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. 2023 Nov 28;48(11):1686-1695.
doi: 10.11817/j.issn.1672-7347.2023.230334.

Comparative study of tumor - free laparoscopic and open surgery in the treatment of early - stage cervical cancer

[Article in English, Chinese]
Jing Zhao  1 , Qiao Liu  2 , Dan Jiang  2 , Tianmin Chen  2 , Shengjun Meng  2 , Chuqiang Shu  3
Affiliations

Comparative study of tumor - free laparoscopic and open surgery in the treatment of early - stage cervical cancer

[Article in English, Chinese]
Jing Zhao et al. Zhong Nan Da Xue Xue Bao Yi Xue Ban. .

Abstract
in English, Chinese, Chinese

Objectives: Laparoscopic surgery for cervical cancer has the advantages of little blood loss and rapid recovery, but its therapeutic effect is still controversial. This study aims to analyze the surgical procedure and clinical efficacy of tumor-free laparoscopic radical hysterectomy without a uterine manipulator for early-stage cervical cancer, and to explore the indications of laparoscopic surgery for cervical cancer.

Methods: This study was a retrospective study. The data of patients who underwent radical hysterectomy for early-stage cervical cancer admitted to Hunan Provincial Maternal and Child Health Care Hospital from July 2019 to December 2021 were collected. According to 2018 the International Federation of Gynecology and Obstetrics (FIGO) clinical staging, all patients were in IA1 with lymphovascular invasion, IA2, and IB1 stage. Among them, 45 patients underwent tumor-free laparoscopic radical hysterectomy without a uterine manipulator (laparoscopy group) and 16 patients underwent open surgery (open surgery group). Patients were followed up for 12-41 months. The differences between the 2 groups in terms of operative time, bleeding volume, extent of surgical resection, surgical complications, and prognosis were compared and analyzed.

Results: Compared to the open surgery group, the laparoscopy group had significantly shorter operation time and less intraoperative blood loss (both P<0.001). There were no significant differences between the 2 groups in terms of the length of excised uterosacral ligaments, cardinal ligaments, vagina, and the number of excised lymph nodes (all P>0.05). The incidence of postoperative complications did not differ significantly between the groups (P>0.05). No death or recurrence occurred in the 2 groups during the follow-up period. The overall survival rate and disease-free survival rate were both 100%.

Conclusions: For early-stage cervical cancer with a diameter ≤2 cm, tumor-free laparoscopic radical hysterectomy without a uterine manipulator is safe and feasible, and the short-term outcomes is no less than that of open surgery.

目的: 腹腔镜手术治疗宫颈癌具有出血少、恢复快等优点，但对其治疗效果目前仍有争议。本研究旨在分析早期宫颈癌腹腔镜手术的无瘤化无举宫手术操作方式及临床效果，探讨腹腔镜宫颈癌手术的适应证。方法: 本研究为回顾性研究。收集2019年7月至2021年12月湖南省妇幼保健院收治的早期宫颈癌行广泛性子宫切除术患者的资料。按2018年国际妇产科学联合会(International Federation of Gynecology and Obstetrics，FIGO)临床分期，患者均为IA1期伴脉管阳性、IA2期、IB1期，随访12~41个月。其中行无瘤化无举宫腹腔镜广泛性子宫切除术(腹腔镜手术组)患者45例，行开腹广泛性子宫切除术(开腹手术组)患者16例。比较分析2组患者在手术时间、出血量、手术切除范围、手术并发症、预后等方面的差异。结果: 与开腹手术组相比，腹腔镜手术组的手术时间明显更短，术中出血量更少(均P<0.001)。2组在切子宫骶韧带、主韧带、阴道切除长度，淋巴结切除数量，并发症发生率方面的差异均无统计学意义(均P>0.05)。随访期间2组患者无复发和死亡，总生存率和无瘤生存率均为100%。结论: 对于直径≤2 cm的早期宫颈癌，无瘤化无举宫腹腔镜广泛性子宫切除术安全可行，短期疗效与开腹手术接近。.

目的: 腹腔镜手术治疗宫颈癌具有出血少、恢复快等优点，但对其治疗效果目前仍有争议。本研究旨在分析早期宫颈癌腹腔镜手术的无瘤化无举宫手术操作方式及临床效果，探讨腹腔镜宫颈癌手术的适应证。

方法: 本研究为回顾性研究。收集2019年7月至2021年12月湖南省妇幼保健院收治的早期宫颈癌行广泛性子宫切除术患者的资料。按2018年国际妇产科学联合会(International Federation of Gynecology and Obstetrics，FIGO)临床分期，患者均为IA1期伴脉管阳性、IA2期、IB1期，随访12~41个月。其中行无瘤化无举宫腹腔镜广泛性子宫切除术(腹腔镜手术组)患者45例，行开腹广泛性子宫切除术(开腹手术组)患者16例。比较分析2组患者在手术时间、出血量、手术切除范围、手术并发症、预后等方面的差异。

结果: 与开腹手术组相比，腹腔镜手术组的手术时间明显更短，术中出血量更少(均P<0.001)。2组在切子宫骶韧带、主韧带、阴道切除长度，淋巴结切除数量，并发症发生率方面的差异均无统计学意义(均P>0.05)。随访期间2组患者无复发和死亡，总生存率和无瘤生存率均为100%。

结论: 对于直径≤2 cm的早期宫颈癌，无瘤化无举宫腹腔镜广泛性子宫切除术安全可行，短期疗效与开腹手术接近。

Keywords: cervical cancer; laparoscopy; radical hysterectomy; tumor-free; without a uterine manipulator.

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Conflict of interest statement

The authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Whole piece resection of lymph nodes and immediate isolation within a specimen bag
Figure 2
Figure 2. Suspension of the uterus with a figure-of-eight suture at the uterine cervix
Figure 3
Figure 3. Ligation and closure of the upper part of the vagina
Figure 4
Figure 4. Vaginal transection under laparoscopy
Figure 5
Figure 5. Repeated irrigation of the pelvic and abdominal cavities with distilled water at 43 ℃
See this image and copyright information in PMC

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