Orr J W, Holimon J L, Orr P F
Division of Gynecologic Oncology, Patty Berg Cancer Center, Columbia Regional Medical Center, Southwest Florida, USA.
Am J Obstet Gynecol. 1997 Apr;176(4):777-88; discussion 788-9. doi: 10.1016/s0002-9378(97)70601-x.
Our aim was to evaluate the perioperative morbidity after hysterectomy and lymphadenectomy as primary treatment of endometrial cancer and to analyze the recurrence and survival of patients classified as having surgical stage I disease who did not receive adjunctive teletherapy.
Over a 10-year interval 444 patients underwent extensive surgical staging for corpus cancer. Perioperative events were recorded prospectively. Outcome events were updated after the last year of study.
After patients with high-risk histologic types of cancer were excluded, 396 patients were evaluable. The risk of extrauterine disease, detected in 21.8% of patients, increased with increasing lack of tumor differentiation. The associated surgical morbidity, including blood loss (mean 336 ml), surgical site infection (3.5%), thromboembolic events (1.5%), and urinary injury (0.6%), and deaths (0.6%) did not differ from those in reports of women undergoing lesser operative procedures. Late complications, including lymphocyst (1.2%), leg edema (1.8%), and hernia (2.9%), were infrequent. Recurrence and survival analysis indicated a calculated 5-year survival of 97% of all patients with surgical stage I disease. There was a significant survival difference related to grade and stage for women in whom disease was confined to the uterus. Overall survival in patients with stage IA (100%) was significantly different (p < 0.0001) from that of patients with stage IB (97%) and stage IC (93%). All recurrences included a distal component.
Extensive surgical staging including lymphadenectomy can be performed safely. Our results suggest that the risk of pelvic recurrence is not increased and the risk of survival is not compromised in those women not receiving adjunctive teletherapy.
我们的目的是评估子宫切除术和淋巴结切除术作为子宫内膜癌主要治疗方法后的围手术期发病率，并分析未接受辅助远距离放疗的手术分期为I期疾病患者的复发和生存情况。
在10年期间，444例患者接受了广泛的子宫体癌手术分期。围手术期事件进行前瞻性记录。在研究的最后一年后更新结局事件。
排除高危组织学类型癌症患者后，396例患者可进行评估。21.8%的患者检测到子宫外疾病风险，其随着肿瘤分化程度降低而增加。相关手术并发症包括失血（平均336毫升）、手术部位感染（3.5%）、血栓栓塞事件（1.5%）、泌尿系统损伤（0.6%）和死亡（0.6%），与接受较小手术操作的女性报告中的情况无差异。晚期并发症包括淋巴囊肿（1.2%）、腿部水肿（1.8%）和疝气（2.9%），发生率较低。复发和生存分析表明，所有手术分期为I期疾病的患者计算得出的5年生存率为97%。对于疾病局限于子宫的女性，生存率与分级和分期存在显著差异。IA期患者（100%）的总生存率与IB期（97%）和IC期（93%）患者的总生存率存在显著差异（p<0.0001）。所有复发均包括远处成分。
包括淋巴结切除术在内的广泛手术分期可以安全进行。我们的结果表明，未接受辅助远距离放疗的女性盆腔复发风险未增加，生存风险也未受到影响。
