| BackgroundOvarian malignant tumor is one of the most common malignant tumors of female reproductive system,which seriously threatens women's life and health.Ovarian cancer is a hidden disease.Due to the short of early and effective screening methods,more than 70% of the patients have advanced stage at first diagnosis,and the prognosis is poor.For many years,the treatment of advanced ovarian cancer is initial cytoreductive surgery and platinum-based adjuvant chemotherapy.In recent years,neoadjuvant chemotherapy combined with intermittent cytoreductive surgery as an alternative to initial cytoreductive surgery has been gradually applied in clinical practice.Satisfactory cytoreductive surgery is an independent risk factor affecting the prognosis of patients with advanced ovarian cancer,the survival benefit will be more if the tumour is complete removed.Up to now,laparotomy is still an important method for the treatment of advanced ovarian tumor.With the development of minimally invasive technology,the application of laparoscopy in ovarian cancer has been more popular,the da Vinci robotic-assisted surgical system has the advantages of clear three-dimensional vision,flexible and stable manipulator and short learning curve,which makes it easier for surgeons to achieve accurate operation.At present,the research of the da Vinci robotic-assisted surgical system in gynecological tumors is increasing.However,there are few studies on the therapeutic effect of the da Vinci robotic-assisted surgical system combined neoadjuvant chemotherapy in advanced ovarian cancer,so there is no consensus yet.The purpose of this study is to explore the safety and feasibility of the application of the da Vinci robotic-assisted surgical system in advanced ovarian cancer.ObjectiveIn this study,we aimed to compare the clinical data of patients with advanced ovarian cancer treated by da Vinci robotic assisted laparoscopic cytoreductive surgery with traditional laparoscopic surgery,to explore the safety and feasibility of the application of the da Vinci robotic-assisted surgical system in advanced ovarian cancer and provide a clinical basis for its application in the cytoreductive surgery of advanced ovarian cancer.Materials and MethodsThe clinical data of 62 patients with advanced ovarian cancer(FIGO stage III-IV)admitted to the First Affiliated Hospital of Zhengzhou University from September 2015 to October 2018 were retrospectively analyzed.Among them,32 cases in the robotic group and 30 cases in the traditional laparoscopic group.The percentage of ideal tumor cell reduction(residual tumor diameter < 1 cm),intraoperative condition(residual tumor focus),operative time(from skin incision to operation completion),intraoperative bleeding volume,number of lymph nodes removed(pelvic lymph nodes and para-aortic lymph nodes),conversion to laparotomy,intraoperative complications,postoperative complications,the postoperative exhausting time,the removal time of the drainage tube,length of hospital stay,overall survival time and progression-free survival time were compared.Result(1)There was no significant difference in general data and the time of neoadjuvant chemotherapy between two groups(P > 0.05),suggesting that the data was comparable.(2)The comparison of intraoperative data: There was one case converted to laparotomy in robotic group.There were two cases converted to laparotomy in laparoscopic group.There was no intraoperative complication between the two groups.There were significant differences in operation time,intraoperative bleeding volume and the number of para-aortic lymph nodes resected between two groups(P < 0.05).The operation time of robotic group was shorter than that of laparoscopic group [(158.06+26.23)vs(177.87+21.24)min,P=0.002].Robotic group has less bleeding volume[(107.41+17.77)vs(128.63+22.17)ml,P<0.001].The number of para-aortic lymph nodes resected in robotic group was more than that in laparoscopic group [(13.69 [3.45] vs(11.93 [2.63],P = 0.029].There was no significant difference in operative effect and number of pelvic lymph nodes excised between two groups(P > 0.05).(3)The comparison of postoperative data: The average hospital stay in robotic group was less[(7.16+1.40)vs(9.2+1.69)d,P < 0.001].There was no significant difference among the time of exhausting,the average time of drainage tube removal and the incidence of complications(P > 0.05).(4)Long-term survival: There was no significant difference in progression-free survival rate and overall survival rate between two groups during the follow-up period evaluated by Kaplan-Meier method.ConclusionIn advanced ovarian cancer,compared with traditional laparoscopic surgery,robotic-assisted surgical system can provide high-definition stereoscopic visual.It is easy for the surgeon to perform more elaborate operations.It can obviously reduce the operation time,blood loss and operation risk.It has the similar safety and feasibility compared with traditional laparoscopy.Meanwhile,it can shorten the lenth of hospital stay and reduce the consumption of high-quality medical resources,which is worth further development. |
PDF Full Text Request