Clinic Research Of Short-term And Long-term Efficacy After Laparoscopic Surgery For Uterus Tumor And Early-stage Cervical Cancer

Clinic research of short-term and long-term efficacy after laparoscopichysterectomy for uterus benign tumorObjective: To evaluate the short-term and long-term efficacy after laparoscopichysterectomy (LH) compared with abdominal hysterectomy (AH) in case of uterus benigntumor.Methods: A multi-center retrospective study of population among3895hysterectomiesbetween2007and2011was involved from23third-grade class-A communal hospitals inGuangxi Zhuang Province.2539were performed by laparoscopy,1356by laparotomy. Thedata of operative time, estimated blood loss, intra-and post-operative complications, anusexhausting time, preserved days of installing catheter, use of analgesics, post-operative lengthof stay, questionnaires covered pelvic floor functions and sexual functions were assessedbetween two groups.Results: There were significant difference in estimated blood loss, intra-operativecomplications, post-operative complications, use of analgesics, anus exhausting time,preserved days of installing catheter, post-operative length of stay, post-operative abnormaldefecation and sexual disfunctions between LH group and AH grou（pP＜0.05）. There was nosignificant difference in operative time and post-operative stress urinary incontinence in thetwo groups(P＞0.05).Conclusion: LH is the alternative and effective choice in the management of uterusbenign tumor. However, more well-designed RCTs are needed to assess the long-term clinical outcomes, particularly quality of life. Evidence-based medicine research of laparoscopic hysterectomy forbenign gynecological conditionsObjective: To assess the safety and efficacy of laparoscopic hysterectomy for womenwith benign gynecological conditions.Methods: Trials were searched by the Cochrane Central Register of Controlled Trials(CENTRAL) on the Cochrane Library before2013, issue11, The Literature published beforeNovember of2013was searched in MEDLINE, EMBASE, PUBMED, CBM, CNKI, WanFang and VIP to identify the randomized controlled trials(RCTs) about laparoscopic versusabdominal hysterectomy for benign gynecological diseases. Unpublished and Grey literatureswere hand-searched, Reference lists of identified studies, conference abstract were alsoscanned. The literature was screened according to the inclusive and exclusive criteria by tworeviewers independently, and the methodology quality was evaluated after abstracting the data,then the RevMan5.1software was used for Meta-analyses.Results: There were26included studies with3069women. The benefits of LH versusAH were quicker return to normal activities, smaller hemoglobin change, lower minorpost-operative complications, less post-operative pain scores and shorter length of hospitalstay. The dis-advantage of LH were the higher intra-operative urinary tract injury, the highermajor long-term post-operative complications and the longer operation time. Quality of lifeand costs outcomes were descriptive data.Conclusion: LH appears to offer benefits to women requiring total hysterectomy forbenign indications compared to AH, particularly regarding hemoglobin change,post-operative pain scores, minor post-operative complications, return to normal activities andhospital stay. However, more well-designed RCTs are needed to assess the long-term clinicaloutcomes, particularly quality of life. The epidemiological investigation of hospitalized patients withgynecological malignancies in Guangxi Zhuang Autonomous Region,1985-2011Objective: To investigate the epidemiological characteristics of gynecologic malignanttumors in hospitalized patients in Guangxi Zhuang Autonomous Region in1985-2011.Methods: Clinical data of16123in-patients who suffered from gynecologic malignanttumors in23third-grade class-A communal hospitals from1985-2011in Guangxi ZhuangAutonomous Region were analyzed.Results:(1) The top4types of malignant tumors were cervical cancer, ovarian cancer,endometrial cancer, gestational trophoblastic neoplasia according to the constitutive ratios ofthe tumors. The constitutive ratio of cervical cancer patients increased from17.48%duringthe1985-1989period to56.74%during the2010-2011period (P＜0.01), while theconstitutive ratio of gestational trophoblastic neoplasia decreased from30.69%to1.75%(P＜0.01); The change of ovarian cancer, endometrial cancer, vulvar and vaginal cancer, andsarcoma of uterus were not obvious (P＞0.05).(2) The occurring age of cervical cacnerbecame younger obviously, from≥60years old dropped to＜40years old; The constitutiveratio of＜60years old parients in endometrial cancer was also increased and the youngertrend was showed; The occurring age of ovarian cancer, and gestational trophoblasticneoplasia were stable.(3) Ovarian cancer and endometrial cancer were mainly in urban areas,while gestational trophoblastic neoplasia was mainly in rural areas; Cervical cancer werefound mainly in urban residents in the former10years, the constitutive ratio being67.1%,while in the later10years it shifted to rural areas, the constitutive radio was52.6%.(4)Majority of patients for cervical cancer, endometrial cancer, vulvar and vagina cancer,sarcoma of uterus and fallopian tube cancer were stage I-II, accounting for66.3%,67.3%,51.4%,73.7%and67.9%respectively, while the patients of ovarian cancer and gestationaltrophoblastic neoplasia were usually at the stage III and stage IV, accounting for56.2%and53.1%respectively.Conclusions:We should focus on strengthening the screening program of cervical cancer,pay more attention to prevention and treatment of the other gynecological malignant tumors atthe same time. Inaddition, we should explore corresponding tumor markers, new methods of diagnosis and treatment to improve the early diagnosis and treatment of ovarian cancer andgestational trophoblastic neoplaisa. Clinic research of short-term and long-term efficacy after laparoscopicsurgery for endometrial cancerObjective: To evaluate the short-term and long-term efficacy after laparoscopic surgerycompared with traditional laparotomy in case of endometrial cancer.Methods: A multi-center retrospective study of population among567patients forendometrial cancer between2007and2011was involved from6third-grade class-Acommunal hospitals in Guangxi Zhuang Province.266were performed by laparoscopy,301by laparotomy. The data of operative time, estimated blood loss, intra-and post-operativecomplications, anus exhausting time, preserved days of installing catheter, lymph nodesyielded, post-operative length of stay, questionnaires covered pelvic floor functions andsexual functions, recurrence rate, disease-free survival and overall survival rate were assessedbetween two groups. Survival rates were estimated by Kaplan-Meier analysis. The survivalcurves were compared by Log-Rank test. Cox regression analysis was used to select the riskfactors for prognosis.Results: There were significant difference in operative time, estimated blood loss, anusexhausting time, preserved days of installing catheter, post-operative length of stay,post-operative urine retention and poor wound healing between LH group and AH group（P＜0.05）. There was no significant difference in lymph nodes yielded, overall ofintra-operative complications, overall of post-operative complications, post-operative pelvicfloor disfunctions, sexual disfunctions, recurrence rate, disease-free survival and overallsurvival rate in the two groups(P＞0.05). In the univariate and multivariate analyses,pathological type and surgical stage were the independent prognostic factors.Conclusion: The safety and the feasibility of the laparoscopy are confirmed forendometrial cancer. However, more well-designed RCTs are needed to assess the long-termclinical outcomes, particularly quality of life. Evidence-based medicine research of laparoscopic surgery forendometrial cancerObjective: To assess the efficacy and safety of laparoscopic treatment of endometrialcancer when compared with laparotomy.Methods: Trials were searched by the Cochrane Central Register of Controlled Trials(CENTRAL) on the Cochrane Library before2013, issue11, The Literature published beforeNovember of2013was searched in MEDLINE, EMBASE, PUBMED, CBM, CNKI, WanFang and VIP to identify the randomized controlled trials(RCTs) about laparoscopic versuslaparotomic approach for all stages of endometrial cancer, Unpublished and Grey literatureswere hand-searched, Reference lists of identified studies, gynecological cancer handbooksand conference abstract were also scanned. The literature was screened according to theinclusive and exclusive criteria by two reviewers independently, and the methodology qualitywas evaluated after abstracting the data, then the RevMan5.1software was used forMeta-analyses.Results: There were9included studies with3616endometrial cancer patients. Thebenefits of laparoscopic surgery versus laparotomy were shorter length of hospital stay, andlower rates of post-operative complications. The disadvantages were the higher rates ofintra-operative complications and the longer time of surgical procedures. There was nosignificant difference between laparoscopic and laparotomic approaches to endometrial cancerin3-year overall,3-year disease-free survival,3-year recurrence and pelvic nodes yield.Conclusions: Laparoscopic surgery appears to show benefits for women withendometrial cancer as compared with laparotomy. Particularly regarding post-operativecomplications and length of hospital stay. However, more well-designed RCTs are needed toassess the long-term clinical outcomes, particularly the quality of life. Clinic research of short-term and long-term efficacy after laparoscopicsurgery for early-stage cervical cancerObjective: To evaluate the short-term and long-term outcomes after laparoscopicsurgery compared with traditional laparotomy in case of early-stage cervical cancer.Methods: A multi-center retrospective study of population among1091patients forFIGO stage IA1-IIB cervical cancer between2007and2011was involved from6third-gradeclass-A communal hospitals in Guangxi Zhuang Province.455were performed bylaparoscopy,636by laparotomy. The data of operative time, estimated blood loss, intra-andpost-operative complications, anus exhausting time, preserved days of installing catheter,lymph nodes yielded, The parametrial width, vaginal cuff, post-operative length of stay,questionnaires covered pelvic floor functions and sexual functions, recurrence rate,disease-free survival and overall survival rate were assessed between two groups. Survivalrates were estimated by Kaplan-Meier analysis. The survival curves were compared byLog-Rank test. Cox regression analysis was used to select the risk factors for prognosis.Results: There were significant difference in operative time, estimated blood loss, anusexhausting time, preserved days of installing catheter, post-operative length of stay, overall ofpost-operative complications, poor wound healing, The parametrial width, vaginal cuff,post-operative stress urinary incontinence and sexual disfunctions between LH group and AHgroup（P＜0.05）. There was no significant difference in lymph nodes yielded, overall ofintra-operative complications, post-operative abnormal defecation (constipation), recurrencerate, disease-free survival and overall survival rate in the two groups(P＞0.05). In theunivariate and multivariate analyses, deep cervical stromal invasion and lymph nodemetastasis were the independent prognostic factors.Conclusion: The safety and the feasibility of the laparoscopy are confirmed forearly-stage cervical cancer. However, more well-designed RCTs are needed to assess thelong-term clinical outcomes, particularly quality of life. Evidence-based medicine research of laparoscopic surgery forearly-stage cervical cancerObjective: To assess the efficacy and safety of laparoscopy in the surgical treatment ofearly-stage cervical cancer.Methods: Trials were searched by the Cochrane Central Register of Controlled Trials(CENTRAL) on the Cochrane Library before2013, issue11, The Literature published beforeNovember of2013was searched in the Cochrane Gynecological Cancer CollaborativeReview Group’s Trial Register, MEDLINE, EMBASE, PUBMED, CBM, CNKI, Wan Fangand VIP. Unpublished and Grey literatures were hand-searched, Reference lists of identifiedstudies, conference abstract were also scanned. The literature was screened according to theinclusive and exclusive criteria by two reviewers independently, All these where randomizedcontrolled trials (RCTs) and controlled clinical trials (CCTs) about laparoscopic surgeryversus laparotomy for early stage cervical cancer were selected. The methodology quality wasevaluated after abstracting the data, then the RevMan5.1software was used forMeta-analyses.Results: The search yielded5control clinic trials (CCTs) and1RCT with322cervicalcancer patients. There was no significant difference between laparoscopic and laparotomicapproaches to early stage cervical cancer in3-year overall survival,3-year recurrence,intra-operative complications rates, post-operative complications rates and pelvic nodes yield.The benefits of laparoscopic surgery versus laparotomy were shorter length of hospital stay,and less blood loss. The dis-advantages was the longer time of surgical procedure.Conclusions: Laparoscopic surgery appears to show benefits for women with early stagecervical cancer as compared with laparotomy in the length of hospital stay and blood loss.However, there were not any good evidence for the recommendation of laparoscopy for theroutine management of patients with early stage cervical cancer. Further well-designed,multi-centre RCTs are needed to assess the long-term clinical outcomes, particularly thequality of life.