A retrospective assessment of the safety and efficacy of laparoscopic radical hysterectomy in Japan during the early years following its introduction: a Japanese Gynecologic Oncology Group study (JGOG1081S)
A retrospective assessment of the safety and efficacy of laparoscopic radical hysterectomy in Japan during the early years following its introduction: a Japanese Gynecologic Oncology Group study (JGOG1081S)
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DOI：
10.1007/s10147-020-01799-3
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发表时间：
2021-01-12
影响因子：
3.3
通讯作者：
Mikami, Mikio
中科院分区：
文献类型：
--
作者：
Kobayashi, Eiji;Kanao, Hiroyuki;Mikami, Mikio
目的评价腹腔镜根治性子宫切除术（LRH）治疗宫颈癌的安全性和有效性，从LRH引入日本后的发病率和短期肿瘤学结局来看。方法我们对2014年12月至2016年12月接受LRH的早期宫颈癌患者（FIGO分期IA 2、IB 1和IIA 1）进行了回顾性分析。我们评估了发病率，总生存期（OS）和无复发生存期（RFS），RFS.Results的预后因素，共251例患者，包括来自日本各地的22个设施。有8例IA 2期宫颈癌，226例IB 1期宫颈癌，17例IIA 1期宫颈癌。中位手术时间为343 min，中位失血量为190 ml。2例患者（0.8%）发生术后并发症，Clavien-Dindo分级为3级或更高。中位随访时间为15.6个月后，2年RFS为87.4%，2年OS为97.8%。当将2年RFS率与患者病理上肿瘤是否小于2 cm与2 cm或更大进行比较时，RFS分别为95.8%和80.4%。多因素分析发现，肿瘤大小和淋巴结切除途径是复发的独立预后因素。结论当LRH首次引入日本时，我们发现除了大肿瘤（>= 2 cm）外，淋巴结切除途径是复发的独立预后因素。我们的研究结果表明，预后可能是安全的注意淋巴结切除途径。
Objective To evaluate the safety and efficacy of laparoscopic radical hysterectomy (LRH) for cervical cancer, in terms of morbidity and short-term oncologic outcome following LRH's introduction into Japan.Methods We conducted a retrospective analysis of patients with early-stage cervical cancer (FIGO staging IA2, IB1, and IIA1) who underwent LRH from Dec 2014 to Dec 2016. We assessed the morbidity, overall survival (OS) and recurrence-free survival (RFS), and prognostic factors for RFS.Results A total of 251 patients were included from 22 facilities across Japan. There were 8 cases of stage IA2 cervical cancer, 226 of IB1, and 17 of IIA1. The median operating time was 343 min and the median blood loss was 190 ml. Two patients (0.8%) had a postoperative complication with a Clavien-Dindo classification of grade 3 or higher. After a median follow-up time of 15.6 months, the 2-year RFS was 87.4%, and the 2-year OS was 97.8%. When the 2-year RFS rate was compared with whether the patient pathologically had tumors of less than 2 cm, versus 2 cm or more, the RFS was 95.8% and 80.4%, respectively. Multivariate analysis found that tumor size and the route of lymph node removal were independent prognostic factors for recurrence.Conclusion When LRH was first introduced into Japan, we found that the route of lymph node removal was an independent prognostic factor for recurrence in addition to large tumors (>= 2 cm). Our results suggest that prognosis may be secured by paying attention to the lymph node removal route.