Efficacy Evaluation Of Vaginal Assisted Laparoscopic Radical Hysterectomy For Cervical Cancer

Objective:To investigate the survival outcomes of abdominal surgery、total laparoscopic surgery and vaginal assisted laparoscopic surgery on the patients of cervical cancer.Methods:A retrospective study.Collected the clinical data from March 2016 to June 2019 in Cancer Hospital of China Medical University,the patients were treated with abdominal(ARH),laparoscopic(LRH)and vaginal assisted laparoscopy(VALRH)radical hysterectomy.Athological types including squamous cell carcinoma,adenocarcinoma,adenosquamous cell carcinoma,clinical stages were IB1-IIA2(FIGO2009).The patients underwent open surgery were the control group,and the patients underwent laparoscopic surgery or vaginal assisted laparoscopic surgery were the experimental group.Results:A total of 654 patients,406 in ARH group,172 in LRH group and 76 in VALRH group,A median follow-up of 38 months.The overall DFS of the three groups were 93.3%,86.0%and 94.7%.LRH vs.ARH p=0.004;VALRH vs.ARH p=0.880;LRH vs.VALRH P=0.064.Cox multivariate analysis showed that LRH increased the overall risk of postoperative recurrence,and there was no significant difference between VALRH and ARH(LRH vs.ARH:HR=2.338,95%CI1.186-4.661,P=0.014;VALRH vs.ARH:HR=0.791,95%CI 0.263-2.380,P=0.676;LRH vs.VALRH:HR=3.065,95%CI 1.001-9.386,P=0.050).There was no significant difference in the distant recurrence rates between the three groups.Pelvic recurrence rates of ARH,LRH and VALRH were 1.0%,11.6%and 1.3%,LRH vs.ARH P<0.001;VALRH vs.ARH P=0.855;LRH vs.VALRH P=0.011.Cox multivariate analysis showed that different surgical approaches were associated with higher local recurrence rate(LRH vs.ARH,HR 10.313,95%CI 2.839-37.460,P<0.001;VALRH vs.ARH,HR=1.343,95%CI 0.136-13.232,P=0.800;LRH vs.VALRH,HR=7.049,95%CI 0.909-54.687,P=0.062).In subgroup analysis,the outcome of LRH was similar to that of ARH when the tumor size was less than 2cm.However,in the other subgroups,tumor size≥2,<4cm,tumor size≥4cm,positive postoperative lymph node,negative postoperative lymph node,with postoperative adjuvant therapy,without postoperative adjuvant therapy,LRH had a higher local recurrence rate compared with ARH,while the recurrence rates of VALRH and ARH were similar in each subgroup analysis.There was no significant difference in OS among the subgroups.Conclusions:The Pelvic recurrence rate and overall recurrence rate of LRH were higher than ARH,and there was no significant difference in the distant recurrence rates.VALRH can avoid tumor spillage and achieve the same prognosis as open surgery.Through the improvement of the operation standardization,we can improve the oncological outcome after the minimally invasive surgery for cervical cancer.