腹腔镜方法进行宫颈癌试验和相关并发症的宫颈癌的根治性子宫切除术方法：一项国家手术质量改善计划研究

腹腔镜研究的宫颈癌研究方法的结果彻底改变了我们对这种疾病最佳手术管理的理解。该准则在发布后指出，从根治性子宫切除术的标准和推荐方法是开放的腹部方法。然而，腹腔镜方法对宫颈癌试验的影响对实现自由基宫颈切除术的手术方法的现实世界变化仍然难以捉摸。这项研究旨在研究自由性子宫内膜切除术的趋势和途径，并评估术前和评估术后和术后术后术后术后的术后效果，以改进腹部癌症试验（2018）。在2012年至2022年之间进行的子宫颈癌子宫切除术。这项研究不包括阴道自由基子宫切除术和简单的子宫切除术。主要结果指标是手术途径（微创手术与剖腹手术）和手术并发症发生率的趋势，在2018年（2012-2017-2017 vs 2019-2022）发表腹腔镜方法之前和之后按周期进行了分层。次要结局指标是与包括不同手术的不同途径相关的主要并发症。包括3611例患者，2080（57.6％）进行了剖腹手术，1531（42.4％）进行了微创的自由基子宫切除术。 There was a significant increase in the minimally invasive surgery approach from 2012 to 2017 (45.6% in minimally invasive surgery in 2012 to 75.3% in minimally invasive surgery in 2017; P<.01) and a significant decrease in minimally invasive surgery from 2018 to 2022 (50.4% in minimally invasive surgery in 2018 to 11.4% in minimally invasive surgery in 2022; p <.001）。在腹腔镜方法进行宫颈癌试验之前，小小的并发症的发生率低于试验后（317 [16.9％]和288 [21.3％]； p = .002）。在腹腔镜方法进行宫颈癌试验之前和之后的主要并发症率相似（分别为139 [7.4％]和78 [5.8％]； p = .26）。在腹腔镜癌症试验之前，输血和浅表手术部位感染的发生率低于试验后（137 [7.3％] vs 133 [9.8％] [p = .012]和20 [1.1％] vs 53 [3.9％] [P <.00] [P <.001]，比试验的期间（137 [7.3％）[9.8％] [p = .012]。在整个研究期间，在比较微创手术与剖腹手术宫颈切除术中，微创手术组的患者的轻微并发症发生率低于剖腹手术组（190 [12.4％] [12.4％]和472 [22.7％] [22.7％]；剖腹手术组的入侵手术组为139 [6.7％]； p = .89）。在特定的并发性分析中，在微创手术组中输血率和表面手术部位感染的速率低于剖腹运动组（分别为2.4％和12.7％和0.6％和0.6％和0.6％vs 3.4％； p <.001; p <.001; p <.001;在两种比较中），而对术中的临床率较低。组（分别为0.2％和0.7％； p = .048）。 In the multiple logistic regression analysis, the route of radical hysterectomy was not independently associated with the occurrence of major complications (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65).Although the proportion of minimally invasive radical hysterectomies decreased abruptly after the Laparoscopic Approach to Cervical Cancer trial, there was no change in the rate of major postoperative并发症。此外，子宫切除术途径与术后主要并发症无关。

The Laparoscopic Approach to Cervical Cancer study results revolutionized our understanding of the best surgical management for this disease. After its publication, the guidelines state that the standard and recommended approach for radical hysterectomy is an open abdominal approach. Nevertheless, the effect of the Laparoscopic Approach to Cervical Cancer trial on real-world changes in the surgical approach to radical hysterectomy remains elusive.This study aimed to investigate the trends and routes of radical hysterectomy and to evaluate postoperative complication rates before and after the Laparoscopic Approach to Cervical Cancer trial (2018).The National Surgical Quality Improvement Program registry was used to examine radical hysterectomy for cervical cancer performed between 2012 and 2022. This study excluded vaginal radical hysterectomies and simple hysterectomies. The primary outcome measures were the trends in the route of surgery (minimally invasive surgery vs laparotomy) and surgical complication rates, stratified by periods before and after the publication of the Laparoscopic Approach to Cervical Cancer trial in 2018 (2012-2017 vs 2019-2022). The secondary outcome measure was major complications associated specifically with the different routes of surgery.Of the 3611 patients included, 2080 (57.6%) underwent laparotomy, and 1531 (42.4%) underwent minimally invasive radical hysterectomy. There was a significant increase in the minimally invasive surgery approach from 2012 to 2017 (45.6% in minimally invasive surgery in 2012 to 75.3% in minimally invasive surgery in 2017; P<.01) and a significant decrease in minimally invasive surgery from 2018 to 2022 (50.4% in minimally invasive surgery in 2018 to 11.4% in minimally invasive surgery in 2022; P<.001). The rate of minor complications was lower in the period before the Laparoscopic Approach to Cervical Cancer trial than after the trial (317 [16.9%] vs 288 [21.3%], respectively; P=.002). The major complication rates were similar before and after the Laparoscopic Approach to Cervical Cancer trial (139 [7.4%] vs 78 [5.8%], respectively; P=.26). The rates of blood transfusions and superficial surgical site infections were lower in the period before the Laparoscopic Approach to Cervical Cancer trial than in the period after the trial (137 [7.3%] vs 133 [9.8%] [P=.012] and 20 [1.1%] vs 53 [3.9%] [P<.001], respectively). In a comparison of minimally invasive surgery vs laparotomy radical hysterectomy during the entire study period, patients in the minimally invasive surgery group had lower rates of minor complications than in those in the laparotomy group (190 [12.4%] vs 472 [22.7%], respectively; P<.001), and the rates of major complications were similar in both groups (100 [6.5%] in the minimally invasive surgery group vs 139 [6.7%] in the laparotomy group; P=.89). In a specific complications analysis, the rates of blood transfusion and superficial surgical site infections were lower in the minimally invasive surgery group than in the laparotomy group (2.4% vs 12.7% and 0.6% vs 3.4%, respectively; P<.001; for both comparisons), and the rate of deep incisional surgical site infections was lower in the minimally invasive surgery group than in the laparotomy group (0.2% vs 0.7%, respectively; P=.048). In the multiple logistic regression analysis, the route of radical hysterectomy was not independently associated with the occurrence of major complications (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65).Although the proportion of minimally invasive radical hysterectomies decreased abruptly after the Laparoscopic Approach to Cervical Cancer trial, there was no change in the rate of major postoperative complications. In addition, the hysterectomy route was not associated with major postoperative complications.