目的：探讨达芬奇机器人手术系统应用于宫颈癌患者手术治疗后对其肿瘤结局的影响。方法：选取 2013 年 3 月—2018 年 3 月在空军军医大学西京医院妇产科行达芬奇机器人辅助腹腔镜下宫颈癌根治术的 1142 例患者 临床资料。回顾性分析临床病理资料、术后辅助治疗、复发率，并用 Kaplan-Meier 计算患者的无病生存期（Disease-free Survival，DFS）及总生存期（Overall Survival，OS）。结果：本研究共纳入 1142 例患者，早期患者（ⅠA2~ⅠB1 期）691 例， 晚期患者（ⅠB2~ⅡB 期）451 例，中位随访时间 70.9 个月，失访 72 例（6.30%），随访率为 93.70%。早期患者中，复发 78 例（11.29%），死亡 59 例（8.54%），3 年 OS 96.7％，DFS 93.2％；5 年 OS 95.3％，DFS 91.9％。晚期患者 中，复发 135 例（29.93%），死亡 120 例（26.61%），3 年 OS 85.1％，DFS 79.2％；5 年 OS 82.3％，DFS 77.2％。 结论：本次单中心、回顾性研究结果表明，达芬奇机器人手术系统可有选择性地应用于早期宫颈癌患者，但需要改 善手术相关措施，进一步评估其对肿瘤结局的影响。

Objective: To investigate the clinical efficacy of Da Vinci robotic surgical system in treating patients with cervical cancer. Methods: The clinical data of patients who underwent Da Vinci robot-assisted radical hysterectomy in Xijing Hospital of Air Force Military Medical University from March 2013 to March 2018 were selected. The pathological data, postoperative adjuvant therapy and recurrence rate were analyzed retrospectively. The disease-free survival (DFS) and overall survival (OS) of patients were calculated by Kaplan-Meier. Results: A total of 1142 patients were selected into this study, including 691 patients in early stage (ⅠA2-ⅠB1) and 451 patients in advanced stage (ⅠB2-ⅡB). The median follow-up time was 70.9 months, and 72 patients (6.30%) were lost to follow-up, with a follow-up rate of 93.70%. In early stage of cervical cancer, 78 cases (11.29%) relapsed, 59 cases (8.54%) died with the 3-year OS of 96.7%, 3-year DFS of 93.2%, 5-year OS of 95.3%, and 5-year DFS of 91.9%. Among the patients with advanced cervical cancer, 135 cases (29.93%) relapsed, 120 cases (26.61%) died, with the 3-year OS of 85.1%, 3-year DFS of 79.2%, 5-year OS of 82.3%, and 5-year DFS of 77.2%. Conclusion: This single-center, retrospective observational study found that the Da Vinci robotic surgical system could be selectively applied to early cervical cancer. However, its effect on the outcome of cervical cancer should be further evaluated by improving surgical measures.

收稿日期：2022-04-21  录用日期：2022-10-16 

Received Date: 2022-04-21  Accepted Date: 2022-10-16 

基金项目：国家自然科学基金（82002740） 

Foundation Item: National Natural Science Foundation of China(82002740) 

通讯作者：陈必良，Email：cblxjh@fmmu.edu.cn 

Corresponding Author: CHEN Biliang, Email: cblxjh@fmmu.edu.cn 

引用格式：吕小慧，翟梁好，董健，等 . 达芬奇机器人手术系统应用于 1142 例宫颈癌患者的肿瘤结局分析 [J]. 机器人外科学杂志（中英文），2023，4（5）：389-396. 

Citation: LYU X H, ZHAI L H, DONG J, et al. Oncology outcomes of Da Vinci robot-assisted radical hysterectomy for 1142 cases of cervical cancer [J]. Chinese Journal of Robotic Surgery, 2023, 4(5): 389-396.

[1] Sedlis A, Bundy B N, Rotman M Z, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage Ⅰ Bcarcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study[J]. Gynecol Oncol, 1999, 73(2): 177-183. 

[2] Uppal S, Liu J R, Reynolds R K, et al. Trends and comparative effectiveness of inpatient radical hysterectomy for cervical cancer in the United States (2012-2015) [J]. Gynecol Oncol, 2019, 152(1): 133-138. [3] Melamed A, Margul D J, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer[J]. N Engl J Med, 2018, 379 (20): 1905- 1914. 

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

[5] Clark J G. A more radical method of performing hysterectomy for cancer of the uterus[J]. Bull Johns Hopkins Hosp, 1895, 6: 120-124. 

[6] Ries E. The operative treatment of cancer of the cervix uteri [J]. JAMA, 1906, XLVII(23): 1869-1872. 

[7] Nezhat C R, Burrell M O, Nezhat F R, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection[J]. Am J Obstet Gynecol, 1992, 166(3): 864-865. 

[8] Sert M B, Abeler V. Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy: one surgeon’s experience at the Norwegian Radium Hospital[J]. Gynecol Oncol, 2011, 121(3): 600-604. 

[9] 吕艳红 , 马向东 , 刘淑娟 , 等 . 机器人早期宫颈癌 单中心经验与思考 [J]. 中华腔镜外科杂志 ( 电子版 ), 2019, 12(4) : 231-235. 

[10] 吕小慧 , 陈必良 . 达芬奇机器人手术系统在妇科手 术中的应用 [J]. 机器人外科学杂志 ( 中英文 ), 2020, 1(1) : 57-60. 

[11] Cibula D, Pötter R, Planchamp F, et al. The European society of gynaecological oncology/European society for radiotherapy and oncology/European society of pathology guidelines for the management of patients with cervical cancer[J]. Int J Gynecol Cancer, 2018, 28(4): 641-655. 

[12] Benson A B, Venook A P, Al-Hawary M M, et al. Rectal Cancer, version 2. 2018, NCCN Clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2018, 16(7): 874-901. 

[13] Cantrell L A, Mendivil A, Gehrig P A, et al. Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience[J]. Gynecol Oncol, 2010, 117(2): 260-265. 

[14] Alfonzo E, Wallin E, Ekdahl L, et al. No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study[J]. Eur J Cancer, 2019. DOI: 10.1016/ j.ejca.2019.05.016. 

[15] Nitecki R, Ramirez P T, Frumovitz M, et al. Survival after minimally invasive vs open radical hysterectomy for early-Stage cervical cancer: a systematic review and Meta-analysis[J]. JAMA Oncol, 2020, 6(7): 1019-1027. 

[16] CHEN B L, JI M, LI P F, et al. Comparison between robot-assisted radical hysterectomy and abdominal radical hysterectomy for cervical cancer: a multicentre retrospective study[J]. Gynecol Oncol, 2020, 157(2): 429-436. 

[17] 陈春林 , 郎景和 . 中国专家“关于宫颈癌腹腔镜手 术相关问题”的几点意见 [J]. 中国实用妇科与产科 杂志 , 2019, 35(2): 188-193. 

[18] 陈春林 , 郎景和 , 向阳 , 等 . 子宫颈癌腹腔镜手术 治疗的中国专家共识 [J]. 中华妇产科杂志 , 2020, 55(9): 579-585. 

[19] Gennigens C, Cuypere M D, Hermesse J, et al. Optimal treatment in locally advanced cervical cancer[J]. Expert Review of Anticancer Therapy, 2021, 21(6): 657-671. 

[20] 刘佳琪 , 李朋飞 , 纪妹 , 等 . 基于中国子宫颈癌临 床诊疗大数据的子宫颈癌诊疗规范化调查分析 [J]. 中国实用妇科与产科杂志 , 2021, 37(1): 82-86. 

[21] 罗恒 , 陈必良 , 张若涵 , 等 . 免缝式宫颈闭合器的 设计及其在宫颈癌手术中的应用 [J]. 局解手术学杂 志 , 2021, 30(11): 943-946. 

[22] 郭琳 , 赵宏喜 , 李艳红 , 等 . 宫底悬吊免举宫技术辅 助应用于早期宫颈癌达芬奇机器人系统手术效果 [J]. 中国计划生育学杂志 , 2021, 29(12): 2696-2699.