宫颈癌微创与开腹根治性子宫切除术后结局的系统综述和Meta分析

A Systematic Review and Meta-Analysis of Outcomes following Minimally Invasive versus Open Radical Hysterectomy for Cervical Cancer

摘要: 目的：旨在评价2018年之后微创根治性子宫切除术(MIS)与开腹根治性子宫切除术(ORH)治疗宫颈癌的术后疗效，探讨MIS和ORH在治疗宫颈癌中的价值。方法：系统检索PubMed、Embase及Web of Science自2018年之后发表的相关文献，初检获得399篇研究。经双人独立去重筛选后，最终纳入11篇符合预设标准的文献。采用RevMan 5.3软件进行Meta分析，纳入的结局指标包括死亡、复发、术后淋巴结转移、术后并发症、术后辅助治疗、手术时间、术中失血量、住院时长、5年无病生存率及5年总生存率等。结果：筛选后纳入11项研究，包括9028例患者。Meta分析显示(P < 0.05具有统计学意义)，MIS与较低的死亡人数相关(95%CI = 0.66~0.94, P = 0.01)，MIS术后辅助治疗人数少(95%CI = 0.72~0.88, P < 0.00001)，MIS患者术后淋巴结转移少(95%CI = 0.70~0.80, P = 0002)，MIS和ORH在住院时间上有显著差异，即MIS术后住院时间较ORH短(95%CI = −2.53~0.63, P = 0.001)，MIS和ORH在5年无病生存率上有显著差异，ORH术后5年无病生存率优于MIS (95%CI = 1.01~1.59, P = 0.04)，MIS术中失血量少于ORH，MIS和ORH在术中失血量上通过敏感性分析后有统计学意义，即微创术中失血量少(95%CI = −128.45~60.04, P < 0.00001)。MIS和ORH术后复发人数无显著差异(95%CI = −0.02~0.02, P = 0.95)，MIS和ORH在术后并发症上无显著差异(95%CI = 0.67~1.44, P = 0.91)，MIS和ORH在操作时间上无显著差异(95%CI = −42.47~60.55, P = 0.73)，MIS和ORH在5年总生存率无显著差异(95%CI = 0.78~1.63, P = 0.52)。结论：微创根治性子宫切除术在降低围手术期死亡率、减少淋巴结转移、缩短住院时间及减少术中失血方面优于开腹手术，且术后辅助治疗需求更低；然而，其5年无病生存率不及ORH。这些发现为宫颈癌的手术治疗提供了重要的临床指导，有助于医生根据患者的具体情况选择最适合的手术方法，具有十分重要的临床意义。

Abstract: Objective: To evaluate the postoperative outcomes of minimally invasive radical hysterectomy (MIS) versus open radical hysterectomy (ORH) for the treatment of cervical cancer since 2018, and to explore the value of MIS and ORH in the treatment of cervical cancer. Methods: We systematically searched PubMed, Embase, and Web of Science, identifying 399 initial records published after 2018. After duplicate removal and independent screening by two reviewers, 11 studies meeting the preset criteria were ultimately included. Meta-analysis was performed using RevMan 5.3, assessing mortality, recurrence, lymph node metastasis, complications, adjuvant therapy, operative time, blood loss, hospital stay, 5-year disease-free survival (DFS), and 5-year overall survival (OS). Results: Our Meta-analysis of 11 included studies involving 9028 patients revealed several statistically significant findings (P < 0.05). Minimally invasive surgery (MIS) demonstrated superior outcomes in multiple parameters: significantly lower mortality rates (95%CI = 0.66~0.94, P = 0.01), reduced requirement for adjuvant therapy (95%CI = 0.72~0.88, P < 0.00001), decreased incidence of lymph node metastasis (95%CI = 0.70~0.80, P = 0002), shorter hospitalization duration (95%CI = −2.53~0.63, P = 0.001), and substantially less intraoperative blood loss (95%CI = −128.45~60.04, P < 0.00001). However, open radical hysterectomy (ORH) showed better 5-year disease-free survival outcomes (95%CI = 1.01~1.59, P = 0.04). No statistically significant differences were observed between the two surgical approaches in terms of recurrence rates (95%CI = −0.02~0.02, P = 0.95), postoperative complications (95%CI = 0.67~1.44, P = 0.91), operative time (95%CI = −42.47~60.55, P = 0.73), or 5-year overall survival (95%CI = 0.78~1.63, P = 0.52). Conclusion: Minimally invasive radical hysterectomy demonstrates superior outcomes compared to open procedures in terms of reduced perioperative mortality, decreased incidence of lymph node metastasis, shorter hospital stays, diminished intraoperative blood loss, and lower requirements for adjuvant therapy. However, it is associated with inferior 5-year disease-free survival rates relative to open radical hysterectomy. These findings provide crucial clinical guidance for surgical management of cervical cancer, enabling clinicians to select the most appropriate surgical approach based on comprehensive patient evaluation, with significant clinical importance.