Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes
Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes
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DOI：
10.1016/j.ygyno.2019.12.038
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发表时间：
2020-03-01
影响因子：
4.7
通讯作者：
Leitao, Mario M., Jr.
中科院分区：
文献类型：
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作者：
Brandt, Benny;Sioulas, Vasileios;Leitao, Mario M., Jr.
目标。目的比较新诊断的早期宫颈癌患者接受微创手术和开腹手术后的肿瘤学和围手术期预后。我们回顾了2007年1月1日至2017年12月期间在我们机构接受了IA1期淋巴血管侵犯(LV1)、IA2或IB1宫颈癌的根治性子宫切除术的患者。使用适当的统计检验比较临床病理特征与手术和肿瘤生存结果。多变量COX回归分析用于控制潜在的混杂因素。我们确定了196个可评估的病例-117个管理信息系统(106个机器人[90.6%])和79个开腹病例。队列中有相似的年龄、BMI、亚期、组织亚型、临床和病理肿瘤大小、阳性切缘和LVI的存在。在子宫切除术中未发现肿瘤残留的病例数明显多于单纯子宫切除组(24.8%比10.1%，P=0.01)。腹腔镜组淋巴结阳性例数较多(29.1%比17.1%，P=0.046)，接受辅助治疗的患者较多(532%比33.3%，P=0.006)。中位随访期为4年。5年无瘤生存率(DFS)分别为87.0%和86.6%(P=0.92)，5年疾病特异性生存率(DSS)分别为96.5%和93.9%(P=0.93)，总生存率(OS)分别为96.5%和87.4%(P=0.15)。多变量回归分析显示，MIS与DFS、DSS或OS无关。MI组术后并发症发生率明显低于对照组(11.1%vs.20.3%；P=0.04)。在我们的单中心和并发的早期宫颈癌患者中，MI根治性子宫切除术并不会导致更差的肿瘤学结果。(C)2020 Elsevier Inc.保留所有权利。
Objective. To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma.Methods. We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LV1), IA2, or IB1 cervical carcinoma at our institution from 1/2007-12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders.Results. We identified 196 evaluable cases-117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor size, positive margins, and presence of LVI. The MIS group had more cases with no residual tumor in the hysterectomy (24.8% vs. 10.1%, P = 0.01). The laparotomy group had more cases with positive nodes (29.1% vs. 17.1%, P = 0.046) and more patients who received adjuvant therapy (532% vs. 33.3%, P = 0.006). Median follow-up was -4 years. Five-year disease-free survival (DFS) rates were 87.0% in the MIS group and 86.6% in the laparotomy group (P = 0.92); 5-year disease-specific survival (DSS) rates were 96.5% and 93.9%, respectively (P = 0.93); and 5-year overall survival (OS) rates were 96.5% and 87.4%, respectively (P = 0.15). MIS was not associated with DFS, DSS, or OS on multivariable regression analysis. The rate of postoperative complications was significantly lower in the MIS cohort (11.1% vs. 20.3%; P = 0.04).Conclusions. MIS radical hysterectomy for cervical carcinoma did not confer worse oncologic outcomes in our single-center and concurrent series of patients with early-stage cervical carcinoma. (C) 2020 Elsevier Inc. All rights reserved.