机器人手术广泛用于妇科肿瘤，可以完成早期宫颈癌、内膜癌、卵巢癌、阴道癌等手术，对于复发 的妇科恶性肿瘤的机器人手术治疗报道较少。我们通过相关文献评估机器人手术在妇科恶性肿瘤治疗以及复发手术 治疗中的作用。目前认为病灶复发为中央型、孤立病灶者，机器人手术是可行的，手术方式为局部切除和盆腔廓清术， 需经验丰富的医生进行；手术方法的改进以及医疗器械的研发也是保证手术成功的重要因素。

Robotic surgery has been widely used to treat gynecological cancers, including early-stage cervical cancer, endometrial cancer, ovarian cancer, vaginal cancer etc. However, there are few articles about the application of robotic surgery on treating recurrent gynecological cancer currently. Literatures were reviewed in this paper to evaluate clinical value of robotic surgery in treating recurrent gynecological cancers. Patients with recurrent cancer localized in pelvic and/or isolated regions were included in this study. The results show that robot-assisted surgery is feasible to treat recurrent central pelvic cancer with isolated lesions by skilled surgeons under local resection and pelvic exenteration. Improvement of surgical procedures and development of medical instruments are important factors to ensure the surgery successfully and safely done.

收稿日期：2020-02-26  录用日期：2020-05-15 

Received Date: 2020-02-26  Accepted Date: 2020-05-15 

基金项目：国家重大慢性非传染性疾病防控研究（2016YFC1303100） 

Foundation Item: National Key Research and Development Program of China (2016YFC1303100) 

通讯作者：徐明娟，Email：13636373419@163.com 

Corresponding Author: XU Mingjuan, Email: 13636373419@163.com 

引用格式：孟奇，徐明娟 . 机器人手术系统在妇科恶性肿瘤复发治疗中的临床应用 [J]. 机器人外科学杂志，2020，1（4）：294-299. 

Citation: MENG Q, XU M J. Clinical application of robotic surgery on treating recurrent gynecological cancers[J]. Chinese Journal of Robotic Surgery, 2020, 1 (4):294-299.

[1] National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer (version I.2018) [G]. 2017 (http://oncolife.com.ua/doc/ nccn/Cervical_Cancer.pdf). 

[2] Conrad L B, Ramirez P T, Burke W, et al.Role of minimally invasive surgery in gynecologic oncology: an updated survey of members of the Society of Gynecologic Oncology[J]. Int J Gynecol Cancer, 2015, 25 (6): 1121-1127. 

[3] Frumovitz M, Pareja R, Lopez A, et al.Minimally invasive versus abdominal radical hysterectomy for cervical cancer[J]. N Engl J Med, 2018, 379 (20): 1895-1904. 

[4] Corrado G, Cutillo G, Pomati G, et al.Surgical and oncological outcome of robotic surgery compared to laparoscopic and abdominal surgery in the management of endometrial cancer[J]. Eur J Surg Oncol, 2015, 41 (8): 1074-1081. 

[5] Maenpaa M M, Nieminen K, Tomas E I, et al.Roboticassisted vs traditional laparoscopic surgery for endometrial cancer: a randomized cotrolled trial[J]. Am J Obstet Gynecol, 2016, 215 (5): 581-588. 

[6] Lim P C, Kang E, Parkdo H.A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients [J]. Gynecol Oncol, 2011, 120 (3): 413-418. 

[7] Holloway R W, Ahmad S, DeNardis S A, et al. Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance[J]. Gynecol Oncol, 2009, 115 (3): 447-452. 

[8] Chan J K, Gardner A B, Taylor K, et al.Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients-a comparative analysis of total changes and complication rates[J]. Gynecol Oncol, 2015, 139 (2): 300-305. 

[9] Guy M S, Sheeder J, Behbkht K, et al.Comparative outcomes in older and younger women undergoing laparotomy or robotic surgical staging for endometrial cancer[J]. Am J Obstet Gynecol, 2016, 214 (3): 350-351. 

[10] Chen C H, Chiu L H, Chen H H, et al.Comparison of robotic approach, la paroscopic approach and laparotomy in treating epithelial ovarian cancer[J]. Int J Med Robot, 2016, 12 (2): 268-275. 

[11] Magrina J F, Cetta R L, Chang Y H, et al.Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy [J]. Gynecol Oncol, 2013, 129 (2): 336-340. 

[12] Classe J M, Rauch P, Rodier J F, et al.Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC[J]. Gynecol Oncol, 2006, 102 (3): 523-529. 

[13] Marchetti C, Rosati A, Scaletta G, et al.Secondary cytoreductive surgery in platinum-sensitive recurrent ovarian cancer before olaparib maintenance: Still getting any benefit? A case-control study[J]. Gynecol Oncol, 2019, 155 (3): 400-405. 

[14] Ferrero A, Ditto A, Giorda G, et al.Secondary cytoreductive surgery for isolated lymph node recurrence of epithelial ovarian cancer: a multicenter study[J]. Eur J Surg Oncol, 2014, 40 (7): 891-898. 

[15] Ferrandina G, Legge F, Salutari V, et al.Impact of pattern of recurrence on clinical outcome of ovarian cancer patients: clinical considerations[J]. Eur J Cancer, 2006, 42 (14): 2296-2302. 

[16] Coleman R L, Spirtos N M, Enserro D, et al.Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer[J]. N Engl J Med, 2019, 381 (20): 1929-1939. 

[17] Escobar P F, Levinson K L, Magrina J, et al.Feasibility and perioperative outcomes of robotic-assisted surgery in the management of recurrent ovarian cancer: a multiinstitutional study[J]. Gynecol Oncol, 2014, 134 (2): 253-256. 

[18] Eriksson A G Z, Graul A, Yu M C, et al.Minimal access surgery compared to laparotomy for secondary surgical cytoreduction in patients with recurrent ovarian carcinoma: perioperative and oncologic outcomes[J]. Gynecol Oncol, 2017, 146 (2): 263-267. 

[19] Ramirez P T.Laparoscopic surgery for isolated nodal recurrence: appropriate for all patients or only a select few[J]. J Minim Invasive Gynecol, 2012, 9 (2): 146-147.

[20] Gallotta V, Giudice M T, Conte C, et al.Minimally invasive salvage lymphadenectomy in gynecological cancer patients: A single institution series[J]. Eur J Surg Oncol, 2018, 44 (10): 1568-1572. 

[21] Costantini B, Scambia G, Ferrandina G, et al.Secondary cytoreductive surgery for isolated lymph node recurrence of epithelial ovarian cancer: a multicenter study[J]. Eur J Surg Oncol, 2014, 40 (7): 891-898. 

[22] Pomel C, Rouzier R, Pocard M, et al.Laparoscopic total pelvic exenteration for cervical cancer relapse[J]. Gynecol Oncol, 2003, 91 (3): 534-539. 

[23] Ferron G, Martel P, Querleu D.Laparoscopy-assisted vaginal pelvic exenteration[J]. Gynecol Oncol, 2006, 100 (3): 551-555. 

[24] Lambaudie E, Narducci F, Leblanc E, et al.Robotically assisted laparoscopic anterior pelvic exenteration for recurrent cervical cancer: report of three first cases[J]. Gynecol Oncol, 2010, 116 (3): 582-583. 

[25] Lim P.Robotic assisted total pelvic exenteration: a case report[J]. Gynecol Oncol, 2009, 115 (2): 310-311. 

[26] Jauffret C, Lambaudie E, Bannier M, et al.Robotassisted laparoscopy in the management of recurrent pelvic cancer[J]. Gynecol Obstet Fertil, 2011, 39 (12): 674-680. 

[27] Puntambekar S, Lawande A, Desai R, et al.Initial experience of robotic anterior pelvic exenteration at a single institute[J]. Int J Gynaecol Obstet, 2014, 126 (1): 41-44. 

[28] Blache G, Jauffret C, Mathis J, et al.Can we use robotic surgery for the treatment of pelvic recurrence and locally advanced tumors in gynecological surgery[J]. J Gynecol Obstet Hum Reprod, 2018, 47 (9): 431-435. 

[29] Khadraoui W, Zeybek B, Mutlu L, et al.Robotic type II B posterior exenteration for recurrent vaginal cancer[J]. Gynecologic Oncology, 2019, 155 (2): 384-385. 

[30] Huf S, Platz Batista da Silva N, Wiesinger I, et al. Analysis of liver tumors using preoperative and intraoperative contrast-enhanced ultrasound (CEUS/ IOCEUS) by radiologists in comparison to magnetic resonance imaging and histopathology[J]. Rofo, 2017, 189 (5): 431-440. 

[31] Sun M R, Brennan D D, Kruskal J B, et al. Intraoperative ultrasonography of the pancreas[J]. Radiographics, 2010, 30 (7): 1935-1953. 

[32] Mascilini F, Quagliozzi L, Moro F, et al.Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for treatment of Recurrent Gynecologic Cancer[J]. J Minim Invasive Gynecol, 2018, 25 (5): 848-854.