Kim Jeeyeon, Chang Ha Kyun, Paek Jiheum, Park Hyeon Ji, Moon Hye Yeon
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, The College of Medicine, Seoul, Republic of Korea.
J Cancer. 2024 Aug 13;15(16):5134-5139. doi: 10.7150/jca.99705. eCollection 2024.
Minimally invasive radical hysterectomy (MIRH) is widely performed as a treatment for early-stage cervical cancer. However, in 2018, a randomized controlled trial (RCT) called the Laparoscopic Approach to Cervical Cancer (LACC) trial showed that MIRH had poorer oncologic outcomes compared to laparotomy. Since then, several clinical studies have supported this finding, and most surgeons now perform MIRH with limited surgical indications. However, most of the reported studies evaluated laparoscopic radical hysterectomy rather than robotic radical hysterectomy (RRH). Robotic surgery has advantages for complex surgical procedures in the deep and narrow pelvic cavity in cervical cancer, making it necessary to evaluate the benefits and potential harms of RRH individually. Based on this systematic review, RRH is a safe and effective alternative to abdominal approach for early-stage cervical cancer. RRH offers significant perioperative benefits, including reduced blood loss, shorter hospital stays, and fewer complications, without compromising oncologic outcomes such as overall survival and progression-free survival. Additionally, surgeons should aim to minimize tumor cell spillage into the peritoneal cavity by eliminating the use of uterine manipulators or vaginal colpotomy. Ongoing RCTs will reveal whether we can perform RRH without oncologic compromise in cervical cancer.
微创根治性子宫切除术（MIRH）作为早期宫颈癌的一种治疗方法被广泛应用。然而，2018年一项名为“腹腔镜治疗宫颈癌（LACC）试验”的随机对照试验表明，与剖腹手术相比，MIRH的肿瘤学结局较差。从那时起，多项临床研究支持了这一发现，现在大多数外科医生在手术指征有限的情况下进行MIRH。然而，大多数已报道的研究评估的是腹腔镜根治性子宫切除术，而非机器人辅助根治性子宫切除术（RRH）。机器人手术在宫颈癌深而狭窄的盆腔中进行复杂手术时具有优势，因此有必要单独评估RRH的益处和潜在危害。基于这项系统评价，RRH是早期宫颈癌腹部手术的一种安全有效的替代方法。RRH在围手术期具有显著益处，包括减少失血、缩短住院时间和减少并发症，而不影响总体生存和无进展生存等肿瘤学结局。此外，外科医生应通过避免使用子宫操纵器或阴道切开术，尽量减少肿瘤细胞溢入腹腔。正在进行的随机对照试验将揭示我们是否能够在不影响宫颈癌肿瘤学结局的情况下进行RRH。
