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dc.contributorTrujillo, Lina María
dc.contributor.advisorPosso Valencia, Hector 
dc.contributor.advisorPareja, René 
dc.creatorRodríguez, Juliana 
dc.date.accessioned2020-11-23T23:21:08Z
dc.date.available2020-11-23T23:21:08Z
dc.date.created2020-11-16
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/30634
dc.descriptionIntroducción: El cáncer de cuello uterino es la cuarta causa de muerte por neoplasias ginecológicas a nivel mundial. El manejo de los estadios tempranos es quirúrgico, mediante abordajes laparoscópico o por laparotomía. La evidencia reciente ha mostrado peores resultados oncológicos en términos de recurrencia y muerte cuando la cirugía mínimamente invasiva se usa en este escenario clínico. El objetivo de este estudio fue comparar la supervivencia libre de enfermedad a 4 años en pacientes que se habían sometido a histerectomía radical y linfadenectomía pélvica, por laparoscopia o laparotomía. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo multicéntrico de pacientes diagnosticadas con cáncer de cuello uterino entre el 1 de enero de 2006 y el 31 de diciembre de 2017, en siete centros de referencia para el manejo de cáncer de 6 países. Se incluyeron pacientes con estadio IA1 con invasión linfovascular, IA2 e IB1 (clasificación FIGO 2009) y con histologías escamoso, adenocarcinoma y adenoscamoso. En el análisis principal se utilizó la probabilidad inversa de ponderación del tratamiento (IPTW) para construir una cohorte ponderada de sujetos que diferían con respecto al abordaje quirúrgico pero que, por lo demás, eran similares en otras características medidas. Se estimó la razón de riesgo (HR) para la recurrencia y mortalidad por cualquier causa después de la histerectomía radical laparoscópica, en relación con la laparotomía, mediante modelos de riesgo proporcional ponderado de Cox. Resultados: Un total de 1379 pacientes se incluyeron en el análisis final, con 681 pacientes (49.4%) operados por laparoscopia y 698 pacientes (50.6%) operados por laparotomía. La mediana de edad fue 46 años (22-88). La mediana de seguimiento fue de 52.1 meses (0.8-201.2) para el grupo de laparoscopia, y de 52.6 meses (0.4-166.6) para el grupo de laparotomía. Las mujeres que se sometieron a histerectomía radical laparoscópica tuvieron una supervivencia libre de enfermedad a 4 años menor en comparación con el grupo de laparotomía (cociente de riesgo [HR] 1.64; intervalo de confianza [IC] del 95%: 1.09-2.46; p = 0.02). Después de ajustar por el tratamiento adyuvante, la supervivencia libre de enfermedad (HR 1.7; IC 95% 1.13-2.56; p = 0.01) y la supervivencia global a 4 años (HR 2.14; IC 95% 1.05-4.37; p = 0.03), también fueron más bajas en el grupo de laparoscopia. Conclusión: En este estudio multicéntrico retrospectivo, el abordaje laparoscópico para el cáncer cervical en etapa temprana, se asoció con un mayor riesgo de recurrencia, y también un mayor riesgo de muerte después del ajuste por el tratamiento adyuvante, en comparación con la laparotomía.
dc.description.abstractBackground: 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
dc.description.sponsorshipInstituto Nacional de Cancerología. Bogotá, Colombia
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rightsAtribución-SinDerivadas 2.5 Colombia
dc.rightsAtribución-SinDerivadas 2.5 Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nd/2.5/co/
dc.sourceinstname:Universidad del Rosario
dc.sourcereponame:Repositorio Institucional EdocUR
dc.subjectHisterectomía
dc.subjectLaparoscopía
dc.subjectLaparotomía
dc.subjectNeoplasias del cuello uterino
dc.subjectProcedimientos quirúrgicos robotizados
dc.subject.ddcIncidencia & prevención de la enfermedad 
dc.titleResultados oncológicos de la histerectomía radical laparoscópica versus por laparotomía en pacientes con cáncer cervical temprano: una cohorte multicéntrica retrospectiva
dc.typemasterThesis
dc.publisherUniversidad del Rosario
dc.creator.degreeMagíster en epidemiología
dc.publisher.programMaestría en Epidemiología
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.title.alternativeOncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early stage cervical cancer: A multicenter analysis.
dc.subject.keywordHysterectomy
dc.subject.keywordLaparoscopy
dc.subject.keywordLaparotomy
dc.subject.keywordMinimally invasive surgery
dc.subject.keywordUterine cervical neoplasms
dc.subject.keywordRobotic surgical procedures
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.type.spaTesis de maestría
dc.rights.accesoAbierto (Texto Completo)
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
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dc.type.documentDescriptivo observacional retrospectivo
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