| BackgroundEndometrial cancer is one of the three major malignant tumors of the female reproductive system,of which endometrial adenocarcinoma accounts for about 80-90%.Surgery is the most important treatment for this disease,and early endometrioid adenocarcinoma can achieve a better prognosis after surgery.Compared with traditional open surgery,laparoscopic surgery has the advantages of less trauma,less intraoperative bleeding,low complication rate and faster recovery.It has become the standard surgical procedure for staging endometrial cancer.In recent years,with the continuous development of minimally invasive technology,robot-assisted laparoscopic surgery has begun to be used in clinics.Its high-definition 3D stereo vision system can magnify the surgical field of view by 10-20 times.The stabilization device of the robotic arm can filter tremor and reduce misoperation.In addition,the rotatable wrist structure has 7 degrees of motion,which can complete complex operations that are difficult to handle with traditional laparoscopy.Robot-assisted laparoscopic surgery in China has been developed late.There are few studies on the safety and effectiveness of the staging of endometrioid adenocarcinoma,and there are relatively few studies with large sample size and long follow-up time.ObjectiveIn this study,the clinical data of patients with endometrioid adenocarcinoma treated by robot-assisted laparoscopic surgery and traditional laparoscopic surgery were collected,and the perioperative clinical data and survival prognosis of the two groups of patients were analyzed and compared to discuss the safety and effectiveness of robot-assisted laparoscopic surgery in staging endometrioid adenocarcinoma.MethodsThe clinical data of patients who underwent minimally surgical treatment of endometrioid adenocarcinoma in the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2020 were collected and grouped according to the operation method.Patients undergoing robot-assisted laparoscopic surgery are in the robot group,and patients undergoing traditional laparoscopic surgery are in the laparoscopic group.The general conditions,intraoperative and postoperative indicators of the two groups were analyzed.The general conditions includes patient age,body mass index(BMI),comorbidities,previous history of pelvic surgery,FIGO staging,degree of pathological differentiation,postoperative adjuvant treatment,and hospitalization costs.The intraoperative indicators included operation time,intraoperative blood loss,number of lymph nodes removed,blood transfusion rate and intraoperative complications.The postoperative indicators include postoperative hospital stay,postoperative complications and survival time.SPSS22.0 software was used to analyze and compare the differences in various indicators between the two groups of patients.The measurement data was measured by t-test,the count data was measured by x2 test,and the Kaplan-Meier curve was used to compare the survival time of the two groups of patients.ResultsThere were 336 patients in the robotic group and 682 patients in the laparoscopic group.In general conditions,there were no statistical difference in the patient’s age[(52.81±9.55),(53.18±8.74)],BMI[(28.49±4.13),(28.77±4.35)],comorbidities[28.9%(90/336),26.1%(178/682)],history of pelvic surgery[34.8%(117/336),39.3%(265/682)]and postoperative adjuvant therapy[40.2%(135/336)),35.8%(244/682)]between two groups(P>0.05).The FIGO staging of patients in the robot group was 225(67.0%)patients in stage ⅠA,67(19.9%)patients in stage ⅠB,32(9.5%)patients in stage Ⅱ,4(1.2%)patients in stage ⅢA,1(0.3%)patients in stageⅢB,and 7(2.1%)patients in stage ⅢC.The degree of pathological differentiation after operation included 175(52.1%)cases with high differentiation,122(36.3%)cases with moderate differentiation,and 39(11.6%)cases with poor differentiation.The FIGO staging of patients in the laparoscopic group was 478(70.1%)patients in stage ⅠA,105(15.4%)patients in stage ⅠB,53(7.8%)patients in stage Ⅱ,17(2.5%)patients in stage Ⅲ A,5(0.7%)patients in stage ⅢB,and 24(3.5%)patients cases of stage ⅢC.The degree of pathological differentiation after operation included 370(54.3%)cases of well differentiated grade,228(33.4%)cases of moderately differentiated,and 84(12.3%)cases of poorly differentiated.There were no statistical difference between two groups in postoperative staging and pathological differentiation(P>0.05).The cost of hospitalization in the robot group was higher[(48238.46±4974.91),(32179.27±4762.36),(P<0.001)].Analyzing the intraoperative indicators of two groups,the operation time of the robot group was lower[(153.41 ±64.63)min,(169.19±61.21)min,(P<0.001)],the intraoperative blood loss was less[(87.45±64.44)ml,(116.60 ± 72.42)ml,(P<0.001)],the total complication rate during operation decreased[1.2%(4/336),6.6%(44/682),(P<0.001)],and the incidence of vascular injury was lower[0.6%(2/336),4.7%(32/682),(P<0.05)].There was no statistically significant difference in the number of pelvic lymph nodes removed[(20.0±8.2),(18.8±7.9)],the number of abdominal para-aortic lymph nodes removed[(7.6±4.5),(6.8±4.2)],total number of lymph nodes removed[(27.9±11.1),(26.3±9.6)],and intraoperative blood transfusion rate[1.5%(5/336),2.9%(25/682)](P>0.05).Analyzing the postoperative indicators of two groups,the incidence of postoperative complications in the robot group was lower[18.5%(62/336),24.3%(166/682),(P<0.05)].However,the incidence of lymphatic leakage was higher[8.6%(29/336),5.1%(35/682),(P<0.05)].The postoperative hospital stay in the robot group was shorter[(7.2±3.4)days,(8.1 ±3.5)days,(P<0.05)].In terms of prognosis,the median follow-up time of the robot group was 26 months(4 to 73 months),and the median follow-up time of the laparoscopic group was 26 months(4 to 73 months).There was no statistically significant difference in the cumulative survival rate between the two groups(94.0%,91.3%,P>0.05).Conclusion1.Compared with traditional laparoscopic surgery,robot-assisted laparoscopic surgery has shorter operation time,less intraoperative blood loss,and shorter postoperative hospital stay in staging surgery for endometrial adenocarcinoma.2.Robot-assisted laparoscopic surgery has a lower incidence of intraoperative and postoperative complications,a lower rate of vascular damage,but a higher risk of lymphatic leakage in staging surgery for endometrial adenocarcinoma.3.The survival time of robot-assisted laparoscopic surgery is consistent with that of traditional laparoscopic surgery in staging surgery for endometrial adenocarcinoma. |
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