Comparative Analysis Of Laparoscopic Surgery And Abdominal Surgery For The Oncological Outcome Of Early Cervical Cancer

Objective:The aim of this study is to compare the long-term efficacy of laparoscopic and abdominal radical surgery for early-stage cervical cancer.Methods:Clinicopathologic data of 1226 patients with stage IA1(with LVSI +)-ⅡA1(FIGO2009)cervical cancer who underwent radical hysterectomy from January 2013 to December 2017 in our hospital,were retrospectively screened according to the inclusion and exclusion criteria.A total of 1,226 patients were included in this study,1030 patients in conventional laparotomy group(ARH group)and 196 patients in laparoscopic radical surgery group(LRH group).Because of the imbalance of the data bases of the two groups,risk factors for cervical cancer recurrence and some basic conditions(year of treatment,age,clinical stage,parametrium invasion,positive viginal margin,lymph node metastasis,cervical stromal invasion depth,tumor size,lymphovascular space invasion,and postoperative adjuvant treatment)were matched according to 1: 1 propensity score matching(PSM)and 192 pairs of cases were successfully matched.The basic information and postoperative pathology data are compared,the 5-year disease-free survival(DFS)and 5-year overall survival(Overall Survival,OS)before and after matching are used as the criteria for judging tumor outcomes,and the factors affecting the patient’s prognosis are carried out univariate and multivariate survival analyses,further analyze the independent risk factors(P <0.05)affecting the prognosis and stratified analysis between different surgeons,and compare the prognosis of the two surgical methods in different stratification.Results:1.Uncontrolled / relapse and survival: The uncontrolled / relapse rate in the LRH group and the ARH group were both 5.2%(10/192);the uncontrolled / relapse rate of the pelvic cavity in the LRH group was 50%(5/10),30%(3/10)of distant metastases,20%(2/10)of unknown recurrence sites;50%(5/10)of pelvic uncontrolled / relapsed metastases in the ARH group,and 40 of distant metastases %(4/10),the unknown site of recurrence accounted for 10%(1/10);the difference between the two groups was not statistically significant(P = 0.771);the 5-year relapse-free survival rate of patients in the LRH group and the ARH group(Disease Free Survival(DFS)was 92.4% and 95.1%,and the 5-year overall survival(OS)was 94.5% and 95.1%,respectively.There was no significant difference between the two groups(P = 0.591,P = 0.779);2.Analysis of prognostic factors: Multivariate survival analysis showed that tumor diameter,para-aortic lymph node metastasis,positive vaginal incision margin,and cervical invasion depth were independent risk factors that affected the prognosis of patients with cervical cancer(P <0.01).Further stratified analysis of independent risk factors affecting the prognosis of patients with cervical cancer showed that there was no significant difference in the 5-year DFS and 5-year OS between the LRH group and the ARH group(P> 0.05).Conclusion:Laparoscopic radical cervical cancer surgery is safe and feasible in the treatment of long-term survival outcomes of early cervical cancer IA1(with LVSI +)-ⅡA1.