| Background and ObjectiveAccording to the latest cancer report released in China in 2022,the incidence and mortality of cervical cancer have become the first in the ranking of gynecological malignant tumors,which seriously threatens the health of Chinese women.According to the latest guidelines,surgical treatment is the main treatment for early-stage cervical cancer,including open surgery and laparoscopic surgery.A randomized controlled study and a real-world study published in the New England Journal in 2018 showed that laparoscopic minimally invasive surgery had a higher risk of death than open surgery,which caused a heated discussion among gynecologic oncologists at home and abroad.At present,there is a lack of large-scale studies on the prognosis of early cervical cancer after laparotomy and laparoscopy.Whether laparoscopic surgery can continue to be used in the treatment of early cervical cancer still needs to be further explored.The aim of this study is to compare and analyze the efficacy and survival prognosis of open and laparoscopic surgical approaches in the treatment of early cervical cancer,explore the safety of two different surgical approaches,and analyze the related factors affecting the prognosis of early cervical cancer,in order to provide reference for the formulation of clinical treatment plans and scientific basis for the selection of surgical approaches.MethodsA total of 726 patients with early-stage cervical cancer(stage IA2 ～ IIA)who underwent surgical treatment in Guangdong Women and Children Hospital from January 2005 to December 2017 were retrospectively analyzed,and relevant clinical data were collected.Patients were divided into open surgery group(n = 347)and laparoscopic surgery group(n = 379).The basic clinical data,postoperative pathological data and surgical complications of the two groups were compared,and the patients were followed up to understand the prognosis and recurrence.Data were analyzed by SPSS 26.0 software,measurement data were expressed as mean ±standard deviation or median,and comparison between groups was performed by t test or rank sum test.Count data were expressed as frequency or percentage,and chi-square test or Fisher exact probability test was used.Survival analysis was performed by Kaplan-Meier method and tested by Log-rank test.By Cox regression model analysis,P < 0.05 was considered statistically significant.Results1.Comparison of general data: the onset age of cervical cancer patients was46.34 ± 8.94 years old;The median age of onset was 46 years old.There were no significant differences between the two groups in terms of age,time from diagnosis to onset of main symptoms,gravidity and parity,menopause,contraceptive methods,preoperative complications,high-risk HPV infection preoperative neoadjuvant chemotherapy and clinical staging(P > 0.05).2.All patients successfully completed the operation.The average operation time was 253.21 ± 52.11 min in the open group and 241.87 ± 61.32 min in the laparoscopic group.The average length of hospital stay was 13.56 ±4.74 days in the open group and 13.90 ± 4.90 days in the laparoscopic group(all P > 0.05).The median hospitalization cost was 23342.00 yuan in the laparotomy group and 38176.00 yuan in the laparoscopic group,and the difference was statistically significant(P < 0.05).The mean blood loss was440.23 ± 311.28 m L in the open group and 141.16 ± 144.96 m L in the laparoscopic group.The blood transfusion rate was 19.88% in the laparotomy group and 3.4% in the laparoscopic group,and the difference was statistically significant(P < 0.05).3.Comparison of postoperative complications: a total of 95 patients had surgical complications(13.1%),among which urinary retention was the most common complication(49.5%).The incidence of postoperative complications in the laparotomy group was 15.9%,including 22 cases of urinary retention(6.3%),2 case of ureteral or vesicovaginal fistula(0.6%),2cases of vascular injury(0.6%),2 cases of intestinal obstruction(0.6%),9cases of lower extremity venous thrombosis(2.6%),14 cases of poor healing of abdominal incision(4%),and 4 case of lymphatic reflux disorder(1.6%).The incidence of complications after laparoscopic surgery was10.6%.There were 25 cases of urinary retention(6.6%)6 cases of ureteral or vesicovaginal fistula(1.6%),2 cases of vascular injury(0.5%),1 case of obturator nerve injury(0.3%),0 case of intestinal obstruction,2 cases of lower extremity venous thrombosis(0.5%),2 cases of poor healing of abdominal incision(0.5%),and 2 cases of lymphatic reflux disorder(0.5%).The risk of surgical complications in the open group was higher than that in the laparoscopic group,and the difference was statistically significant(P <0.05).4.Postoperative pathological data comparison: In the open surgery group,228cases(65.7%)had deep stromal invasion and 84 cases(24.2%)had superficial stromal invasion.In the laparoscopic group,there were 194 cases(55.9%)with deep stromal invasion and 135 cases(35.6%)with superficial stromal invasion,the difference was statistically significant(P < 0.05).In the laparotomy group,there were 51 cases(14.7%)with tumor diameter >4cm and 296 cases(85.3%)with tumor diameter ≤ 4cm.In the laparoscopic group,there were 26 cases(6.9%)with tumor diameter > 4cm and 353cases(93.1%)with tumor diameter ≤ 4cm,the difference was statistically significant(P < 0.05).However,there were no significant differences in pathological classification,histological differentiation,lymph node metastasis,parametrial invasion and vascular invasion between the two groups(all P > 0.05).5.Survival analysis of different surgical approaches: The mean follow-up period was 53.15 ± 15.33 months.A total of 599 patients were followed up,and the total loss to follow-up rate was 17.9%.The 5-year overall survival(OS)rate was 89.0%,and the 5-year disease free survival(DFS)rate was86.8%.The 5-year OS was 87.2% in the open group and 90.4% in the laparoscopic group.The 5-year overall DFS was 84.6% in the open group and 88.6% in the laparoscopic group,and the difference was not statistically significant(P > 0.05).6.Univariate analysis of risk factors affecting the prognosis of early cervical cancer after surgery showed that: Clinical stage,stromal invasion,parametrial invasion,lymph node metastasis,tumor diameter,vascular tumor thrombus and preoperative neoadjuvant chemotherapy were related to the prognosis of patients with early cervical cancer(all P < 0.05),while age≤ 45 years old,parity,pathological type,degree of differentiation,vaginal stump,high-risk HPV infection and surgical method did not affect the prognosis of patients(all P >0.05).Further Cox regression analysis showed that the risk of death in stage IB1 was 0.304 times higher than that in stage IIA(HR = 0.304,95.0% CI: 0.164-0.564;P < 0.05).Clinical stage,vascular metastasis and tumor diameter were independent risk factors affecting the survival and prognosis of cervical cancer patients(P < 0.05).Conclusions1.Compared with open surgery,laparoscopic surgery has the advantages of less blood loss,lower blood transfusion rate and lower incidence of postoperative complications.2.The 5-year overall survival rate of patients with early cervical cancer after surgery was 89.0%.There was no significant difference in 5-year OS and DFS between the two surgical approaches.3.There is no correlation between surgical methods and the prognosis of early cervical cancer.The two surgical approaches still have good prospects in the application of early cervical cancer,but the surgical plan should be selected according to the patient’s general condition and disease characteristics.4.Clinical stage,vascular metastasis and tumor diameter > 4cm are independent risk factors for postoperative survival in patients with early-stage cervical cancer. |
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