Efficacy and safety of different surgical approaches for early cervical cancer in patients / 中国基层医药

ABSTRACT

Objective:To investigate the efficacy and safety of laparoscopic versus open surgery for early cervical cancer and analyze the factors that influence laparoscopic surgery for early cervical cancer. Methods:The clinical data of 411 patients with International Federation of Gynecology and Obstetrics (FIGO)stage IA1-IIA2 cervical cancer who received treatment in Liuzhou Worker's Hospital, China between January 1, 2000 and August 31, 2016 were retrospectively analyzed. The clinical data were divided into laparoscopic surgery ( n = 320) and open surgery ( n = 91) groups according to surgical approaches. The operation time, intraoperative injury, intraoperative blood loss, time to first postoperative anal exhaust, postoperative complications, time to extubation, and postoperative recurrence rate were compared between laparoscopic surgery and open surgery groups. Multivariable COX regression analysis was performed to analyze the recurrence of cervical cancer after laparoscopic surgery. Results:The operation time in the laparoscopic surgery group was significantly shorter than that in the open surgery [(223.4 ± 53.2) min vs. (251.0 ± 50.0) min, t = 20.200, P < 0.05]. The intraoperative blood loss, time to extubation and the time to first postoperative anal exhaust in the laparoscopic surgery group were less or shorter than those in the open surgery group (all P < 0.05). Under the premise that there were no significant differences in vascular and lymphatic space invasion, tumor size, parametrial invasion, depth of muscle invasion, lymph node metastasis, and vaginal margin between the laparoscopic surgery and open surgery groups, the 1-year and 3-year recurrence rate of cervical cancer was 9.4% (30/320) and 15.9% (51/320), respectively and the 1-year and 3-year tumor-free survival rate was 90.6% and 84.1%, respectively in the laparoscopic surgery group; the 1-year and 3-year recurrence rate of cervical cancer was 4.4% (4/91) and 9.9% (9/91), respectively and the 1-year and 3-year tumor-free survival rate was 95.6% and 89.6%, respectively in the open surgery group. There were no significant differences in 1-year and 3-year recurrence rate of cervical cancer and 1-year and 3-year tumor-free survival rate between laparoscopic surgery and open surgery groups (all P > 0.05). During the 5-year follow-up, there were no significant differences in the recurrence rate of cervical cancer (18.7% vs. 12.2%) and the tumor-free survival rate (81.9% vs. 86.8%) between the laparoscopic surgery and open surgery groups (both P > 0.05). Univariate and multivariate analysis showed that positive lymph node metastasis, tumor size ≥ 2 cm, FIGO stage > IB1 and non-squamous cell carcinoma pathological type are the risk factors for the recurrence of cervical cancer. Conclusion:Laparoscopic surgery for early cervical cancer can reduce the intraoperative and postoperative complications. Positive lymph node metastasis, tumor size ≥ 2 cm, FIGO stage > IB1, and non-squamous cell carcinoma pathological type are the risk factors of recurrence of cervical cancer after laparoscopic surgery.