Puntambekar Shailesh, Parulekar Maitreyee, Venkateswaran Sneha, Naidu Saranya, Patil Madhavi, Manerikar Kshitij, Bharambe Suyog, Chitale Mihir, Panse Mangesh, Sathe Ravindra, Puntambekar Seema
Consultant Oncosurgeon and Director, Galaxy Care Hospital, Pune, Maharashtra, India. (Dr. Puntambekar).
Fellow in Minimally Invasive Gynecologic Surgery, Department of Gynecology, Galaxy Care Hospital, Pune, Maharashtra, India. (Drs. Parulekar, Venkateswaran, Naidu, and Patil).
JSLS. 2025 Apr-Jun;29(2). doi: 10.4293/JSLS.2024.00073. Epub 2025 May 13.
Aim was to analyze and compare the oncological outcomes, genitourinary quality of life (QOL), disease-free survival (DFS), and overall survival (OS) of patients treated by laparoscopic radical hysterectomy (LRH) and laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer.
Retrospective study in patients of carcinoma cervix FIGO (2009) grade 1A to 2A1 from January 1, 2016 until the publication of Laparoscopic Approach to Cervical Cancer (LACC) trial in 2018, after which only 1A and 1B1 were included up to December 31, 2020.
Total of 285 patients operated over 5 years at the center were placed in 2 groups, LRH and LNSRH, based on surgical approach.
Tumor characteristics, clinical profile, tumor clearance, histopathology, adjuvant treatment, period of follow-up and recurrence were compared. The QOL was analyzed in terms of bladder and sexual function.
LNSRH group had significantly faster recovery of bladder (lesser number of days required for PVR <50 mL, quicker catheter removal time, less requirement of self-catheterization, less incidence of urinary retention and incontinence) and sexual function as compared to LRH group. There was no significant difference in radicality of the procedure. None of them had vault recurrences. DFS at 5 years for LRH and LNSRH was 95.3% and 94.1%, respectively. OS at 2 years for LRH and LNSRH was 95.9% and 96.3%, respectively, whereas the OS at 5 years was 95.3% and 94.1%, respectively.
LNSRH group had significantly better genitourinary QOL as compared to the LRH group without compromising on oncological clearance. The survival is comparable to the results of open surgery in LACC trial.
分析并比较接受腹腔镜根治性子宫切除术（LRH）和腹腔镜保留神经根治性子宫切除术（LNSRH）治疗的早期宫颈癌患者的肿瘤学结局、泌尿生殖系统生活质量（QOL）、无病生存期（DFS）和总生存期（OS）。
对2016年1月1日至2018年《腹腔镜治疗宫颈癌（LACC）试验》发表期间国际妇产科联盟（FIGO，2009年）1A至2A1期宫颈癌患者进行回顾性研究，此后直至2020年12月31日仅纳入1A和1B1期患者。
该中心5年间共285例接受手术的患者根据手术方式分为LRH和LNSRH两组。
比较肿瘤特征、临床资料、肿瘤清除情况、组织病理学、辅助治疗、随访时间和复发情况。从膀胱和性功能方面分析生活质量。
与LRH组相比，LNSRH组膀胱功能恢复明显更快（残余尿量<50 mL所需天数更少、导尿管拔除时间更快、自我导尿需求更少、尿潴留和尿失禁发生率更低），性功能恢复也更快。手术的根治程度无显著差异。两组均无穹窿复发。LRH组和LNSRH组5年DFS分别为95.3%和94.1%。LRH组和LNSRH组2年OS分别为95.9%和96.3%，而5年OS分别为95.3%和94.1%。
与LRH组相比，LNSRH组泌尿生殖系统生活质量明显更好，且不影响肿瘤清除效果。其生存率与LACC试验中开放手术的结果相当。
