| ObjectiveTo compare the efficacy of lymphadenectomy for stage I endometrial carcinoma after initial diagnosis,and to discuss the relationship between the amount of surgery performed by physicians and the number of lymph nodes resected and prognosis of patients.MethodsAs a retrospective,multicenter study that outcomes of 586 patients with stage I endometrial carcinoma who were divided into 2 groups according to the operation method from January 2010 to December 2014 at 3 hospitals including the first affiliated hospital of Zhengzhou university were analyzed.Among them,405 patients who underwent laparoscopic total hysterectomy and bilateral salpingo-oophorectomy and systemic pelvic or para-aortic lymphadenectomy were classified as the group with lymphadenectomy,which is called the observation group,and 181 patients who underwent laparoscopic total hysterectomy and bilateral salpingo-oophorectomy surgery were classified as the group with no lymphadenectomy,namely the control group.The operation time,intro-operative blood loss,hospital stay,postoperative complications and survival were compared respectively.According to the conventional pathological results,the observation group and control group were divided into three subgroups,which were low-risk groups,intermediate-risk groups and high-risk groups,and the survival of two low-risk groups,two intermediate-risk groups and two high-risk groups were compared respectively.At the same time,we also divided the surgery quality of two doctors into several groups with 30 and 60 as the boundary,and to compare the number of lymph nodes removed,postoperative complications and recurrence rate of each group.Results(1)The intraoperative blood loss in the observation group was 71.53± 36.99ml,more than that in the control group 42.90±24.88ml;the operation time of the observation group was 141.96±45.01 min,and the operation time of the control group was 90.74±34.33min;the mean hospital stay in the observation group was 10.58±5.02 days,and the mean hospital stay in the control group was 7.84±4.66 days,the difference of the above results were statistically significant(P<0.001).(2)The mean time of catheter extraction in the observation group was 51.05±30.79h,and was 47.20± 17.14h in the control group,the difference was no statistically significant(t'=-1.933,P=0.054).(3)In the observation group,52 patients had postoperative complications,with an incidence of 12.8%;in the control group,8 patients had postoperative complications,with an incidence of 4.4%,there is a statistically significant difference(?2=9.649,P=0.002).(4)Age(OR=1.042,95%CI-1.005-1.081,P=0.046)and lymph node resection(OR=9.433,95%CI=2.161-41.181,P=0.013)were two risk factors for postoperative complications.(5)The postoperative recurrence rate was 4.9%in the observation group and 8.8%in the control group,showing no significant difference(?2=3.302,P=0.069).(6)The five-year OS of observation group was 92.0%,and that of the control group was 89.3%,showing no significant difference(P=0.114).The five-year DFS of the observation group was 93.1%,and that of the control group was 90.5%,showing no significant difference(P=0.112).(7)The age of the patients(HR=1.06,95%CI=1.03-1.09,P=0.036)and the depth of myometrial invasion(HR=1.03,95%CI=1.01-1.07,P=0.047)were correlated with DFS.The age of patients(HR=1.04,95%CI=1.01-1.08,P=0.029)was correlated with the OS.(8)In the low-risk group,the five-year OS of the observation group and the control group were 92.5%and 94.1%(?2=0.110,P=0.740),and the five-year DFS were 93.6%and 95.5%(?2=0.131,P=0.717),respectively.In the intermediate-risk group,the five-year OS were 92.1%and 87.2%(?=0.889,P=0.346),and the five-year DFS were 94.3%and 87.7%(?2=2.115,P=0.142),showing no significant difference.In the high-risk group,five-year OS in the observation group was 82.5%,higher than 61.5%of the control group(P=0.048),and five-year DFS in the observation group was 87.7%,higher than 63.6%of the control group(P=0.042),the difference was statistically significant.(9)The number of lymph nodes removed by a physician was 17.60±3.67 when the amount of operations was 31-60 cases,and was greater than 9.33±3.98 in 0-30 cases(P<0.05),but there was no difference with 19.93±6.79 when the number of operations was greater than 60 cases(P=0.11).The number of lymph nodes removed by another doctor was 17.80 ± 1.24 when the amount of operations was 31-60 cases,which was more than 11.60±2.54 in 0-30 cases(P<0.05),but the number of lymph nodes removed was 19.82±6.61 when the amount of operations was more than 60 cases,which showed no statistical difference(P=0.089).(10)The incidence rate of postoperative complications was 30%when the number of operations was 0-30 cases performed by a physician,which was higher than that of 10%and 6.9%in the 31-60 cases and 61-89 cases,and the difference was statistically significant(?2=6.244,P=0.044).The incidence rate of postoperative complications was 23.3%when the amount of operations was 0-30 cases performed by another physician,which was higher than 3.3%and 5.9%in the 31-60 cases and 61-94 cases,and the difference was statistically significant(?2=6.396,P=0.047).(11)The recurrence rate of patients was 6.7%when the number of operations was 0-30 cases performed by a physician,and the recurrence rates of patients were 3.3%and 6.9%in 31-60 cases and 61-89 cases,with no statistically significant difference(?2=0.634,P=0.871).In the 0-30 cases performed by another physician,the recurrence rate of patients was 6.7%,and the recurrence rates of patients were 3.3%and 2.9%in 31-60 cases and 61-94 cases,with no statistically significant difference(?2=1.685,P=0.513).Concludes(1)As for low-risk and intermediate-risk patients with stage I endometrial cancer,only total hysterectomy and bilateral salpingo-oophorectomy can be performed;Lymph node resection is feasible for high-risk patients with stage I endometrial carcinoma.(2)The age of the patient and the depth of myometrial invasion may be two risk factors for the prognosis of the patient.(3)Within a certain range,the high amount of surgery performed by physicians was positively associated with the number of lymph nodes removed and negatively correlated with the postoperative complications of patients,but was not clearly associated with the prognosis of patients. |
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