数为 25kg/m（范围 15-68kg/m），1022 例（88.3%）患者的体能状态为最佳（ECOG 体能状态 0 分）。最常见的组织学肿瘤类型为鳞癌（n=794，68.7%），最常见的 FIGO 分期为 IB1（n=510，44.1%）。微创手术组的中位手术时间较长（240 分钟 vs 187 分钟，p<0.01），中位估计失血量较少（100 毫升 vs 300 毫升，p<0.01），中位住院时间较短（4 天 vs 7 天，p<0.01）。两组术中及术后并发症的总发生率无差异。关于 1 级并发症，微创手术组阴道出血（2.9% vs 0.6%，p<0.01）和阴道残端裂开的发生率高于开放性手术组（3.3% vs 0.5%，p<0.01）。关于 3 级术后并发症，膀胱功能障碍（1.3% vs 0.2%，p=0.046）和腹壁感染（1.1% vs 0%，p=0.018）在开放性手术组更为常见。微创组输尿管瘘的发生率高于开放手术组（1.7% vs 0.5%，p=0.037）。
本研究表明，微创根治性子宫切除术与开放性手术相比，术中及术后并发症的总发生率无显著差异。
