Comparison of the short-term and long-term outcomes of laparoscopic surgery and open surgery for early-stage cervical cancer
10.3760/cma.j.issn.0253-3766.2017.06.011
- VernacularTitle: 腹腔镜与开腹手术治疗早期宫颈癌的疗效比较
- Author:
Hongying HE
1
;
Zhijun YANG
;
Dingyuan ZENG
1
;
Desheng YAO
2
;
Jiangtao FAN
3
;
Renfeng ZHAO
4
;
Jieqing ZHANG
2
;
Xiaoxia HU
4
;
Zhong LIN
5
;
Yanming JIANG
6
;
Li LI
2
Author Information
1. Department of Gynecological Oncology, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, 545005, China
2. Department of Gynecologic Oncology, the Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
3. Department of Gynecology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
4. Department of Gynecology, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
5. Department of Gynecology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, China
6. Department of Gynecology, the Liuzhou People′s Hospital, Liuzhou, 545006, China
- Publication Type:Clinical Trail
- Keywords:
Cervical neoplasms;
Laparoscopy;
Laparotomy;
Quality of life;
Prognosis
- From:
Chinese Journal of Oncology
2017;39(6):458-466
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the short-term and long-term outcomes after laparoscopic surgery compared with traditional laparotomy in cases of stage ⅠA2-ⅡA2 cervical cancer.
Methods:We conducted a retrospective study on the clinical data of 1 863 patients diagnosed as FIGO stages ⅠA2-ⅡA2 cervical cancer in 6 third-grade class-A hospitals in Guangxi province between January 2007 and May 2014. One thousand and seventy-one received laparoscopy, and 792 received laparotomy. T-test, U-test and χ2 test were used to compare the short-term and long-term outcomes. The short-term outcomes included surgical related outcomes and operative complications, and the long-term outcomes included quality of life (pelvic floor functions and sexual functions), survival and recurrence. Pelvic floor function and sexual function were assessed with the International Consultation on Incontinence Quesonnaire Female Lower Urinary tract(ICIQ-FLUTS) and the Female Sexual Function Inventory (FSFI), respectively. Survival rates were estimated by Kaplan-Meier analysis. The survival curves were compared with Log-rank test. Cox regression analysis was used to evaluaterisk factors for prognosis.
Results:(1)The short-term outcomes : There were significant difference in operative time([(257±69) vs(238±56)min], estimated blood loss[(358±314) vs(707±431)ml], anus exhausting time[(2.5±0.9) vs (2.9±0.8)d], preserved days of catheter[(15±7) vs(18±9)d], and post-operative length of stay[(19±16) vs (30±21)d] between the laparoscopic surgery group and the opensurgery group(P<0.05). There was no significant difference in lymph nodes yielded[(21±9) vs (21±11)], left parametrial width[(2.5±0.8) vs (2.7±0.7)cm], right parametrial width [(2.6±0.3) vs (2.7±0.2)cm], vaginal cuff length[(2.4±0.7) vs (2.2±0.7)cm] between the laparoscopic surgery group and the opensurgery group(P>0.05). The intra-operative complications occurred in 8.1%(87/1 071)in the laparoscopic surgery group and in 10.7%(85/792)in the open surgery group(P>0.05). However, the complications of vascular injury in the laparoscopic surgery group[2.6%(28/1 071)]was lower than that in the open surgery group[7.7%(61/792), P<0.001]. The laparoscopic surgery exhibited lower post- operative complication rate [33.8%(362/1 071)vs 40.2%(318/792), P<0.05] and poorer wound healing rate [0.7%(7/1 071)vs 4.0%(32/792), P<0.05]. (2)The long-term outcomes(Hierarchical analysis): The overall incontinence in ICIQ-FLUTS questionnaire in nerve-sparing laparoscopic group [28.4%(67/236)] was lower than that in the open surgery group [35.9%(71/198), P=0.004] . However, There was no significant difference in degree of incontinence between the two groups(P>0.05). The overall sexual dysfunction in FSFI questionnaire after 12 months of postoperative in the nerve-sparing laparoscopic group [47.0%(111/236)]was lower than that in the open surgery group [58.6%(116/198), P=0.001], and the six different dimension scores in the laparoscopic surgery group were higher than that in the open surgery group (P<0.05). The recurrence rate was 3.5%(35/1 007)in the laparoscopicsurgery group and 4.7%(35/740)in the open surgery group(P>0.05). The 5-year OS was 94.0% for the laparoscopic surgery group and 90.2% for the open surgery group(P>0.05), and the 5-year DFS was 93.9% for the laparoscopic surgery group and 89.1% for the open surgery group(P>0.05). (3) Prognostic fators: In univariate analysis, tumor dimension, clinical stage, deep stromal invasion, LVSI, and retroperitoneal lymph node metastasis signficantly affected 5-year OS and 5-year DFS(P<0.05); In multivariate analyses, LVSI, deep stromal invasion and LN metastasis were independent prognostic factors(P<0.05).
Conclusions:Laparoscopy can reduceestimated blood loss, accelerate postoperative recovery and improve the quality of life after surgery compared to laparotomy, and it ensures the same oncological results as open surgery. Laparoscopic approach is a safe and effective treatment for early-stage cervical cancer.
