Kamata Mayumi, Fusegi Atsushi, Kurihara Nozomi, Abe Akiko, Nomura Hidetaka, Kanao Hiroyuki
Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Clinical Planning and Strategy, Japanese Foundation for Cancer Research, Tokyo, Japan.
J Gynecol Oncol. 2025 Mar;36(2):e22. doi: 10.3802/jgo.2025.36.e22. Epub 2024 Jul 12.
Minimally invasive radical hysterectomy has a worse prognosis than open surgery, but the reasons for the poor prognosis remain unclear. Tumor spillage occurs when the tumor is exposed to the surgical field and has been suggested to be related to a poor prognosis. This study aimed to compare the prognostic value of tumor spillage in laparoscopic radical hysterectomy and evaluate whether tumor spillage prevention improves oncological safety.
We compared the prognosis of patients who underwent laparoscopic radical hysterectomy between December 2014 and November 2021 with or without tumor spillage prevention, including surgeries without prevention and those with failed prevention. Prevention consisted of vaginal cuff formation or closure of the vaginal canal with clips to prevent tumor exposure at the time of colpotomy. The primary endpoint was disease-free survival, which was adjusted using propensity scores to compare patients.
In total, 165 patients received tumor spillage prevention, and 61 did not or failed to receive such prevention. The median follow-up was 4.4 years. Patients who did not undergo prevention or failed prevention had significantly shorter disease-free survival than those who did (hazard ratio [HR]=3.54; 95% confidence interval [CI]=1.23-10.23). The same trend was observed after adjusting for propensity score matching. Patients who did not or failed to receive prevention were more likely to experience local recurrence (HR=4.01; 95% CI=1.13-14.24).
Tumor spillage prevention was associated with longer disease-free survival in laparoscopic radical hysterectomy.
微创根治性子宫切除术的预后比开放手术差，但其预后不良的原因尚不清楚。肿瘤暴露于手术视野时会发生肿瘤播散，有人认为这与预后不良有关。本研究旨在比较肿瘤播散在腹腔镜根治性子宫切除术中的预后价值，并评估预防肿瘤播散是否能提高肿瘤学安全性。
我们比较了2014年12月至2021年11月期间接受腹腔镜根治性子宫切除术的患者在有无预防肿瘤播散情况下的预后，包括未进行预防的手术和预防失败的手术。预防措施包括形成阴道袖口或用夹子封闭阴道管，以防止阴道切开术时肿瘤暴露。主要终点是无病生存期，使用倾向评分进行调整以比较患者。
共有165例患者接受了肿瘤播散预防，61例未接受或预防失败。中位随访时间为4.4年。未进行预防或预防失败的患者无病生存期明显短于进行预防的患者（风险比[HR]=3.54；95%置信区间[CI]=1.23-10.23）。倾向评分匹配调整后观察到相同趋势。未接受或预防失败的患者更有可能发生局部复发（HR=4.01；95%CI=1.13-14.24）。
在腹腔镜根治性子宫切除术中，预防肿瘤播散与更长的无病生存期相关。
