Clinical Comparative Study Of Abdominal Radical Hysterectomy Versus Laparoscopic Radical Hysterectomy For Squamous Cell Cervical Cancer In Early Figo Stage

Objective:To investigate the clinical value of abdominal radical hysterectomy(ARH)in the treatment of early FIGO stage cervical cancer by comparing intraoperative,postoperative and survival outcomes with laparoscopic radical hysterectomy(LRH),and explore the risky factors of pelvic lymph node metastasis.Method:A retrospective analysis was performed on clinical data of 182 patients who were diagnosed with FIGO stage ? A2?IB1?? A1 cervical cancer and underwent radical hysterectomy plus pelvic lymphadenectomy during January 2013 to March 2016 in Department of Gynecology of the First Affiliated Hospital of Guangxi Medical University.There were 132 cases in ARH group and 50 cases in LRH group.Baseline characteristics,operative time,intraoperative blood loss,number of lymph nodes obtained,postoperative anal exhaust time,catheterization time,indwelling drainage tube time,postoperative hospital day,complications and the short-term outcomes were summarized and analyzed.Pathological conditions(tumor size TS,histological grading,lymph-vascular space invasion LVSI,deep of invasion DI,margin of incision,lymphatic metastasis,vascular cancer thrombus)were also observed.Kaplan-Meier survival analysis was used to compare the 3-year disease-free survival(3-DFS)and 3-year overall survival(3-OS)between laparoscopic and open surgery.Log-rank test was used to compare the survival differences.Logistic regression analysis was applied to identify variables independently associated with more pelvic lymphatic metastasis.SPSS 21.0 statistical software was used,and P<0.05 was considered statistically significant.Results:1.The results showed that the age distribution of the patients confirmed cervical squamous cell carcinoma is unimodal,which ranged from 26 to 65 years old(45.5 mean).There were 132 patients in the ARH group and 50 patients in the LRH group.There was no significant difference in age,BMI,history of abdominal surgery,FIGO stage,HPV infection and SCC-Ag positive baseline materials.2.ARH was more excellent than LRH in terms of both operative time(261.89±64.21min vs.306.64±86.56min P=0.001)and the number of lymph nodes removed(15.42±7.36 vs.12.04±6.96,P=0.006).Meanwhile LRH had advantages over ARH in controlling blood loss(214.2 ±271.32ml vs.467.58±451.27ml,P=0.000)and reducing postoperative anal exhaust time(2.04±0.73d vs.3.11±0.69d,P=0.000).3.In all evaluated scenarios,patients in LRH group had a significantly better prognosis compared to patients in ARH group.There were statistical differences between two groups in postoperative fever(86%vs.96.2%,P=0.032),massive intraoperative bleeding(6%vs.21.2%,P=0.015),and poor wound healing(0 vs.10.6%,P=0.037).In addition,for complications including urinary tract infection,ureteral injury,intestinal injuries,lymphedema,ileus,deep venous thrombosis,and poor vaginal stump healing,there were no statistical difference between two groups respectively.The total incidence of the complications above showed statistical difference(6 cases in LRH group vs.50 cases in ARH group,P=0.001).4.The number of cases that with the tumor size(diameter>2cm)in ARH group was 56 and in LRH group was 9(P=0.002).The two groups were matched in equal significance between histological grading,lymph node metastasis,depth of tumor invasion,vascular invasion,parametrial invasion.5.The mean follow-up time of ARH group was 53.5 mouths.The mean follow-up time of LRH group was 48 mouths.Compared by Log-Rank test,there were no significant in 3-year OS(93.2%vs.96%,P=0.556)and 3-year DFS(91.7%vs.92.3%,P=0808).6.Logistic regression analysis showed:vascular invasion(P=0.000)and the level of SCC-Ag(P=0.038)were independent risk factors for pelvic lymphatic metastasis.7.Detection of SCC-Ag has a good predictive value for pelvic lymph node metastasis of early cervical squamous cell carcinoma,when the cut-off point was 3.0 ng/ml,the predictive value is the best.Conclusion:1?In terms of the number of lymph nodes obtained and operative time,ARH shows its advantages compared with LRH.At the same time,LRH shows its edge on controlling intraoperative bleeding,recovery of gastrointestinal function,faster wound healing,and low complication rate.While both surgical types can clear tumor effectively,ARH performs better when the diameter lager than 2cm compared with LRH.There are no obvious difference of 3-year OS and 3-year DFS.Both ARH and LRH are effective and safe approaches to cure early-stage cervical cancer.LRH has the prospect for more operable applications.2?From our data,it is considered that pelvic lymphatic metastasis is associated with vascular tumor thrombus and SCC-Ag level before treatment.