| Objective:To compare and analyze the perioperative complications and long-term suvival outcome and the factors associated prognosis of laparoscopic radical hysterectomy(LRH)and open radical hysterectomy(ORH)in the treatment of early-stage cervical cancer.Methods:Four hundred and fifty-one patients with newly dignosed stageⅠA2 toⅡA cervical cancer who underwent LRH or ORH treatment from January 2011 to December 2018 in Fujian Provincial Maternity and Children’s Hospital were enrolled in this study.According to the different the surgical methods of patients,they were divided into the LRH group and ORH group,of which 235 cases were in LRH group and 216 cases were in ORH group.Perioperative complications,disease-free survival(DFS),and overall survival(OS)were compared between the two groups,and the risk factors affecting the prognosis of early cervical cancer treated by these two surgical methods were analyzed.Results:1.There was no significant difference in baseline clinical data in the LRH group and ORH group before surgery(P>0.05),including age,body mass index,hemoglobin level,pathological type,and FIGO2009 clinical stage.2.The median operative time in the LRH group was(287.8±52.3)min,while the median operative time in the ORH group was(250.5±44.7)min,and the difference between the two group was statistically significant(P=0.000).The median intraoperative blood loss in the LRH group was(141.7±288.4)ml,with 4 patients receiving intraoperative blood transfusion,while the median intraoperative blood loss in the ORH group was(921±556.5)ml,and the differences in bleeding volume and transfusion rate between the two groups were statistically significant(P=0.000,0.000).There was no significant difference between the two group in bilateral appendectomy(ovarian preservation),preservation of pelvic autonomic nerve function,number of lymph node resections,intraoperative vascular and nerve injury,positive pelvic lymph nodes,positive resection margins,positive angioma plugs,and positive uterine tissue.3.Postoperative complications were 24.7%(58/235)in the LRH group while19.0%(53/216)in the ORH group,and there was no significant difference in the incidence of postoperative complications between the two groups(P=0.972).There was no significant difference in the incidence of non-infectious complications between the two groups(P=0.988),but the incidence of infection complications(mainly incision infections)in the LRH group was significantly lower than in the ORH group(P=0.048).The average postoperative hemoglobin level in the ORH group was significantly lower than that in the LRH group(P=0.000).The incidence of urinary retention in the LRH group was significantly higher than that in the ORH group(P=0.046),and the urinary retention time in the LRH group was also significantly longer than that in the ORH group(P=0.000).Postoperative bowel function recovery(anal exhaust)and postoperative hospital stay in the LRH group were significantly shorter than those in the ORH group(P=0.000、0.000).4.Followed up to February 13,2019,with a median follow-up time of 37.2(2.2-128.3)months,a total of 21 patients(4.66%)relapsed,of whose median time of relapse was 17.2(2.9-27.9)months.The 3-year DFS and OS of all enrolled patients were 94.2%and 95.8%,respectively.The median follow-up time in the LRH group was 20.4(2.2-48.6)months,and 14 patients(5.96%)relapsed;the median follow-up time in the ORH group was 63.9(3.5-128.3)months,and 7 patients(3.2%)relapsed.The 3-year DFS in the LRH group and the ORH group were 90.5%and 96.7%,respectively,and there was significant difference between the two groups(P=0.014).The 3-year OS of the LRH group and the ORH group were 93.4%and 97.2%,respectively,and there was no significant difference between the two groups(P=0.095).5.The univariate analysis of risk factors related to early-stage cervical cancer relapse showed that age≥50 years old,BMI≥25 kg/m~2,FIGO2009 clinical stage,positive resection margins,and positive lymphangioma emboli did not affect DFS(P=0.191,0.145,0.194,0.079,respectively).The DFS of patients with,LRH,special pathological classification of cervical cancer(adenosine carcinoma),tumor maximum diameter>4cm,depth of cervical interstitial invasion≥deep 1/3,uterine tissues positive,and positive pelvic lymph nodes positive were significantly lower than those patients with,ORH,squamous or adenocarcinoma,tumor maximum diameter≤4cm,cervical interstitial infiltration depth<1/3 deep,parauterine tissue negative,and pelvic lymph node negative(P=0.014,0.002,0.002,0.000,0.000,0.000,respectively).Multivariate analysis showed that LRH(HR 2.863,95%CI1.108-7.397,P=0.030),special pathological classification of cervical cancer(adenosine carcinoma),(HR 0.148,95%CI 0.051-0.430,P=0.00),tumor maximum diameter>4cm(HR 0.359,95%CI 0.135-0.957,P=0.041)and the uterine tissue positive(HR 0.123,95%CI 0.035-0.455,P=0.035)is an independent risk factor of cervical cancer relapse.Conclusion:1.Compared with open radical hysterectomy,Laparoscopic radical hysterectomy for early-stage cervical cancer have a higher risk of relapse.But it has the advantages of less intraoperative bleeding,low blood transfusion rate,low postoperative infection rate and short hospital stay.Therefore,patients should be fully informed of the advantages and disadvantages of the two surgical methods and their choice should be respected.2.The LRH、special pathological classification of cervical cancer(Adenosine carcinoma)、maximum diameter>4cm and positive uterine tissue are independent risk factors for the relapse of patients with early-stage cervical cancer. |
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