目的:比较加速康复外科路径下达芬奇机器人手术系统与开腹手术治疗早期宫颈癌的术后并发症和复 发率。方法:纳入 2021 年 12 月—2023 年 1 月于中国医科大学附属盛京医院第一妇科病房行宫颈癌根治术的 81 例患者, 其中 38 例行机器人辅助手术(机器人组),43 例行开腹手术(开腹组)。回顾性分析患者临床资料、术后并发症发 生率及复发率。结果:机器人组手术用时长于开腹组,术中出血量、术后排气时间、疼痛评分、术后住院时间低于开 腹组,切除淋巴结个数多于开腹组,术后远期并发症发生率低于开腹组(P<0.05)。而在术中并发症发生率、术后短 期严重并发症发生率、术后复发率方面,两组差异无统计学意义(P>0.05)。结论:本次单中心、回顾性研究结果表明, 机器人辅助手术治疗早期宫颈癌与开腹手术具有相同的肿瘤结局,同时在术后并发症和术后生活质量方面表现出优势。
Objective: To compare the postoperative complications and recurrence rates between Da Vinci robotassisted surgery and open surgery for early-stage cervical cancer under the concept of enhanced recovery after surgery (ERAS). Methods: 81 patients who underwent radical hysterectomy for cervical cancer in Shengjing Hospital of China Medical University from December 2021 to January 2023 were included, of which 38 cases of robot-assisted surgery were divided into the robotic group and 43 cases of open surgery were divided into the open group. Clinical data, incidence rate of postoperative complications and recurrence rate of patients in the two groups were retrospectively analyzed. Results: The operative time in the robotic group was longer than that in the open group, while the amount of intraoperative bleeding, the time of postoperative exhaust time, the pain score, and the length of hospital stay after surgery were lower than those in the open group. More lymph nodes were dissected in the robotic group than that in the open group, and the incidence rate of long-term complications after surgery was lower than that in the open group (P<0.05). The differences in the incidence rate of intraoperative complications, short-term serious complications, and postoperative recurrence rate between the two groups was not statistically significant (P>0.05). Conclusion: The results of this single-center, retrospective study suggest that robot-assisted surgery for early-stage cervical cancer has the same oncologic outcomes as open surgery. However, it has certain advantages in reducing postoperative complications and improving patients’ quality of life after surgery over open surgery.
收稿日期:2023-12-27 录用日期:2024-02-21
Received Date: 2023-12-27 Accepted Date: 2024-02-21
基金项目:辽宁省科技计划联合计划项目(2023021057-JH2/1017)
Foundation Item: Science and Technology Plan Joint Project of Liaoning Province (2023021057-JH2/1017)
通讯作者:倪莎,Email:carolnisha@sina.com
Corresponding Author: NI Sha, Email: carolnisha@sina.com
引用格式:范爱宁,欧阳玲,倪莎 . 加速康复外科路径下机器人辅助手术与开腹手术治疗早期宫颈癌的术后并发症及复发率(附 手术视频)[J]. 机器人外科学杂志(中英文),2024,5(6):1088-1093.
Citation: FAN A N, OUYANG L, NI S. Postoperative complications and recurrence rate of robot-assisted surgery versus open surgery for early-stage cervical cancer under the concept of enhanced recovery after surgery (with surgical video)[J]. Chinese Journal of Robotic Surgery, 2024, 5(6): 1088-1093.
[1] Meigs J V. Radical hysterectomy with bilateral pelvic lymph node dissections; a report of 100 patients operated on five or more years ago[J]. Am J Obstet Gynecol, 1951, 62(4): 854-870.
[2] Ramirez P T, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy forcervical cancer[J]. N Engl J Med, 2018, 379(20): 1895-1904.
[3] 张知格 , 谈善军 , 吴国豪 . 欧洲临床营养与代谢协会肿瘤病人 营养治疗实践指南解读 [J]. 中华消化外科杂志 , 2021, 20(12): 1259-1271.
[4] Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer[J]. Clin Nutr, 2021, 40(5): 2898-2913.
[5] Taylor J S, Iniesta M D, Zorrilla-Vaca A, et al. Rate of venous thromboembolism on an enhanced recovery program after gynecologic surgery[J]. Am J Obstet Gynecol, 2023, 229(2): 140.e1-140.e7.
[6] DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)[J]. BMJ, 2017, 357: j1455. DOI: 10.1136/bmj.j1455.
[7] 李博 , 倪莎 , 吴晓蕾 , 等 . 加速康复外科理念在妇科围手术期的 应用与价值 [J]. 中国妇产科临床杂志 , 2018, 19(6): 554-556.
[8] 彭瑾 , 孔北华 , 宋坤 . 妇科加速康复外科的肠道准备及围术期 营养支持 [J]. 实用妇产科杂志 , 2021, 37(2): 83-85.
[9] Dindo D, Demartines N, Clavien P A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213.
[10] 中国医师协会微无创医学专业委员会妇科肿瘤学组 , 山东省抗 癌协会妇科肿瘤分会 . 复发性子宫颈癌综合诊治中国专家共识 (2022 年版 )[J]. 中华肿瘤防治杂志 , 2022, 29(24): 1715-1740.
[11] Cusimano M C, Baxter N N, Gien L T, et al. Impact of surgical approach on survival outcomes in women undergoing radical hysterectomy for cervical cancer[J]. Am J Obstet Gynecol, 2019, 221(6): 619.e1-619.e24.
[12] 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.
[13] 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.
[14] Mendivil A A, Rettenmaier M A, Abaid L N, et al. Survival rate comparisons amongst cervical cancer patients treated with an open, robotic-assisted or laparoscopic radical hysterectomy: a five year experience[J]. Surg Oncol, 2016, 25(1): 66-71.
[15] 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, 116(12): 169-177.
[16] Jensen P T, Schnack T H, Frøding L P, et al. Survival after a nationwide adoption of robotic minimally invasive surgery for earlystage cervical cancer- a population-based study[J]. Eur J Cancer, 2020, 128: 47-56. DOI: 10.1016/j.ejca.2019.12.020.
[17] Fernandez-Gonzalez S, Ponce J, Martínez-Maestre MÁ, et al. The impact of surgical practice on oncological outcomes in robot-assisted radical hysterectomy for early-stage cervical cancer, Spanish National Registry[J]. Cancers (Basel), 2022, 14(3): 698.
[18] 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.
[19] Alkatout I, Mettler L, Maass N, et al. Robotic surgery in gynecology[J]. J Turk Ger Gynecol Assoc, 2016, 17(4): 224-232.
[20] Estape R, Lambrou N, Diaz R, et al. A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy[J]. Gynecol Oncol, 2009, 113(3): 357-361.
[21] Maggioni A, Minig L, Zanagnolo V, et al. Robotic approach for cervical cancer: comparison with laparotomy: a case control study[J]. Gynecol Oncol, 2009, 115(1): 60-64.
[22] Ljungqvist O, Scott M, Fearon K C. Enhanced recovery after surgery: a review[J]. JAMA surgery, 2017, 152(3): 292-298.
[23] 中华医学会外科学分会 , 中华医学会麻醉学分会 . 加速康复外 科中国专家共识及路径管理指南 (2018 版 )[J]. 中国实用外科杂 志 , 2018, 38(1): 1-20.
[24] Zikan M, Fischerova D, Pinkavova I, et al. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer[J]. Gynecol Oncol, 2015, 137(2): 291-298.
[25] GUO N, LIU H. Robot-assisted single-port surgery in inguinal lymphnode dissection for vulvar cancer[J]. Asian J Surg, 2022, 45(11): 2469-2470.
[26] Tandogdu Z, Vale L, Fraser C, et al. A systematic review of economic evaluations of the use of robotic assisted laparoscopy in surgery compared with open or laparoscopic surgery[J]. Appl Health Econ Health Policy, 2015, 13(5): 457-467.