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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 278 -282. doi: 10.3877/cma.j.issn.1674-6899.2023.05.005

论著

机器人手术在中央型复发宫颈癌的应用
王楠, 孟元光, 马冰, 张鹏, 杨雯, 顾成磊, 闫志风, 翟青枝, 李明霞, 李震, 王铭洋, 李立安†()   
  1. 100853　北京，解放军总医院第一医学中心妇产科；100853　北京，解放军医学院
    100853　北京，解放军总医院第七医学中心妇产医学部
    100039　北京，解放军总医院第一医学中心普通外科医学部
    100007　北京，解放军总医院第三医学中心泌尿外科医学部
    100853　北京，解放军总医院第一医学中心妇产科
    100034　北京，北京大学第一医院妇产科
  • 收稿日期:2023-09-28 出版日期:2023-10-30
  • 通信作者: 李立安

Application of robot surgery in central recurrent cervical cancer

Nan Wang, Yuanguang Meng, Bing Ma, Peng Zhang, Wen Yang, Chenglei Gu, Zhifeng Yan, Qingzhi Zhai, Mingxia Li, Zhen Li, Mingyang Wang, Li′an Li†()   

  1. Department of Obstetrics and Gynecology, The First Medical Center of PLA General Hospital, Beijing 100853, China; Medicine School of Chinese PLA, Beijing 100853, China
    Faculty of Obstetrics and Gynecology, The Seventh Medical Center of the PLA General Hospital, Beijing 100007, China
    Faculty of General Surgery, The First Medical Center of the PLA General Hospital, Beijing 100853, China
    Faculty of Urology, The Third Medical Center of the PLA General Hospital, Beijing 100039, China
    Department of Obstetrics and Gynecology, The First Medical Center of PLA General Hospital, Beijing 100853, China
    Faculty of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
  • Received:2023-09-28 Published:2023-10-30
  • Corresponding author: Li′an Li
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引用本文：

王楠, 孟元光, 马冰, 张鹏, 杨雯, 顾成磊, 闫志风, 翟青枝, 李明霞, 李震, 王铭洋, 李立安. 机器人手术在中央型复发宫颈癌的应用[J]. 中华腔镜外科杂志(电子版), 2023, 16(05): 278-282.

Nan Wang, Yuanguang Meng, Bing Ma, Peng Zhang, Wen Yang, Chenglei Gu, Zhifeng Yan, Qingzhi Zhai, Mingxia Li, Zhen Li, Mingyang Wang, Li′an Li. Application of robot surgery in central recurrent cervical cancer[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(05): 278-282.

目的

通过总结单中心机器人手术治疗中央型复发宫颈癌病例资料，探讨该疗法的临床应用价值。

方法

选取2014年9月至2022年12月期间在解放军总医院第一医学中心诊断并接受机器人手术治疗的19例中央型复发宫颈癌病例作为研究对象，回顾性分析病例特点、机器人手术相关情况、随访资料，讨论并分享相关经验。

结果

19例患者平均年龄47.53±7.33岁，平均体质量指数(body mass index，BMI)22.54±2.56 kg/m2，鳞癌17例、腺癌2例，平均复发间隔18.84±12.55个月，先期化疗5例，手术完成R0切除18例，发生严重并发症2例。其中接受盆腔廓清术(pelvic exenteration，PE)13例，与非PE手术组比较，PE手术组的先期化疗比例更高，手术时间更长、多学科协作比例更高，平均住院时间更长(P<0.05)。所有患者平均随访时间42.11±30.54个月，中位随访时间为25个月，1年期、2年期总生存率(overall survival，OS)分别为89.47%、68.42%。

结论

对于中央型复发宫颈癌，机器人手术是一种合理的治疗选择，应充分评估病情，合理把握手术指征，发挥机器人手术和多学科协作的优势，同时重视利用综合治疗的各种手段，改善患者预后。

关键词: 机器人手术, 宫颈癌, 中央型复发, 盆腔廓清术, 多学科团队
Objective

To investigate the clinical application value of robotic surgery in the treatment of central recurrent cervical cancer in a single center.

Methods

A total of 19 cases of central recurrent cervical cancer diagnosed and treated by robotic surgery in the First Medical Center of PLA General Hospital from Sep. 2014 to Dec. 2022 were selected as the research objects. The characteristics of the cases, the relevant situation of robotic surgery, and follow-up data were retrospectively analyzed. In addition, the diagnosis and treatment experience were discussed and shared.

Results

The average age of the 19 patients was 47.53±7.33 years, the average BMI was 22.54±2.56 kg/m2, there were 17 cases of squamous cell carcinoma and 2 cases of adenocarcinoma. The mean recurrence interval was 18.84±12.55 months, 5 cases of neoadjuvant chemotherapy, 18 cases of surgical R0 resection, and 2 cases of serious complications. Among them, 13 patients received pelvic exenteration(PE). Compared with the non-PE surgery group, the PE surgery group reported a higher proportion of neoadjuvant chemotherapy, a longer operation time, a higher proportion of multidisciplinary collaboration, and a longer mean hospital stay (P<0.05). The mean follow-up time of all patients was 42.11±30.54 months, and the median follow-up time was 25 months. The 1-year and 2-year overall survival were 89.47% and 68.42%, respectively.

Conclusion

For central recurrent cervical cancer, robotic surgery is a reasonable treatment option. The condition should be fully evaluated, surgical indications should be strict, the advantages of robotic surgery and multidisciplinary collaboration should be brought into play, and various means of comprehensive treatment should be emphasized to improve the prognosis of patients.

Key words: Robotic surgery, Cervical cancer, Central recurrence, Pelvic exenteration, Multidisciplinary team
表1 机器人PE手术组与非PE组相关情况比较[n(%)]
项目 PE手术组(13例) 非PE手术组(6例) Z/卡方值 P值
复发间隔(月) 19.31±11.49 17.83±15.77 －1.820 0.069
肿瘤切除最大径(cm) 4.45±2.53 4.13±1.75 －0.531 0.596
先期化疗(例) 5 0 －31.386 <0.001
手术时间(min) 301.23±84.71 179.17±83.27 －27.549 <0.001
手术出血量(ml) 251.54±299.91 105±62.85 － 0.111
输血率(例) 4 1 － 0.480
R0切除(例) 12 6 0.487 0.485
中转开腹(例) 1 0 － 0.684
机器人MDT手术(例) 13 0 － <0.001
平均住院日(d) 17.54±5.59 13.5±7.5 －2.955 0.003
1
Adiga D, Eswaran S, Pandey D, et al. Molecular landscape of recurrent cervical cancer[J]. Crit Rev Oncol Hematol, 2021, 157：103178.
2
Podwika SE, Duska LR. Top advances of the year: cervical cancer[J]. Cancer, 2023, 129(5)：657-663.
3
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3)：209-249.
4
刘继红，黄鹤，万挺. 盆腔器官廓清术在复发宫颈癌治疗中的价值[J]. 中国实用妇科与产科杂志，2018, 34(11)：1223-1226.
5
Bankar GR, Keoliya A. Robot-assisted surgery in gynecology[J]. Cureus, 2022, 14(9)：e29190.
6
Matsuo K, Machida H, Mandelbaum RS, et al. Validation of the 2018 FIGO cervical cancer staging system[J]. Gynecol Oncol, 2019, 152(1)：87-93.
7
Bouraoui I, Bouaziz H, Tounsi N, et al. Survival after pelvic exenteration for cervical cancer[J]. J Obstet Gynaecol India, 2022, 72(1)：66-71.
8
Martínez-Gómez C, Angeles MA, Martinez A, et al. Urinary diversion after pelvic exenteration for gynecologic malignancies[J]. Int J Gynecol Cancer, 2021, 31(1)：1-10.
9
Straubhar AM, Chi AJ, Zhou QC, et al. Pelvic exenteration for recurrent or persistent gynecologic malignancies: clinical and histopathologic factors predicting recurrence and survival in a modern cohort[J]. Gynecol Oncol, 2021, 163(2)：294-298.
10
谢鹏，郭秋芬，张师前. 复发性子宫颈癌的综合治疗[J]. 中国实用妇科与产科杂志，2022, 38(5)：499-503.
11
Lewandowska A, Szubert S, Koper K, et al. Analysis of long-term outcomes in 44 patients following pelvic exenteration due to cervical cancer[J]. World J Surg Oncol, 2020, 18(1)：234.
12
Rubin SC, Hoskins WJ, Lewis JL Jr. Radical hysterectomy for recurrent cervical cancer following radiation therapy[J]. Gynecol Oncol, 1987, 27(3)：316-324.
13
Marescaux J, Seeliger B. Robotic surgery: a time of change[J]. Updates Surg, 2023, 75(4)：793-794.
14
Garbutt AM. Working towards clinical effectiveness-a multi-disciplinary approach to robotic surgery[J]. Ann Cardiothorac Surg, 2019, 8(2)：255-262.
15
Li L, Ma SQ, Tan XJ, et al. Pelvic exenteration for recurrent and persistent cervical cancer[J]. Chin Med J (Engl), 2018, 131(13)：1541-1548.
16
Li J, Gong X, Li P, et al. Application of Da Vinci robotic surgery system in cervical cancer: a single institution experience of 557 cases[J]. Asian J Surg, 2022, 45(2)：707-711.
17
王楠，李立安，范文生，等. 达芬奇机器人盆腔廓清术在妇科肿瘤患者中的应用[J/CD]. 中华腔镜外科杂志(电子版), 2023, 16(2)：91-95.
18
Cibula D, Raspollini MR, Planchamp F, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023[J]. Int J Gynecol Cancer, 2023, 33(5)：649-666.
19
Glane LT, Hegele A, Wagner U, et al. Gynecologic oncology: pelvic exenteration for advanced or recurring cervical cancer - a single center analysis[J]. Cancer Diagn Progn, 2022, 2(3)：308-315.
20
李立安，张唯一，马鑫，等. 机器人辅助腹腔镜盆腔廓清术的初步经验--附1例报告[J]. 中国微创外科杂志，2015(4)：347-349, 354.
21
孟元光，翟青枝. 达芬奇机器人系统在妇科领域的应用进展及展望[J/CD]. 妇产与遗传(电子版), 2019, 9(2)：10-13.
22
陈振波，范文生，李立安，等. 机器人辅助腹腔镜手术治疗深部浸润型子宫内膜异位症[J]. 中国微创外科杂志，2020, 20(7)：624-627.
23
刘云玥，范文生，顾成磊，等. 达芬奇机器人MDT模式全盆腔廓清术治疗晚期宫颈癌一例[J/CD]. 中华腔镜外科杂志(电子版), 2022, 15(4)：249-251.
24
陈圆，王志启，邓浩，等. 复发性子宫颈癌行盆腔廓清术围术期情况及近期预后分析[J]. 实用妇产科杂志，2019, 35(2)：141-145.
25
Germanova A, Raspagliesi F, Chiva L, et al. Oncological outcome of surgical management in patients with recurrent uterine cancer-a multicenter retrospective cohort study-CEEGOG EX01 Trial[J]. Int J Gynecol Cancer, 2019, 29(4)：711-720.
26
Cohen AC, Roane BM, Leath CA 3rd. Novel therapeutics for recurrent cervical cancer: moving towards personalized therapy[J]. Drugs, 2020, 80(3)：217-227.
27
Mabuchi S, Shimura K, Matsumoto Y. The significance of post-radiotherapy parametrial involvement and the necessity of parametrial resection in locally-recurrent or persistent cervical cancer developed after radiotherapy[J]. J Gynecol Obstet Hum Reprod, 2021, 50(10)：102190.
28
李静，孔为民. 复发性子宫颈癌的治疗研究进展[J]. 中国妇幼保健，2023, 38(9)：1743-1746.
29
Mutlu L, Tymon-Rosario J, Harold J, et al. Targeted treatment options for the management of metastatic/persistent and recurrent cervical cancer[J]. Expert Rev Anticancer Ther, 2022, 22(6)：633-645.
30
Colombo N, Dubot C, Lorusso D, et al. Pembrolizumab for persistent, recurrent, or metastatic cervical cancer[J]. N Engl J Med, 2021, 385(20)：1856-1867.
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