Comparison Of Clinical Efficacy And Oncology Prognosis Between Abdominal Surgery And Laparoscopic Surgery For Early Stage Cervical Cancer

Objective: To compare the short-term outcomes and long-term oncology outcomes between abdominal radical hysterectomy(ARH)and laparoscopic radical hysterectomy(LRH)for cervical cancer,we collected clinical-pathological data of patients admitted in our hospital with stage IA1(LVSI +)-IIA.To explorer the value of two different surgery procedures and provide new data for clinical treatment selection,we aim to discuss the controversy of two surgical treatment for early-stage cervical cancer and provide our own data related this controversy.Methods: From January 2013 to December 2016,584 cases of cervical cancer with FIGO stage IA(LVSI+)-IIA who underwent ARH or LRH were selected in Tianjin Central Obstetrics and Gynecology Hospital as the subjects of this study.The materials we collected included preoperative clinical data(age,pathological type,stage,history of preoperative conization and neoadjuvant treatment),pathological data(histological differentiation,invasion of cervical stroma,pelvic lymph node status,vascular invasion status,margin status of vagina and parametrium),intraoperative surgical indexes(time of operation,lymph node resections numbers,length of parametrial and vaginal resection,blood loss,intraoperative and postoperative complications,hospital stay).Follow-up period of the two groups of patients were collected by telephone calls.The end of follow-up date is December 2019.Analyze and compare the survival and recurrent time between ARH and LRH.Results:1.429 of 584 cases underwent ARH and 155 of 584 cases received LRH.The proportion of LRH increased gradually from 2013 to 2016,and gradually approached 50%.2.Comparison of short-term effectiveness between LRH and ARH:(1)The operation time in the ARH group(200 ± 37min)was shorter than that in LRH group(220 ± 48min)(P = 0.005).The blood loss of ARH(489±305ml)was more than LRH group(223 ± 219ml)((P <0.001).The length of hospital stay of ARH group((12 ± 4 days)was longer than LRH group((10 ± 3 days)(P<0.001).The number of lymph node resections in ARH group(26 ± 9)was not significantly different from that in LRH group(25 ± 9)(P = 0.924).(2)Comparison of intraoperative complications incidence: the intraoperative blood transfusion rate in the ARH(72 cases,17.1%)was higher than that in LRH(5 cases,3%)and the difference was statistically significant(P < 0.001);there was no significant difference on the rate of ureteral stent placement between ARH group(1 case,0.2%)and the LRH group(2 cases,1.2%)(P = 0.397).(3)Comparison of the postoperative complications incidence between the ARH group and LRH group:the incidence of intestinal obstruction in ARH group(2 cases,2.9%)was not significantly different from the LRH group(2 cases,1.2%)(P = 0.389);The incidence of urinary retention in the ARH group(81 cases,21.7%)was not significantly different from that in the LRH group(31 cases,23.3%)(P = 0.704).3.Comparison of oncological outcomes between ARH group and LRH group:(1)For patients with stage IA1(LVSI +)-IIA,survival rate and disease-free survival rate of the ARH group was 96.4% while LRH was 96% with median follow-up of 56 months,and there was no significant difference in survival and recurrence rates between the two groups(P = 0.725 and P = 0.721,respectively).(2)For stage IB1 patients,survival rate and disease-free survival rate of ARH group was 96.1% while LRH group was 97.1% and there was no significant difference(P = 0.630,P = 0.637).COX multivariate survival analysis showed that lymph node metastasis(P = 0.006)and tumor size(P = 0.028)were independent risk factors for patients with stage IB1 of early stage cervical cancer(3)(2)The median follow-up of patients with stage IB1 early cervical cancer was 57 months.KM single-factor survival analysis showed tumor size(P = 0.002),lymph node metastasis(P <0.001),and cervical interstitial infiltration depth ≥1 / 2(P = 0.018).Lymphatic vessel cancer thrombus(P = 0.003)may have an impact on the postoperative mortality of patients with early cervical cancer,but age,pathological type,preoperative cone-cutting history,parauterine infiltration,vaginal resection margin,and surgical methods have an early impact The impact of cervical cancer postoperative death outcome was not statistically significant(P> 0.05).COX multivariate survival analysis showed that lymph node metastasis(P = 0.006)and tumor size(P = 0.028)were independent risk prognostic factors for postoperative death outcomes in patients with stage IB1 early cervical cancer;KM univariate analysis for patients with stage IB1 cervical cancer received open Or there was no significant difference between the tumor-free survival outcome and survival outcome after laparoscopic surgery(P = 0.281 and P = 0.171).(3)K-M single factor analysis of the correlation between the surgical methods and prognosis of early stage cervical cancer in each stage: There are no significant difference(P = 0.535)on disease-free survival outcome and overall survival outcome of patients with early stage cervical cancer with stage IB1(d<2cm)undergoing ARH or LRH;there are no significant difference on disease-free survival outcome(P=0.883)and overall survival(P=0.903)outcome of stage IB1(d≥2cm)early stage cervical cancer undergoing ARH or LRH.The disease-free survival outcome was lower in patients with stage IB2 early stage cervical cancer who underwent LRH than patients who underwent ARH(P=0.024),but the overall survival outcome was similar(P=0.056).;There were no significant difference on disease-free survival outcome and overall survival between LRH and ARH in IIA1 early-stage cervical cancer(P= 0.597).Conclusions: 1.Laparoscopic surgery has unique advantages in terms of surgical value,including reduced intraoperative bleeding and blood transfusion rate,and significantly shortening the length of hospital stay.The operating time of laparoscopic surgery is affected by the surgeon’s experience.2.According to 2009 FIGO staging,IB2 and above stage cervical cancer,abdominal surgery is recommended.For early stage cervical cancer of IA1(LVSI +)-IB1,patients should be informed of the latest research results with fully informed consent,and we should respect for patients’ choice.3.The independent risk factor that affect the survival outcome of early cervical cancer is lymph node metastasis.The independent risk factors that affect the survival outcome of early stage cervical cancer in stage IB1(FIGO stage in 2009)include tumors size and lymph node metastasis.