| [Obejective]Cervical cancer is one of the most commonly seen malignant neoplasm of the female reproductive tract.The treatment modality remains different according to FIGO stage individually.For early stage cervical cancer patients,surgical treatment is the first option.Nevertheless,radiotherapy or concurrent radio-chemotherapy is mostly recommended for late stage patients.Trans-abdominal radical hysterectomy together with bilateral pelvic lymphadenectomy as described by Dr E.Wertheim has been the traditional and standard surgical management for early cervical cancer for centuries.Since 1990 s,the concept of minimally invasive surgery was put forward,the surgery procedures has undergone a strikingly huge change.People now are able to choose different procedures to finish the operations.The aim of this research is to analyze the robotic-assisted laparoscopic hysterectomy,traditional laparoscopic hysterectomy and trans-abdominal hysterectomy for cervical cancer patients in terms of surgical and oncological outcomes and provide patients with a comprehensive evaluation of different surgery options.[Method]According to the predesigned inclusion and exclusion criteria,we finally included 348 cervical cancer patients in the research.All the data were collected via the electronic medical record system or the record room storage.52 patients operated with the robotic system were compared with 190 and 106 patients who respectively underwent traditional laparoscopic and trans-abdominal radical hysterectomy and bilateral lymphadenectomy.Peri-operative data likeoperation time,and survival rates were collected and subsequently analyzed among groups to comprehensively evaluated the operative ways.[Results]All the relevant data was analyzed with SPSS 24.0.The baseline distributions of patients were equivalent and comparable within three groups in age,BMI,FIGO stage.The mean operation time was the longest in RRH group(P <0.001)which was 293.96±73.98 minutes.There was no difference in LRH(216.25±55.47 minutes)and TRH(227.69±52.76 minutes)groups concerning operation time.The estimated blood loss for RRH,LRH and TRH groups were 374.04±273.05 ml,347.11±480.26 ml and 861.79±618.89 ml respectively.It was significantly the most in the TRH group(P <0.001).When it comes to the lymph node retrieve,no group gained more than the other two ones.All patients gained successful operations without intra-operative complications.The post operative complications incidence in RRH,LRH and TRH groups were 19.2%,17.4% and 21.7%,however with no significant difference.The resumption of urinary function was defined as the duration for catheter implantation time,and robotic surgery was associated with a significant reduction in urinary recovery with 14.81±4.72 days versus 16.96±8.16 and 17.60±8.67 days in LRH and TRH respectively(P <0.05).Length for hospital stay was 18.41±5.84 days in TRH groups and it was the longest.RRH and LRH were the same in urinary recovery or hospital stay.Kaplan-Meier survival analysis illustrated an equivalent overall survival and disease-free survival within three groups,both with a p-value more than 0.05.Robotic surgery was associated with a shorter learning curve when compared with laparoscopic surgery.Besides,after the turning point there is a significant reduction in operation time with robotic system.And only robotic system provides the surgeons with a humanized and comfortable working environment which improves the efficiency.[Conclusions] According to the above results,we get the following conclusions.1.The RRH group was associated with the longest operation time however,after experiencing the turning point there will be an obvious reduction.2.The estimated blood loss was the most in the TRH group and that was similar in RRH and LRH groups.3.The post operative complications were distributed equally among three groups.4.Patients in the RRH group had an earlier urinary recovery than the other two groups.5.No significant differences existed among three groups in OS or DFS.6.The application of Robotic-assisted surgery in the treatment of cervical cancer patients was safe and feasible,but further prospective research with larger samples was expected. |
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