采用改良无瘤技术的腹腔镜根治性子宫切除术的肿瘤学结局
Oncologic Outcomes of Laparoscopic Radical Hysterectomy Incorporating Modified Tumor-Free Techniques.
作者信息
Li Yuan, Zhao Jiayuan, Ding Xuesong, Liang Chao, Wang Weidi, Ren Tong, Jiang Fang, Yang Junjun, Xiang Yang
机构信息
National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
出版信息
Obstet Gynecol. 2025 Feb 1;145(2):134-143. doi: 10.1097/AOG.0000000000005805. Epub 2024 Dec 19.
OBJECTIVE
It remains unclear whether modifying laparoscopic radical hysterectomy to adopt tumor-free principles can improve oncologic outcomes in patients with early-stage cervical cancer.
METHODS
We performed a single-center retrospective cohort study of 276 patients with early-stage cervical cancer who were treated between January 2017 and January 2023, including 151 patients who underwent laparoscopic radical hysterectomy that incorporated modified tumor-free techniques (MTF group) and 125 patients who underwent conventional laparoscopic radical hysterectomy with a uterine manipulator and unprotected intracorporeal colpotomy (non-MTF group). Oncologic outcomes and perioperative results were analyzed using inverse probability treatment weighting (IPTW).
RESULTS
Patients in the MTF group had shorter length of hospital stay than those in the non-MTF group. However, there were no significant differences in operative time, decrease in hemoglobin, or complications. After a median follow-up of 36.0 months (range 15.3-62.0 months) for the MTF group and 66.8 months (range 3.0-82.5 months) for the non-MTF group, recurrence was observed in two (1.3%) and 16 (12.8%) of the patients, respectively. The 2-year disease-free survival (DFS) rates in the MTF group and non-MTF group were 99.3% and 91.9%, respectively. In the primary analysis limited to 2-year survival, the adjusted multivariate analysis showed that use of modified tumor-free techniques was an independent predictor of longer DFS (hazard ratio 0.10 95% CI, 0.01-0.77, P =.027). After IPTW, patients in the MTF group had a more favorable DFS than those in the non-MTF group (log-rank P =.031).
CONCLUSION
Laparoscopic radical hysterectomy that incorporates modified tumor-free techniques is a feasible treatment for patients with early-stage cervical cancer. Oncologic outcomes of individuals who underwent this procedure were more favorable than those of conventional laparoscopic radical hysterectomy.
目的
目前尚不清楚改良腹腔镜根治性子宫切除术以采用无瘤原则是否能改善早期宫颈癌患者的肿瘤学结局。
方法
我们对2017年1月至2023年1月期间接受治疗的276例早期宫颈癌患者进行了单中心回顾性队列研究，其中151例患者接受了采用改良无瘤技术的腹腔镜根治性子宫切除术（MTF组），125例患者接受了使用子宫操纵器和无保护体内阴道切开术的传统腹腔镜根治性子宫切除术（非MTF组）。使用逆概率处理加权法（IPTW）分析肿瘤学结局和围手术期结果。
结果
MTF组患者的住院时间比非MTF组短。然而，手术时间、血红蛋白下降或并发症方面无显著差异。MTF组中位随访36.0个月（范围15.3 - 62.0个月），非MTF组中位随访66.8个月（范围3.0 - 82.5个月），分别有2例（1.3%）和16例（12.8%）患者出现复发。MTF组和非MTF组的2年无病生存率（DFS）分别为99.3%和91.9%。在仅限于2年生存的初步分析中，调整后的多变量分析显示使用改良无瘤技术是DFS延长的独立预测因素（风险比0.10，95%可信区间，0.01 - 0.77，P = 0.027）。IPTW后，MTF组患者的DFS比非MTF组更有利（对数秩P = 0.031）。
结论
采用改良无瘤技术的腹腔镜根治性子宫切除术是早期宫颈癌患者的一种可行治疗方法。接受该手术的患者的肿瘤学结局比传统腹腔镜根治性子宫切除术更有利。
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