| BackgroundEndometrial cancer is a common malignant tumor of the reproductive system in women,and the incidence of cancer in China is increasing year by year.Endometrial cancer is divided into type ? and type ?,among which type ? endometrial cancer is more common,accounting for 80%-90%,and the pathological types are all endometrial like cancer.Nearly 80%of patients with endometrial cancer have been diagnosed as stage ?,and the treatment is mainly surgical,including open surgery,vaginal surgery,traditional laparoscopic surgery and robot-assisted laparoscopic surgery.Minimally invasive surgery compared with open surgery,vaginal surgery,less surgical complications,used in the treatment of endometrial cancer staging surgery is more safe and feasible,is widely used at present.Robot-assisted laparoscopic surgery was approved by the Food and Drug Administration of the United States(FDA)in 2005 and began to be applied in the field of gynecology.It started relatively late in china.Domestic research on robot-assisted laparoscopic surgery compared with traditional laparoscopic surgery for endometrial cancer complications is relatively few.The application of Clavein-Dindo grading system can better evaluate and compare the severity of surgical complications.In recent years,it has been widely used and recommended by many foreign scholars,but it is rarely used in domestic surgical field,especially gynecology.At present,there are few domestic and foreign studies on the related factors of the complications of stage I endometrial cancer surgery,and there is still no objective evidence to guide clinical prevention and reduce the occurrence of surgical complications.Objective1.Compare the difference in the incidence of surgical complications in patients with stage I endometrial cancer treated by robotic-assisted laparoscopic surgery and traditional laparoscopic surgery.2.Use the Clavein-Dindo grading system to grade the surgical complications of stage I endometrial cancer patients,and compare the differences in the severity of the complications in the treatment of the two surgical methods.3.To explore the main risk factors affecting the occurrence of surgical complications in patients with stage I endometrial cancer.Methods1.Data sources:Using a retrospective case-control study,we analyzed the data of 421 patients with stage I endometrial cancer treated by laparoscopic surgery from October 2014 to June 2019 in the First Affiliated Hospital of Zhengzhou University.The patients were divided into two groups according to the operation mode:robotic-assisted laparoscopy group and traditional laparoscopy group,of which 131 cases were robot group and 290 cases were traditional laparoscopy group.2.Analysis index:(1)The occurrence of intraoperative and postoperative complications in the two groups;(2)Using the Clavein-Dindo grading system to grade the surgical complications and analyze the severity of the surgical complications in the two groups;(3)Statistics of the two groups of factors that may affect the occurrence of surgical complications in patients with stage I endometrial cancer,such as age,body mass index(BMI),comorbidities,past history of pelvic surgery,American Society of Anesthesiologists(ASA)grade,preoperative anemia,number of pelvic lymph node resection,number of para-arterial lymph node resection,total lymph node resection,operation time,surgical methods(robot-assisted laparoscopic surgery and traditional laparoscopic surgery).The above factors were analyzed by univariate analysis(using x2 test)and multivariate analysis(using logistic regression analysis).3.Statistical methods:The collected clinical data were statistically analyzed using SPSS 25.0 statistical software.The quantitative data are in accordance with the normal distribution by the normality test,presented as meanąstandard deviation.The group comparison is used as independent sample T test.The enumeration data is expressed as the number of cases and percentage(%),and the Chi-square test was used to evaluate the difference.Risk factors affecting the occurrence of surgical complications in patients with stage I endometrial cancer were analyzed.Univariate analysis was performed using Chi-square test,multivariate analysis was performed using logistic regression,and the relative risk(odds ratio,OR)values and 95%confidence intervals(confidence interval,CI)of each factor were calculated.Considered the difference statistically significant when P<0.05.Results1.Complications of operation:the incidence of operative complications(intraoperative and postoperative complications)in robot group(20.6%,27/131)was significantly lower than that in traditional laparoscopy group(34.8%,101/290),the difference was statistically significant(?2=8.620,P=0.003).The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group[1.5%(2/131)vs 6.2%(18/290);?2=4.368,P=0.037].The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group[0.75%(1/131)vs 5.2%(15/290);?2=4.798,P=0.022].The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group[19.1%(25/131)vs 28.6%(83/290;X2=4.303,P=0.038],but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group[10.7%(14/131)vs 5.2%(15/290);?2=4.279,P=0.039].2.Clavein-Dindo classification:The incidence of Clavein-Dindo ?,?,?,?and V was 3.8%(5/131)vs 11.0%(32/290),13.7%(18/131)vs 14.5%(42/290),3.1%(4/131)vs 8.6%(25/290),0(0/131)vs 0.3%(1/290),0(0/131)vs 0.3%(1/290),and the incidence of ?(?2=5.684,P=0.015)and ? grade(?2=4.361,P=0.037)complications were statistically significant.The incidence of severe complications in robot group(? grade and above)was lower than that in traditional laparoscopy group[3.0%(4/131)vs 9.3%(27/290);X2=5.179,P=0.023].3.Analysis of influencing factors of surgical complications:univariate analysis showed that:BMI(?2=15.801,P=0.000),preoperative anemia(?2=14.299,P=0.000),total number of lymph node resection(?2=10.425,P=0.001),surgical methods(X2=8.620,P=0.003)was related to the occurrence of surgical complications of endometrial carcinoma,there was no significant correlation between age,complications,past pelvic surgery history,ASA grade,pelvic lymph node division,abdominal aortic lymph node division and operative time of the surgical complications occurrence in patients with stage ? endometrial cancer(P>0.05).Multivariate analysis showed that:BMI(OR=0.289,95%CI:0.097-0.864,P=0.026),preoperative anemia(OR=0.309,95%CI:0.129-0.740,P=0.008),total lymph node resection(OR=0.624,95%CI:0.403-0.966,P=0.034)and surgical methods(OR=3.491,95%CI:1.030-11.840,P=0.045)were independent risk factors for surgical complications of endometrial cancer.Conclusions1.Robotic assisted laparoscopic surgery has a lower incidence of intraoperative,postoperative and total complications than conventional laparoscopic surgery for stage ? endometrial cancer.Among them,robot-assisted laparoscopy compared with traditional laparoscopic surgery,the incidence of intraoperative vascular injury is lower,while the incidence of postoperative lymphatic leakage is higher.2.Compared with traditional laparoscopic surgery,robot-assisted laparoscopic surgery has lower incidence of severe complications.3.BMI,preoperative anemia,total lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of endometrial cancer. |
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