Retrospective Analysis Of Different Surgical Procedures For 141 Cases Of Stage ? Endometrial Caicinoma

Objective: Endometrial cancer is one of the three most malignant tumors of female reproductive system,the incidence rate has gradually increased in recent years.The 2019 NCCN guidelines recommend the standard procedure for endometrial cancer is comprehensive surgical staging.Total hysterectomy and bilateral salpingo-oophorectomy and surgical staging are primary surgery for disease limited to the uterine body.The 2018 FIGO guidelines clearly state that the basic operation for endometrial cancer is total hysterectomy with bilateral adnexectomy,and lymph node resection is required for patients with high-risk factors.Both of them have clear regulations on the scope of hysterectomy.However,many scholars have questioned whether the scope of total hysterectomy is adequate for patients with stage ?endometrial cancer complicated by high-risk factors.In clinical practice,we noticed that the cervical invasion was suspected preoperatively,and the operation scope of stage ?endometrial cancer was adopted,but the postoperative surgical pathological staging was stage I.For these two questions,we compared the differentsurgical methods of 141 patients with stage ? endometrioid adenocarcinoma,in order to investigate the influence of surgical scope on operation related index,surgical complications and prognosis,hoping to provide reference for the selection of surgical methods for stage ? endometrioid adenocarcinoma.Methods: 141 patients with stage ? endometrioid adenocarcinoma who underwent surgical treatment from January 1,2013 to October 1,2018 in the First Affiliated Hospital of Chongqing Medical University were collected.They were divided into 5 groups according to different surgical methods.Group A: Laparoscopic extensive hysterectomy,bilateral adnexectomy and pelvic lymphadenectomy were performed in 15 cases(10.64%).Group B: Laparoscopic sub-extensive hysterectomy,bilateral adnexectomy and pelvic lymphadenectomy were performed in 63 cases(44.68%).Group C: Laparoscopic extended hysterectomy,bilateral adnexectomy and pelvic lymphadenectomy were performed in 16 cases(11.35%).Group D: Laparoscopic total hysterectomy,bilateral adnexectomy and pelvic lymphadenectomy were performed in 34 cases(24.11%).Group E: Laparoscopic sub-extensive hysterectomy,bilateral adnexectomy,pelvic lymphadenectomy and para-aortic lymphadenectomy were performed in 13 cases(9.22%).Excel software was used to establish the database for the included cases,SPSS 25.0 software was used for data analysis.Kruskal-wallis test(H test)of multiple independent samples andkruskal-wallis single-factor ANOVA analysis were used for comparison between grouped data.The survival rate was calculated by Kaplan-meier and the survival curve was obtained.The significant differences are defined as P < 0.05.Results: There were no significant differences in the age of onset,the proportion of stage IA and stage IB,the proportion of patients with high-risk factors and the proportion of patients with medical diseases between the 5 groups,indicating that there was no significant difference in the basic characteristics of patients before operation.There were no significant differences in intraoperative blood loss,surgical complications and postoperative exhaust time among the 5 groups.Group A was longer than Group B,C and D in operation time;In terms of the time of indwelling catheter,Group A was longer than Group C and D,Group B was longer than Group C and D,Group E was longer than Group D;In terms of the length of postoperative hospital stays,Group A was longer than Group D,Group B was longer than Group C and D.According to the survival curve,the postoperative survival time of group A is less than that of group B,C and D,and group E is less than group B,C and D.Conclusion: The survival of stage ? endometrioid carcinoma could not be improved by extending the excision of uterus and para-aortic lymphadenectomy.Although it would not increase the incidence of bleeding and postoperative complications,it increases the operation timeand postoperative hospitalization time,as well as the stress from postoperative recovery,hospitalization costs,and mental pressure.