Minimally Invasive Radical Hysterectomy for Cervical Cancer Is Associated With Reduced Morbidity and Similar Survival Outcomes Compared With Laparotomy
Minimally Invasive Radical Hysterectomy for Cervical Cancer Is Associated With Reduced Morbidity and Similar Survival Outcomes Compared With Laparotomy
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DOI：
10.1016/j.jmig.2016.12.005
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发表时间：
2017-03-01
影响因子：
4.1
通讯作者：
Growdon, Whitfield
中科院分区：
文献类型：
--
作者：
Diver, Elisabeth;Hinchcliff, Emily;Growdon, Whitfield
研究目的：评估在美国2家大型学术机构通过微创手术（MIS）或传统剖腹手术（XL）方法进行前期根治性子宫切除术（RH）的宫颈癌妇女的结局，以确定手术模式是否影响患者结局。设计：回顾性队列研究（加拿大工作组分类II-1）。设置：美国的两个学术医疗机构。患者：2000年至2013年间因宫颈癌接受前期RH的女性。干预：与XL相比，RH的微创技术（腹腔镜和机器人），测量和主要结果：共有383名女性符合资格要求。其中，101人接受了MIS（即，传统腹腔镜、腹腔镜单部位或机器人）方法，282例接受XL方法。总生存期（中位数未达到; p = 0.29）在两组之间没有差异。两组的复发罕见且相当，MIS组和XL组分别有5.0%和6.4%的患者复发（p = 0.86）。MIS组和XL组分别有98%和97%的患者进行了盆腔淋巴结清扫（p > 0.99），分别有10.9%和8.5%的患者进行了盆腔淋巴结清扫（p = 0.55）。MIS组的平均盆腔淋巴结数量较高（19.4 vs 16.0; p <0.001）。术后化疗（p = 0.32）或放疗（p = 0.28）的比率在组间无差异。MIS组中5.0%的标本和XL组中4.6%的标本的手术切缘呈阳性（p = 0.54）。尽管两组的总体并发症发生率没有差异（分别为15.1%和17.2%; p = 0.87），但剖腹手术的中位估计失血量（EBL）较高（50 cm（3）vs 500 cm（3）），围手术期输血率较高（3.0% vs 26.2%; p <0.001）。微创组的围手术期住院时间明显缩短（1.9天vs 4.9天; p
Study Objective: To assess outcomes of women with cervical cancer undergoing upfront radical hysterectomy (RH) via a minimally invasive surgery (MIS) or a traditional laparotomy (XL) approach at 2 large US academic institutions to determine whether the mode of surgery affects patient outcomes.Design: Retrospective cohort study (Canadian Task Force classification II-1).Setting: Two academic medical institutions in the United States.Patients: Women undergoing upfront RH for cervical cancer between 2000 and 2013.Intervention: Minimally invasive techniques (laparoscopic and robotic) for RH compared with XL,Measurements and Main Results: A total of 383 women met the eligibility requirements. Of these, 101 underwent an MIS (i.e., traditional laparoscopy, laparoendoscopic single site, or robotic) approach, and 282 underwent an XL approach. Overall survival (median not reached; p =.29) was not different between the 2 groups. Recurrence was rare and equivalent in the 2 groups, affecting 5.0% of patients in the MIS group and 6.4% of those in the XL group (p = .86). Pelvic lymph nodes were dissected in 98% of patients in the MIS group and 97% of those in the XL group (p > .99) and were found to be positive in 10.9% and 8.5% of those patients, respectively (p =.55). The mean number of pelvic lymph nodes retrieved was higher in the MIS group (19.4 vs 16.0; p < .001). There was no between -group difference in the rate of postoperative chemotherapy (p = .32) or radiation therapy (p = .28). Surgical margins were positive in 5.0% of specimens in the MIS group and in 4.6% of specimens in the XL group (p = .54). Although there was no difference in the overall rate of complications (15.1% and 17.2%, respectively; p = .87), laparotomy was associated with a higher median estimated blood loss (EBL) (50 cm(3) vs 500 cm(3)) and a higher rate of perioperative blood transfusion (3.0% vs 26.2%; p < .001). Length of perioperative hospital stay was significantly shorter in the MIS group (1.9 days vs 4.9 clays; p