腹腔镜宫颈癌治疗 (LACC) 研究结果彻底改变了我们对这种疾病最佳手术治疗的理解。指南发布后指出，根治性子宫切除术的标准和推荐方法是开腹手术。尽管如此，LACC试验对根治性子宫切除术手术方式的现实变化的影响仍然难以捉摸。我们的目的是研究根治性子宫切除术的趋势和路径，并评估LACC试验前后的术后并发症发生率（2018年） ）。国家手术质量改进计划登记册用于检查 2012 年至 2022 年间针对宫颈癌进行的根治性子宫切除术。我们排除了阴道根治性子宫切除术和简单子宫切除术。主要结局指标是手术途径[微创手术 (MIS) 与剖腹手术]和手术并发症发生率的趋势，按 2018 年 LACC 试验发表前后的时间段进行分层（2012-2017 年与 2019-2022 年） ）。次要结果指标是与不同手术途径相关的主要并发症。在 3,611 名患者中，2,080 名 (57.6%) 接受了剖腹手术，1,531 名 (42.4%) 接受了 MIS 根治性子宫切除术。从 2012 年到 2017 年，MIS 方法显着增加（2012 年为 45.6% MIS，2017 年为 75.3% MIS，p<.001），而从 2018 年到 2022 年，MIS 方法显着下降（2018 年为 50.4% MIS，到 2017 年为 11.4） 2022 年 MIS 百分比，p<.001）。 LACC 试验前的轻微并发症发生率较低 [317 例 (16.9%) 对比 288 例 (21.3%)，p=0.002]。 LACC 试验前后主要并发症发生率相似 [139 (7.4%) vs. 78 (5.8%)，p=.26]。 LACC 试验前的输血率和浅表手术部位感染率较低 [137 (7.3%) 比 133 (9.8%)，p=0.012 和 20 (1.1%) 比 53 (3.9%) ，p<.001，分别]。在整个研究期间，对 MIS 与剖腹根治性子宫切除术进行比较，MIS 组患者的轻微并发症发生率较低 [190 (12.4%) vs. 472 (22.7%)，p<.001]，并且两组的主要并发症相似[MIS 组有 100 例（6.5%），剖腹手术组有 139 例（6.7%），p=.89]。在一项具体的并发症分析中，MIS 组的输血率和浅表手术部位感染率较低（2.4% vs. 12.7%，以及 0.6% vs. 3.4%，两个比较的 p<.001），并且MIS 组的深部切口手术部位感染率较低（0.2% vs. 0.7%，p=0.048）。在多元逻辑回归分析中，根治性子宫切除术的途径与主要并发症的发生并不独立相关[aOR 95% CI 1.02 (0.63-1.65)]。虽然 LACC 试验后 MIS 根治性子宫切除术的比例突然下降，但主要术后并发症的发生率没有变化。此外，子宫切除术途径与主要术后并发症无关。版权所有 © 2024 Elsevier Inc. 保留所有权利。

The Laparoscopic Approach to Cervical Cancer (LACC) study results revolutionized our understanding of the best surgical management for this disease. Following its publication, guidelines state that the standard and recommended approach for radical hysterectomy is with an open abdominal approach. Nevertheless, the impact of the LACC trial on real-world changes in the surgical approach to radical hysterectomy remains elusive.We aimed to study the trends and routes of radical hysterectomies and to evaluate post-operative complication rates before and after the LACC trial (2018).The National Surgical Quality Improvement Program registry was used to examine radical hysterectomies performed for cervical cancer between 2012-2022. We excluded vaginal radical hysterectomies and simple hysterectomies. The primary outcome measures were the trends in route of surgery [minimally invasive surgery (MIS) vs. laparotomy] and surgical complications rate, stratified by periods before and after the publication of the LACC 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 3,611 patients included, 2,080 (57.6%) underwent laparotomy and 1,531 (42.4%) underwent MIS radical hysterectomy. There was a significant increase in the MIS approach from 2012 to 2017 (45.6% MIS in 2012 to 75.3% MIS in 2017, p<.001), and a significant decrease in MIS from 2018 to 2022 (50.4% MIS in 2018 to 11.4% MIS in 2022, p<.001). The rate of minor complications was lower in the period before the LACC trial [317 (16.9%) vs. 288 (21.3%), p=.002]. Major complications rate was similar before and after the LACC trial [139 (7.4%) vs. 78 (5.8%), p=.26]. The rates of blood transfusions and superficial surgical site infections were lower in the period before the LACC 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 MIS vs. laparotomy radical hysterectomy during the entire study period, patients in the MIS group had lower rates of minor complications [190 (12.4%) vs. 472 (22.7%), p<.001] and the rate of major complications was similar in both groups [100 (6.5%) in the MIS 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 MIS groups (2.4% vs. 12.7%, and 0.6% vs. 3.4%, p<.001 for both comparisons) and the rate of deep incisional surgical site infections was lower in the MIS group (0.2% vs. 0.7%, p=.048). In a multiple logistic regression analysis, the route of radical hysterectomy was not independently associated with occurrence of major complications [aOR 95% CI 1.02 (0.63-1.65)].While the proportion of MIS radical hysterectomy decreased abruptly following the LACC trial, there was no change in the rate of major post-operative complications. In addition, hysterectomy route was not associated with major post-operative complications.Copyright © 2024 Elsevier Inc. All rights reserved.