| BackgroundOvarian bordering tumors(BOTs)account for about 20%of all ovarian tumors and are a low-grade malignant potential tumor[1-4].Its common subtypes include serous ovarian junctional tumors and mucosal ovarian bordering tumors.The 2014 International Society of Obstetrics and Gynecology staging of ovarian malignancy showed that ovarian bordering tumours confined to the ovaries or fallopian tubes belonged to FIGO stage I.The 2020 National Comprehensive Cancer Network recommends that the main treatment for BOTs should be surgical treatment,with the option of open surgery or minimally invasive surgery.Minimally invasive surgeries currently include laparoscopic surgery and robotic surgery.Although open surgery has a good tumor control effect when applied to BOTs,it has the disadvantages of high postoperative complication rate,large abdominal incision and slow healing.With the concept of minimally invasive being accepted by more and more gynecological surgeons,the surgical method for BOTs has gradually transitioned from open surgery to laparoscopic surgery,which reduces the incidence of postoperative complications,and the abdominal wound is small,and the healing of the incision is accelerated,thereby improving the postoperative quality of life of patients.Robotic surgery is a newly developed minimally invasive technology in recent years,which not only has similar advantages to laparoscopic surgery,but also has some features that are superior to laparoscopic technology,such as proprietary three-dimensional stereoscopic video images that make the intraoperative field of view clear,the endoWrist can be operated freely in a narrow space,fixed lens arms and adjustable endoscopic lenses can filter involuntary shaking,making surgical operations more stable.With the concept of late marriage and late childbearing and the concept of two or even three children being accepted by more and more young people,some young patients with ovarian junction tumors have strong fertility needs,and Robot surgery provides a new idea for gynecological minimally invasive technology because of its low damage to surrounding organs and fast recovery after surgery.With the continuous update and optimization of robotic surgery,it is more and more widely used in the field of gynecological disease treatment.By comparing the perioperative period related indicators of open surgery,laparoscopic surgery and robotic surgery,this study aimed to compare the short-term efficacy of three different surgical approaches in ovarian junctional tumors,and to provide a basis for the treatment of BOTs in the clinic.ObjectiveBy comparing the clinical data of open surgery,traditional laparoscopic surgery and robotic-assisted laparoscopic surgery in patients with FIGO stage I BOTs,we aimed to explore the safety,feasibility and effectiveness of different surgical methods in stage I borderline ovarian tumors.Methods(1)The clinical case data of patients with FIGO stage I BOTs admitted to the First Affiliated Hospital of Zhengzhou University from September 2014 to December 2021 were collected and divided into three groups according to different surgical approaches:open surgery group(LAP group),laparoscopic surgery group(TLS group)and robotic surgery group(RALS group).The inclusion criteria are:(1)Postoperative pathology was clearly diagnosed as FIGO stage I ovarian borderline tumors,and the clinical pathological stage adopted the 2009 edition of the International Union of Obstetrics and Gynecology(FIGO);(2)The first surgery is performed at the First Affiliated Hospital of Zhengzhou University in the form of LAP,TLS or RALS,and the scope of surgery is fertility preservation surgery or full-scale staging surgery;(3)Preoperative related ancillary examinations(gynecological examination,pelvic and abdominal ultrasound,CT,MRI,tumor markers,etc.)have been perfected,and there are no obvious contraindications to surgery;(4)The indications for surgery are clear and th e patient signs a consent form for surgery;(5)The patient’s case information is complete and there is no leakage.The exclusion criteria are:(1)Combined with severe cardiopulmonary dysfunction or medical and surgical diseases that affect the survival of patients;(2)Malignant tumors of other systems.(3)There are contraindications to surgery or can not cooperate with treatment due to neurological and psychiatric diseases.The three groups were analyzed and compared with age,comorbidities,body mass index(BMI),clinical symptoms,serum tumor marker abnormalities,sex hormone abnormalities,preoperative menstrual conditions,previous pelvic surgery history,imaging showing the maximum diameter of the tumor,surgical range(fertility preservation or full stage surgery),operation time,intraoperative bleeding volume,pathological type,postoperative exhaust time,postoperative adjuvant chemotherapy treatment,postoperative hospital stay time,postoperative complications,survival rate,recurrence rate,pregnancy and other indicators.(2)Statistical methods:If the measurement data conforms to the normal distribution,(the mean±standard deviation)is described,if the normal distribution is not normal,the median and quartiles are described;when the multi-group comparison is followed by the normal distribution and the variance homogeneity,the one-way ANOVA is used,and the Kruskal-Wallis rank sum test is used if the normal distribution is not followed;if the P<0.05 is compared between the three groups,the Bonferroni method or LSD method is used for two-by-two comparisons.Categorical variables are expressed in composition ratios,using chi-square tests or Fisher’s exact probability method,and the two-by-two comparison of multi-group rates using LSD or Bonferroni methods.P<0.05 was statistically significant for the difference.ResultsAll three groups of BOTs were successfully operated without intraoperative blood transfusion,anesthesia accident,etc.There was no conversion to laparotomy in the two groups of minimally invasive surgery,and postoperative compliance was good.(1)Comparison of preoperative case data:age,body mass index(BMI),comorbidities,clinical symptoms,abnormal serum tumor markers,menstrual status,sex hormone levels,previous history of pelvic and abdominal surgery,and imaging findings of tumors in the three groups of patients There was no statistically significant difference between the maximum diameters(P>0.05)(2)Intraoperative related indicators:three groups(LAP,TLS,RALS)fertility-sparing operation time[(151.93±56.17),(114.54±25.33),(194.72±24.11)min],comprehensive staging operation time[(202.60±66.81),(157.13±31.42),(256.88±35.65)min],the difference was statistically significant(P<0.05).The intraoperative blood loss in the LAP group[fertility-sparing surgery(111.04±51.97)ml,comprehensive staging surgery(139.33±43.50)ml]was more than that in the TLS group[(40.35±33.04),(63.04±48.02)ml]and the RALS group[(29.89±27.24),(34.38±28.72)ml],the difference was statistically significant(P<0.05),and there was no significant difference between the two groups(P>0.05).There was no significant difference in the scope of surgery(fertility-sparing surgery and comprehensive staging surgery)between pairs(P>0.05).(3)Postoperative related indicators:three groups(LAP,TLS,RALS)postoperative hospital stay[(10.49±4.51),(6.34±2.05),(4.96±1.51)d],complications(36 cases,65 cases,5 cases)),the difference was statistically significant(P<0.05).The anal exhaust time[(2.57±0.63)d]in the LAP group was longer than that in the TLS group[(2.33±0.62)d]and the RALS group[(2.29±0.50)d],and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups(P>0.05).There was no significant difference in pathological type and postoperative adjuvant chemotherapy among the three groups(P>0.05),(4)Comparison of prognostic observation indicators:the follow-up deadline was March 2022,the median follow-up time was 53 months(3-90 months),a total of 11 cases were lost to follow-up,and the total loss rate was 2.87%(11/383).Two patients were lost to follow-up,9 cases in the TLS group,and all in the RALS group.Three groups underwent fertility-sparing surgery:67 cases in the LAP group,200 cases in the TLS group,and 47 cases in the RALS group.Eleven patients in the three groups were excluded from the follow-up,and the remaining patients survived during the follow-up period(100%).There was no significant difference in postoperative recurrence rate,postoperative menstruation,and postoperative pregnancy among the three groups(P>0.05).Conclusion1.The three surgical approach applications for FIGO stage I BOTs are safe and feasible.2.Compared with the short-term treatment effect of laparoscopic surgery,robot surgery has the advantages of shorter postoperative hospital stay time and low complication rate;compared with open surgery,robot surgery has the advantages of less intraoperative bleeding,short exhaust time,short postoperative hospital stay and low complication rate.There were no significant differences in postoperative short-term recurrence rate,survival rate,and pregnancy status between the three surgical approaches,but robotic surgery was at a disadvantage in terms of cost and duration.3.Make a full preoperative assessment of the patient’s condition,combined with the surgeon’s technology,the patient’s condition and the comprehensive measurement of the economic status,and develop an individualized treatment plan according to the patient’s condition.4.The application of robotic surgery in ovarian junctional tumors is worth further exploration,and prospective,multi-center,large-sample studies are still needed,and the research on the long-term efficacy of open surgery,laparoscopic surgery and robotic surgery needs to continue to be followed up. |
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