早期子宫颈癌——该放弃腹腔镜手术吗?

Should we abandon laparoscopic surgery in the management of early stage cervical cancer?

近10年来,腹腔镜在子宫颈癌手术中得到广泛应用。然而,Pedro T.Ramirez等发表于《新英格兰医学杂志》的LACC研究显示,腹腔镜与开腹手术相比,子宫颈癌患者复发和死亡风险均显著升高;由于该研究存在一些缺陷,如未考虑腔镜手术学习曲线的影响,因此又不能排除研究结果偏倚。由此引发的广泛争议使子宫颈癌手术方式的选择陷入两难的境地。文章通过对LACC研究的审视、子宫颈癌腹腔镜手术中的潜在问题以及潜在优势的分析,探讨我们是否应该放弃子宫颈癌腹腔镜手术以及今后努力的方向。

Laparoscopy has been widely used in the surgical treatment of early stage cervical cancer.However,the unexpected results of LACC reported by Pedro T.Ramirez,et al.in the New England Journal of Medicine that minimally invasive surgery was associated with significantly increased risks of disease recurrence and death of cervical cancer patients sounded the warning bell.Meanwhile,the less rigorous study design of the trail of Ramirez,et al,particularly the disparity of surgical competency and experience of the included centers,has been criticized,because that possibly led to bias in the results.That triggered a great debate and caused a choice dilemma over surgery approaches.Hereby,we analyzed the limitations of LACC trial and the potential problems and advantages of laparoscopic surgery to find out the answer to the question whether laparoscopic surgery should be abandoned in cervical cancer or not and the direction which we should head towards in the post-LACC era.