Application Of Da Vinci Robot-assisted Laparoscopy In Radical Hysterectomy Of Locally Advanced Cervical Cancer

BackgroundCervical cancer is a malignant tumor from the female reproductive system,which is a major global health challenge.Currently,cervical cancer screening technology has not been fully popularized in developing countries,so the incidence of cervical cancer is still increasing year by year and the age of onset tends to be younger,and most of the cases are already in the locally advanced state when diagnosed.According to the existing research results,the quality of life of patients with locally advanced cervical cancer(LACC)is generally reduced after comprehensive treatment,and the rate of local recurrence and distant metastasis is high,and the efficacy is poor.In order to improve the survival rate of patients and give consideration to the quality of life of patients,new treatment methods and schemes are being tried constantly.Surgical treatment is also a common treatment for LACC.Laparoscopy is a minimally invasive technique innovation,greatly reducing the laparotomy patients with complications and shortening the length of hospital stay,with the further development of minimally invasive techniques.The rise of da Vinci robot system make up for the deficiency of the traditional laparoscopic,gynecologic minimally invasive surgery is a new breakthrough,and now has been widely used in gynecological malignancy surgery.In order to provide the certain clinical basis for the treatment of locally advanced cervical cancer.we make this study to compare the da Vinci robot-assisted laparoscopy with traditional laparoscopy applied in LACC.ObjectiveTo compare the clinical and follow-up data of patients with stage IB3 and IIA2(FIGO2018)who received da Vinci robot-assisted laparoscopy or traditional laparoscopy radical hysterectomy of cervical cancer,and to assess the safety,feasibility and advantages of da Vinci robotic surgery.MethodsClinical and follow-up data of patients with stage IB3 and IIA2 cervical cancer admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2018 were retrospectively analyzed.Among them,79 patients underwent da Vinci robot-assisted laparoscopic radical hysterectomy(robot group)and 129 patients underwent traditional laparoscopic radical hysterectomy(laparoscopic group).The operative time,intraoperative blood loss,postoperative anal exhaust time,postoperative abdominal drainage tube removal time,intraoperative and postoperative complications,postoperative pathological results,postoperative hospital stay,overall survival rate and progression-free survival rate were analyzed and compared between the two groups.SPSS21.0 statistical software was used for data analysis.Normal test was performed for continuous variables.Normal distribution was expressed as mean ±standard deviation.T-test was used for comparison between the two groups.Categorical variables were expressed as constituent ratio or rate(%),and χ2 test was used for comparison between groups.Kaplan-Meier method was used to draw the survival curve,and log-rank test was used to compare the survival rate between the two groups.P<0.05 was considered statistically significant.Results(1)Clinical characteristics:There was no significant statistical difference in the general data between the robot group and the laparoscopic group(P>0.05),which suggests that the clinical characteristics of the two groups were comparable.(2)Comparison of intraoperative related indicators:There were no statistically significant differences in intraoperative blood loss,postoperative anal exhaust time,and abdominal drainage tube removal time between the two groups(P>0.05).Compared with the laparoscopic group,the operative time in the robot group[(199.16±69.39)vs(220.37±56.50)min,P=0.024]and postoperative hospital stay[(9.03±2.40)vs(9.98±3.97)min,P=0.003]were shorter.(3)Comparison of postoperative pathological features:Compared with the pathological results of the two groups,the robot group removed more lymph nodes.There was no statistical significance in the comparison of pathologic subtype,differentiation of tumor,invasion depth of stroma,parametrial involvement,positive vaginal margin,metastasis to lymph nodes,lymph-vascular space invasion(LVSI)(P>0.05).(4)Comparison of complications:the total complication rate of the robot group was 15%,and the total complication rate of the laparoscopic group was 25%.There was no significant difference in the incidence of total complications between the two groups(χ2=2.716;P=0.099).(5)Comparison of recurrence and prognosis:the average follow-up time of robot group was 32.70±12.05(9-66 months).There were 20 cases of recurrence,including 9 cases of local recurrence,6 cases of distant metastasis,5 cases of pelvic lymph node metastasis.In the laparoscopic group,the mean follow-up time was 31.51±10.63(6-66 months).Thirty-two patients had recurrence,including 14 local recurrence,11 distant metastasis,7 pelvic lymph node metastasis and.There was no significant difference in overall survival rate and disease-free survival rate between the two groups during follow-up(P>0.05).Conclusion(1)Compared with traditional laparoscopic surgery,da Vinci robot-assisted laparoscopic radical hysterectomy of LACC has shorter operative time and more pelvic lymph nodes removed,Moreover,it can reduce the length of hospital stay and save the cost and medical resources of patients.(2)Compared with traditional laparoscopy,the short-term recurrence rate,disease-free survival rate and overall survival rate of LACC patients with da Vinci robot-assisted laparoscopy were similar.(3)Da Vinci robot-assisted laparoscopy is safe and feasible in the radical operation of LACC.