@mastersthesis{10336/30634,
author = {Rodríguez, Juliana},
url = {https://repository.urosario.edu.co/handle/10336/30634},
abstract = {Background: Cervical cancer is the fourth leading cause of death from gynecological malignancies worldwide. Management for the early stages is surgical, using laparoscopic approaches or laparotomy. Recent evidence has shown worse oncological outcomes in terms of recurrence and death when minimally invasive surgery is used in this clinical setting. The objective of this study was to compare 4-year disease-free survival in patients who had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy. Materials and methods: We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2 and IB1(FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from 6 countries. We included squamous, adenocarcinoma and adenosquamous histologies. In the main patient-level analysis we used inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women who differed only with respect to surgical approach. We estimated the hazard ratio (HR) for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models. Results: A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy, and 698 (50.6%) by laparotomy. Median age was 46 (22-88) years. Median follow-up was 52.1(0.8-201.2) months for laparoscopy, and 52.6 (0.4-166.6) for laparotomy group. Women who underwent laparoscopic radical hysterectomy had inferior 4-year disease-free survival compared with laparotomy group (Hazard ratio [HR] 1.64; 95% Confidence Interval [CI] 1.09-2.46; p= 0.02). After adjustment for adjuvant treatment, the 4-year disease-free survival (HR 1.7; 95% CI 1.13-2.56; p= 0.01) and overall survival (HR 2.14; 95% CI 1.05-4.37; p= 0.03) were also lower in the laparoscopy group. Conclusions: In this retrospective multicenter study, the laparoscopic approach for early stage cervical cancer, was associated with a higher risk of recurrence and also a higher risk of death after adjustment for adjuvant treatment, compared to laparotomy},
organization = {Instituto Nacional de Cancerología. Bogotá, Colombia},
keywords = {Histerectomía},
keywords = {Laparoscopía},
keywords = {Laparotomía},
keywords = {Neoplasias del cuello uterino},
keywords = {Procedimientos quirúrgicos robotizados},
title = {Resultados oncológicos de la histerectomía radical laparoscópica versus por laparotomía en pacientes con cáncer cervical temprano: una cohorte multicéntrica retrospectiva},
publisher = {Universidad del Rosario},
keywords = {Hysterectomy},
keywords = {Laparoscopy},
keywords = {Laparotomy},
keywords = {Minimally invasive surgery},
keywords = {Uterine cervical neoplasms},
keywords = {Robotic surgical procedures},
}