| Part one Comparison of laparoscopy and robotic radical surgery for cervical cancerObjective: To explore the safety and feasibility of DVSS for cervical cancer surgery.Methods: The clinical data of 494 patients with cervical cancer who had received MIS in Xijing Hospital from March 2013 to June 2015 were retrospectively analyzed.All the patients had underwent radical hysterectomy and pelvic lymphadenectomy and/or paraortic lymphadenectomy.The patients were divided into two groups according to the type of the MIS: the robotic surgery group(n =369)and the laparoscopic surgery group(n=125).The under indexes was observed and compared,such as the mean OT,the EBL,the number of lymph node dissected,the postoperative exhaust time,the maximum temperature,the LOS,intraoperative and postoperative complications,the postoperative radiotherapy and chemotherapy,recurrence and survival,and so on.Results:1.The age,FIGO stage,pathological type,the history of pelvic and abdominal surgery between the two groups had no statistical significance(p>0.05).2.The operation of the robot surgery group were successfully completed,while no cases were converted to open surgery.No intraoperative blood transfusion was required.There was one patient converted to laparotomy and one blood transfusion in the laparoscopic surgery group.The mean OT of the robotic surgery group was195.00(167.50,225.00)min,was longer than the laparoscopic surgery group which was170.00(152.50,200.00)min(p<0.001).In the robotic group,the EBL was 50(30,50)ml,the recovery time of gastrointestinal function was(1.30±0.21)d,the LOS was 6(5,7)d and the mean time of indwelling catheter was 14(14,17)d.They were significantly shorter than the laparoscopic surgery group which was 100(50,200)ml,(1.53 ± 0.32)d,6(6,7)d and20(14,34)d(p<0.05).No significant difference was found between the two group about the number of lymph node dissected.The highest temperature after operation also had no statistical difference(p>0.05)。3.There was no intraoperative complication in the two groups.24 cases(6.50%)had postoperative complications in the robotic surgery group.24 cases(19.20%)had postoperative complications in the laparoscopic surgery group.They were statistically different(p<0.001).4.The robotic surgery group had 18(4.88%)patients recurred and 9(2.44%)patients died.While 10(8.00%)patients recurred and 5(4.00%)patients died in the laparoscopic surgery group.There was no significant difference in recurrence rate and mortality between the two groups(p>0.05).The three-year survival rates of the robot surgery group and laparoscopic surgery group was 97.30% and 94.20%,respectively.There was no statistical difference(p=0.285).Conclusions: For the cervical cancer with FIGOⅡB and before,compared with LRH,the RRH was less invasive,less EBL,shorter recovery time of gastrointestinal function,shorter LOS,and faster recovery of bladder function.In RRH,the rate of blood transfusion and conversion to laparotomy,the number of lymph nodes removed duringoperation and the postoperative maximum temperature of the robotic radical surgery were comparable to those in LRH.Although the OT was longer in RRH,the time will be shorter with the strengthening of proficiency.Moreover there were less postoperative complications in RRH.The recurrence rate,mortality and the three-year survival rates had no statistical difference between the two groups.The RRH is a safe and effective surgical procedure for cervical cancer.Part 2 Feasibility of robotic radical hysterectomy after preoperative chemoradiation in locally advanced cervical cancerObjective: To assess the feasibility of RRH in patients with LACC who receive chemoradiotherapy before surgery.Methods: A total of 101 patients with LACC(FIGOⅠB2 and ⅡA2)who had underwent RRH at Xijing Hospital,Fourth Military Medical University between March 2013 and June 2015 were enrolled in the study.The patient were divided into observation group and control group.38 patients in observation group were treated by preoperative chemoradiation,while 50 patients in control group were treated by surgery without preoperative chemoradiation.The clinical data of the patients were collected.The mean OT,the EBL,the LOS,intraoperative and postoperative complications,the postoperative pathological data,the postoperative radiotherapy and chemotherapy,recurrence and survival were compared between the two groups.The effects of preoperative chemoradiation in observation group was analyzed statistically.Results:1.Patients’ age,BMI,FIGO staging,pathological type and previous pelvic and abdominal surgery,was similar between the two groups(p>0.05).2.The number of lymph nodes in the observation group was less than that in the control group(p<0.001).The mean OT,the EBL,intraoperative blood transfusion rate,the mean postoperative maximum temperature,the LOS and postoperative indwelling catheter time were similar between groups(p>0.05).There were no significant differences in terms of intraoperative and postoperative complications(p>0.05).3.The 38 patients in the observation group received preoperative chemoradiation,the total effective rate was 73.68%(28/38),the CR rate was 23.68%(9/38),the PR rate was50.00%(19/38).4.In the observation group and the control group,the cervical deep interstitial invasion rates were 31.58% and 94.00% respectively,the positive rates of invasion of lymph-vessels space were 0.00% and 14.00% respectively,and the metastasis rate of pelvic lymph node were 5.30% and 28.00% respectively.The difference of these indexes was statistically significant(p< 0.05).5.The number of patients who underwent supplementary radiotherapy and chemotherapy after surgery were 15 in the observation group and 47 in the control group.The difference had statistical significance(p<0.001).The three-year survival rates of the two groups were 100.00% and 92.8%,respectively.The difference was not statistically significant(p>0.05).There was no difference in postoperative quality of life between the two groups(p>0.05).Conclusions: For LACC,preoperative chemoradiotherapy can not only reduce the size of the tumor,thereby providing surgery chances for patients,but also may improve the prognosis of patients.In the study,preoperative chemoradiotherapy did not increase the surgical trauma and complications.Therefore,LACC should be treated by comprehensive treatment combined preoperative chemoradiotherapy with robotic surgery.RRH after preoperative chemoradiation in women with LACC seems to be safe and feasible.These results need to be confirmed in RCT studies with a larger patients sample. |
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