中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

机器人辅助腹腔镜手术与开腹手术治疗早期宫颈癌术后生存影响因素的对比分析

Comparative analysis on the influencing factors of postoperative survival between robot-assisted laparoscopic surgery and laparotomy in the treatment of early cervical cancer

作者:周潇妮,张琦玲,蔡丽萍,涂春华,张智,唐旭秀,肖子文,赵娜

Vol. 4 No. 5 Oct. 2023 DOI: 10.12180/j.issn.2096-7721.2023.05.006 发布日期:2023-10-19
关键词:早期宫颈癌;机器人辅助手术;开腹手术;总生存期;无病生存期

作者简介:

目的:分析早期宫颈癌患者行机器人辅助腹腔镜手术与开腹手术对其术后生存质量的影响及其相关 因素,并进行对比。方法:回顾性分析 2016 年 1 月—2021 年 6 月于南昌大学第一附属医院妇科接受治疗的 904 例 早期宫颈癌患者的临床资料。其中研究组为机器人手术组,共 413 例,患者全部行机器人辅助子宫切除术及盆腔淋 巴结清扫术,并对部分患者行腹主动脉旁淋巴结取样;对照组为开腹手术组,共 491 例,行开腹子宫切除术及盆腔 淋巴结清扫术,并对部分患者行腹主动脉旁淋巴结取样。结果:研究组与对照组的一般临床特征相比,差异无统计 学意义(P>0.05),但两组术后多项手术质量评价指标(如并发症等)比较,差异有统计学意义(P<0.05)。两组 在病理预后因素以及总生存期、无病生存期的对比中并无明显统计学差异(P>0.05)。结论:与开腹手术相比,机 器人辅助手术治疗早期宫颈癌患者的手术质量评价较好,但在患者病理预后因素及术后生存期上无明显改善。

Objective: To compare and analyze the quality of life of patients underwent robot-assisted laparoscopic surgery and laparotomy for early cervical cancer and and its related factors. Methods: A retrospective study was performed on 904 patients with early cervical cancer who were treated in the Department of Gynecology, the First Affiliated Hospital of Nanchang University from January 2016 to June 2021. The study group (robotic surgery group) had a total of 413 cases, all patients underwent robot-assisted hysterectomy and pelvic lymph node dissection, and some patients underwent abdominal aortic lymph node sampling. The control group (laparotomy group) had a total of 491 cases, laparotomy for hysterectomy and pelvic lymph node dissection was performed, and para-aortic lymph node sampling was performed in some patients. Results: There was no significant difference in general clinical characteristics between the study group and the control group (P>0.05), but several postoperative surgical quality evaluation indicators (such as complications) in the study group were significantly different from those in the control group (P<0.05). In addition, there was no significant difference in the comparison of pathological prognostic factors, overall survival and disease-free survival between the two groups (P>0.05). Conclusion: For patients with early cervical cancer, compared with the laparotomy, robotic surgery has better surgical quality evaluation, but there is no significant improvement in terms of pathological prognostic factors and postoperative survival.

稿件信息

收稿日期:2022-04-29  录用日期:2022-11-30 

Received Date: 2022-04-29  Accepted Date: 2022-11-30 

基金项目:江西省自然科学基金(20192ACBL20038);江西省科技计划重大项目(20152ACG70022);江西省卫生计生委中医 药科研计划(2020Z001) 

Foundation Item: Natural Science Foundation of Jiangxi Province(20192ACBL20038); Major Science and Technology Project of Jiangxi Province(20152ACG70022); Chinese Medicine Research Plan of Health and Family Planning Commission of Jiangxi Province(2020Z001) 

通讯作者:蔡丽萍,Email:cailiping2550@163.com 

Corresponding Author: CAI Liping, Email: cailiping2550@163.com 

引用格式:周潇妮,张琦玲,蔡丽萍,等 . 机器人辅助腹腔镜手术与开腹手术治疗早期宫颈癌术后生存影响因素的对比分析 [J].机器人外科学杂志(中英文),2023,4(5):431-440. 

Citation: ZHOU X N, ZHANG Q L, CAI L P, et al. Comparative analysis on the influencing factors of postoperative survival between robot-assisted laparoscopic surgery and laparotomy in the treatment of early cervical cancer [J]. Chinese Journal of Robotic Surgery, 2023, 4(5): 431-440.

参考文献

[1] Pimple S A, Mishra G A. Global strategies for cervical cancer prevention and screening [J]. Minerva Ginecol, 2019, 71(4): 313-320. 

[2] Buskwofie A, David-West G, Clare C A. A review of cervical cancer: incidence and disparities [J]. J Natl Med Assoc, 2020, 112(2): 229-232. 

[3] Hill E K. Updates in cervical cancer treatment [J]. Clin Obstet Gynecol, 2020, 63(1): 3-11. 

[4] Gadducci A, Cosio S. Neoadjuvant chemotherapy in locally advanced cervical cancer: review of the literature and perspectives of clinical research [J]. Anticancer Res, 2020, 40(9): 4819-4828. 

[5] 温晓春 , 蔡丽萍 , 涂春华 , 等 . 达芬奇机器人手术 系统在妇科肿瘤手术中的应用 [J]. 南昌大学学报 ( 医学版 ) , 2016, 56(6): 60-62. 

[6] CAO L, XU H, CHEN Y, et al. A detailed analysis of the learning curve: da vinci robot-assisted radical hysterectomy in cervical cancer [J]. J Minim Invasive Gynecol, 2015, 22(6S): S228-S229. 

[7] 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. 

[8] 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. 

[9] Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix[J]. Int J Gynaecol Obstet, 2009, 105(2): 107-108. 

[10] Bhatla N, Aoki D, Sharma D N, et al. Cancer of the cervix uteri [J]. Int J Gynaecol Obstet, 2018, 143(Suppl 2): 22-36. 

[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] Koh W J, Abu-Rustum N R, Bean S, et al. Cervical Cancer, Version 3.2019, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(1): 64-84. 

[13] Park D A, Yun J E, Kim S W, et al. Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2017, 43(6): 994- 1002. 

[14] Diver E, Hinchcliff E, Gockley A, et al. Minimally invasive radical hysterectomy for cervical cancer is associated with reduced morbidity and similar survival outcomes compared with laparotomy[J]. J Minim Invasive Gynecol, 2017, 24(3): 402-406. 

[15] Corrado G, Vizza E, Legge F, et al. Comparison of different surgical approaches for stage IB1 cervical cancer patients: a multi-institution study and a review of the literature [J]. Int J Gynecol Cancer, 2018, 28(5): 1020-1028. 

[16] 陈春林 , 黎志强 , 孙立新 , 等 . IA1(LVSI+)~IB2 期子 宫颈癌腹腔镜与开腹手术长期肿瘤学结局真实世 界研究 [J]. 中国实用妇科与产科杂志 , 2020, 36(6): 536-543. 

[17] 刘开江 , 赵绚璇 . 腹腔镜恶性肿瘤手术中无瘤技 术的应用 [J]. 中华腔镜外科杂志 ( 电子版 ), 2018, 11(1): 17-19. 

[18] 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. 

[19] Greggi S, Casella G, Scala F, et al. Surgical management of early cervical cancer: when is laparoscopic appropriate? [J]. Curr Oncol Rep, 2020, 22(1): 7. 

[20] Querleu D, Cibula D, Concin N, et al. Laparoscopic radical hysterectomy: a european society of gynaecological oncology (ESGO) statement [J]. Int J Gynecol Cancer, 2020, 30(1): 15. 

[21] FIGO Gynecologic Oncology Committee. FIGO statement on minimally invasive surgery in cervical cancer [J]. Int J Gynaecol Obstet, 2020, 149(3): 264. 

[22] Rakowski J A, Tran T A, Ahmad S, et al. Does a uterine manipulator affect cervical cancer pathology or identification of lymphovascular space involvement? [J]. Gynecol Oncol, 2012, 127(1): 98-101. 

[23] Uccella S, Bonzini M, Malzoni M, et al. The effect of a uterine manipulator on the recurrence and mortality of endometrial cancer: a multi-centric study by the Italian society of gynecological endoscopy [J]. Am J Obstet Gynecol, 2017, 216(6): 592.e1-592.e11. 

[24] Tinelli R, Cicinelli E, Tinelli A, et al. Laparoscopic treatment of early-stage endometrial cancer with and without uterine manipulator: our experience and review of literature [J]. Surg Oncol, 2016, 25(2): 98-103. 

[25] 付振华 , 张智 , 蔡丽萍 , 等 . 早期子宫颈癌行机器 人手术系统免举宫器联合经阴道封闭肿瘤广泛性 子宫切除术 20 例分析 [J]. 中国实用妇科与产科杂 志 , 2020, 36(9): 863-865. 

[26] Chiva L, Zanagnolo V, Querleu D, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer [J]. Int J Gynecol Cancer, 2020, 30(9): 1269-1277. 

[27] Kohler C, Hertel H, Herrmann J, et al. Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff-a multicenter analysis [J]. Int J Gynecol Cancer, 2019, 29(5): 845-850. 

[28] Kanao H, Matsuo K, Aoki Y, et al. Feasibility and outcome of total laparoscopic radical hysterectomy with no-look no-touch technique for FIGO IB1 cervical cancer [J]. J Gynecol Oncol, 2019, 30: e71. [29] Kong T W, Chang S J, Piao X, et al. Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer [J]. J Obstet Gynaecol Res, 2016, 42(1): 77-86. 

[30] Volz J, Köster S, Spacek Z, et al. The influence of pneumoperitoneum used in laparoscopic surgery on an intraabdominal tumor growth [J]. Cancer, 1999, 86(5): 770-774. 

[31] Lin F, Pan L H, Li L, et al. Effects of a simulated CO2 pneumoperitoneum environment on the proliferation, apoptosis, and metastasis of cervical cancer cells in vitro [J]. Med Sci Monit, 2014. DOI: 10.12659/msm.891179. 

[32] 向阳 , 蒋芳 . 宫颈癌腹腔镜手术的争议及策略 [J]. 中 国实用妇科与产科杂志 , 2019, 35(10): 1112-1116. 

[33] 齐金红 , 袁勇 , 冯文娟 , 等 . 达芬奇机器人在妇科 手术应用中的安全性评价 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(2): 111-122. 

[34] 郎驿天 , 吴斌 , 王育 . 达芬奇机器人用于妇科手术 的技术评价 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(2): 100-110.

印象笔记
有道云笔记
微博
QQ空间
微信
二维码
意见反馈