| BackgroundVulvar cancer is a rare malignant tumor of female reproductive system,which has a low incidence and is more common in postmenopausal women.It seriously threatens the life and health of women.In recent years,due to the increase of HPV infection rate,the incidence rate of vulvar cancer has gradually increased,and the age of onset tends to be younger.The treatment of vulvar cancer is mainly surgery,supplemented by radiotherapy and chemotherapy.Inguinal lymph node is the first lymph node of metastasis.Radical vulvectomy and open inguinal lymphadenectomy are traditional radical surgeries for vulvar cancer.Although it is effctive in tumor resection,there are many postoperative complications(such as inguinal incision infection,incision split,incision scar contracture,lymphocyst and lymphoedema)seriously affecting patients’ living quality.In recent years,the gradual development of laparoscopic technology has greatly reduced the incidence of surgical complications.But with the progress of technology and the deepening of the understanding of minimally invasive concepts,the limitations of laparoscopy have gradually appeared.For example,the two-dimensional surgical field results in the instereoscopic anatomic structure during the operation.The assistants hold the mirror which makes the lens unstable and so on.The newly-developed da Vinci robotic surgical system has overcomethe limitations of the laparoscopy.In addition,its enlarged three-dimensional surgical field makes the exposure of deep and narrow field of groin more clear.Its flexible EndoWrist system can better perform the separation,suture,knotting and other surgical manipulations.It has become a new choice of gynecological minimally invasive surgery and greatly promotes the development of the gynecological surgery.At present,the application of da Vinci robotic surgical system in gynecological benign and malignant tumors has gradually increased.However,there are few domestic and foreign studies on the application of robotic surgery in vulvar cancer,which causes lake of unified opinion.The purpose of this study is to investigate the safety and effectiveness of the da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy for vulva squamous cell cancer.ObjectiveTo investigate the safety and effectiveness of the da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy for vulva squamous cell cancer by comparing the clinical data of da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy with that of the traditional laparoscopic surgery.Materials and MethodsRetrospective analysis was performed on the clinical information of 58 patients with vulvar squamous cell cancer(FIGO stage ⅠB～Ⅳ)who underwent radical vulvar resection+robotic or traditional laparoscopic inguinal lymphadenectomy in the First Affiliated Hospital of Zhengzhou University from October 2014 to July 2019.21 cases underwent da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy and 37 cases underwent traditional laparoscopic inguinal lymphadenectomy.The operative time(time of completing unilateral inguinal lymphadenectomy),the amount of unilateral blood loss,the number of unilateral inguinal lymph nodes resected,intraoperative complications(vascular injury),postoperative exhaust time,postoperative extubation time,postoperative hospitalization,postoperative complications(complications of lower limb and incision),recurrence,overall survival and progression-free survival were analyzed and compared between the two groups.The data were analyzed by independent sample t-test and χ2 test in SPSS22.0,Kaplan-meier method was used to compare the survival and prognosis of patients between two groups.If P<0.05,the difference was statistically significant.Result(1)The general information(age,BMI,FIGO stage,histological grade,lesion,comorbidities,preoperative lymph node status,postoperative adjuvant therapy,the follow-up)of two groups were not significantly different(P>0.05).(2)Comparison of intraoperative index:The operations were successfully completed in both groups without major vascular injury.There was no case transferred to laparotomy.The unilateral operative time of robotic group was significantly longer than that of traditional laparoscopic group[(96.95±22.96)vs(81.82±25.01)min,P=0.026].The unilateral blood loss of the robotic group was less than that of the traditional laparoscopic group[(13.67±6.16)vs(20.27±9.20)ml,P=0.005].More unilateral inguinal lymph nodes were removed in the robotic group than the traditional laparoscopic group[(10.06±3.73)vs(8.16±3.43),P=0.010].(3)Comparison of postoperative data:The postoperative hospitalization days of robotic group was significantly lower than that of the traditional laparoscopic group[(9.95±3.06)vs(13.00±4.44)d,P=0.015].There was no significant difference in postoperative exhausting time,the removal time of the drainage tube and postoperative complication(P>0.05).(4)Comparison of recurrence and survival prognosis:The follow-up of robotic group is(19.57±11.65)months and the follow-up of traditional laparoscopic group is(23.95±16.19)month.The recurrence rate,overall survival and progression-free survival of two groups during the follow-up were not significantly different(P>0.05).Conclusion1.The application of da Vinci robotic surgical system in the inguinal lymphadenectomy for vulvar squamous cell cancer is safe and feasible.2.Da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy has less intraoperative blood loss and more inguinal lymph nodes resected than traditional laparoscopic surgery.Moreover,it has reduced length of postoperative hospitalization.3.The short-term recurrence rate and the survival prognosis of da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy for vulvar squamous cell cancer are similar to traditional laparoscopic surgery.4.The application of da Vinci robotic-assisted laparoscopic inguinal lymphadenectomy for vulvar squamous cell cancer requires further investigation.Multicenter,large-sample and prospective studies are still needed. |
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