Comparative Analysis Of Laparoscopic Surgery And Open Surgery In Elderly Age Women With Early Cervical Cancer

Background and objective:Cervical cancer is one of the most common malignant tumor of department of gynaecology with the high incidence of cervical cancer in our country at the age of 50 to 55 years old populations, the happening of cervical cancer in elderly age women increased in recent years. In 2006 the world health organization (WHO) defines the elderly age as above 65 years old in Europe and the United States developed countries, while in developing countries such as China above 60 years old is considered as the elderly age. Surgery is the preferred treatment of the early cervical cancer. Condidering the development of minimally invasive technology, diversified sugery method, individualized surgical treatments, and the difference of the physiological and pathological characteristics between the the women before menopause and the elderly age women after menopause,, what kind of surgery option is safer and more effective still needs to be further discussed.Methods:This study retrospectively analyzed the elderly age women of early cervical cancer (ⅠA2-ⅡA period) underwent laparoscopic and open radical hysterectomy combined with pelvic lymphadenectomy, compared the intraoperative and postoperative indicators and disscussed the appropriate safe and effective surgery treatment. Total 91 ederly age patients with early stage cervical cancer (ⅠA2-ⅡA period)from January 2010-July 2014 in three tertiary hospitals in Ningbo (Yinzhou, NingboUniversityAffiliatedHospital, Third Affiliated Hospital Ningbo Women and ChildrenHospital) were randomly enrolled in the study. There were 33 patients undergoing open radical hysterectomy (open group), and the other 58 patientrecieved laparoscopic radical hysterectomy (laparoscopic group). Surgery safety (surgery time, blood loss and major intraoperative surgery complications such as leeding, organ injury, death, and the number of resected lymph nodes and resected metastasis lymph nodes in each group), postoperative rehabilitation (postoperative complications such as infection, organ damage, nerve damage, thrombosis, the incidence of lymphatic cyst), and economic indicators (postoperative hospital stay and unplanned readmission and the difference between the total cost of hospitalization) in different surgery option was compared.Result:1.All the 91 surgery were successfully completed.2. the bleeding of laparoscopic group was significantly lower than the open group (206.3±10.6 vs 325.0±25.5,p <0.05) ml, flatus time after operation of Laparoscopic group was shorter than the laparotomy group (56.20±17.32 vs 76.80±22.41,p<0.05) h, pelvic infection and wound infection was also lower in laparoscopic y group, laparoscopic y group had shoter postoperative hospital stay than the laparotomy group ((14.50±4.1 vs 17.20± 3.2 d,p<0.05);3.There is no difference of the number of resected lymph nodes and resected metastasis lymph nodes between two groups. Postoperative rehabilitation indexes:the laparoscopic group/abdominal laparotomy group 5/6 patients with postoperative intestinal obstruction 1/2 cases,removal of the catheter time (14.40± 2.86) d/(14.00±3.15) d, urinary tract 10/10 cases of infection, urinary retention due to catheterization 6/6 example again, rectal 2/1 cases of ureteral injury, nerve damage 1/1 cases of lymphatic cyst 1/1,1/1 patients with the number of cases of deep vein thrombosis; the economy Indexes:laparoscopic group/laparotomy group 2/1 cases of unplanned readmissions, and total cost of hospitalization (22660±4723) yuan/(18650 ±3560) dollars, the two groups showed no significant difference (p> 0.05);4. The operative time (193.6±55.6) min inlaparoscopic group is longer than the open group (165.2±50.4) min, there is significant difference (P<0.05).Conclusion:1. The safety and the radical surgery degree of laparoscopic and open radical hysterectomy combined with pelvic lymphadenectomy is almost same in the elderly age patients of early cervical cancer.2. The laparoscopic radical hysterectomy has the advantage of less bleeding, faster bowel function recovery, rare pelvic infection and wound infection and shorter hospitalization time.3. Considering the physiological and pathological characteristics of elder patient, the laparoscopic and open radical hysterectomy combined with pelvic lymphadenectomy is feasible after preoperative detailed assessment of surgical indications and excluding the surgical contraindications。...