局部晚期子宮頸癌接受新輔助化療後行根除性子宮切除術：傳統手術與機器人手術的比較

Radical hysterectomy after neoadjuvant chemotherapy for locally bulky-size cervical cancer: a retrospective comparative analysis between the robotic and abdominal approaches

根除性子宮切除術是早期子宮頸癌的標準治療方法，但對於局部晚期子宮頸癌的治療能否藉由新輔助化療（NACT）來幫助提高根除性手術的成功率尚無定論。我們回溯性的比較了這類病人在接受新輔助化療後進行兩種不同的手術方式手術後結果和整體預後：機器人根除性子宮切除術（RRH）和傳統的開腹式根除性子宮切除術（ARH）。在2012年至2014年之間，共有39名患有FIGO stage IB2-IIB期腫瘤體積較大的子宮頸癌患者進行了NACT-R-RH（n＝18）與NACT-A-RH（n＝21）治療。兩組患者之間NACT-R-RH組的FIGO stage IIB患者較多，也有較多病患接受了多重藥物的NACT（紫杉烷／鉑基）治療。統計分析的結果顯示NACT-R-RH雖然有較好的手術結果，但生存結果及整體預後（DFS及OS）明顯較差。因此，我們總結FIGO stage IIB期且腫瘤體積較大的局部晚期子宮頸癌患者不適合接受NACT後再進行機器人根除性子宮切除手術。

Radical hysterectomy (RH) is the standard treatment for early-stage cervical cancer, but the surgical approach for locally bulky-size cervical cancer (LBSCC) is still unclear. We retrospectively compared the outcomes of women with LBS-CC treated with neoadjuvant chemotherapy (NACT) and subsequent RH between the robotic (R-RH) and abdominal approaches (A-RH). Between 2012 and 2014, 39 women with LBS-CC FIGO (International Federation of Gynecology and Obstetrics) stage IB2-IIB were treated with NACT-R-RH (n=18) or NACT-A-RH (n=21). Surgical parameters and prognosis were compared. Patient characteristics were not significantly different between the groups, but the NACT-R-RH group had significantly more patients with FIGO stage IIB disease, received multi-agent-based NACT, and had a lower percentage of deep stromal invasion than the NACT-A-RH group. After NACT-R-RH, surgical parameters were better, but survival outcomes, such as disease-free survival (DFS) and overall survival (OS), were significantly worse. On multivariate analysis, FIGO stage IIB contributed to worse DFS (p=0.003) and worse OS (p=0.012) in the NACT-A-RH group. Women with LBS-CC treated with NACT-R-RH have better perioperative outcomes but poorer survival out-comes compared with those treated with NACT-A-RH. Thus, patients with FIGO stage IIB LBS-CC disease might not be suitable for surgery after multi-agent-based NACT.