盆腔廓清术在原发及复发性宫颈癌中应用的系统评价

目的:系统评价盆腔廓清术在原发及复发性宫颈癌中的应用现状及预后。方法:在PubMed、EMbase、Cochrane Library、CNKI、WanFang Data和VIP数据库上检索原发及复发性宫颈癌行盆腔廓清术的相关文献,检索时限1990年1月至2019年3月。由两名评价员筛选符合纳入标准的文献,提取资料并行质量评价后进行循证评价。结果:研究纳入11篇文献,共818例宫颈癌患者接受盆腔廓清术,其中原发宫颈癌患者160例,复发宫颈癌658例。164例患者行前盆腔廓清术,39例患者行后盆腔廓清术,615例患者行全盆腔廓清术。中位手术时间为5.9~10.3h,中位出血量为800~2537.9ml,中位输血量为800~1600ml,中位术后住院天数为17~65.5天。患者的早期并发症发生率为1.8%~55.3%,晚期并发症为36.1%~74.5%,并发症总发生率为34.3%~83.3%。5年无瘤生存率为13.2%~61.0%,5年总生存率为20.5%~56.0%,其中原发性宫颈癌5年总生存率为49.0%~52.5%,复发性宫颈癌5年总生存率为20.5%~65.8%。8篇文献认为手术切缘阳性是影响患者生存时间的重要因素。结论:盆腔廓清术并发症发生率高,但仍在可预防、可治疗的范围内。适当的盆腔廓清术可延长原发及复发性宫颈癌患者的无瘤生存时间及总生存时间。

Current status and outcomes of pelvic exenteration for primaryand recurrent cervical cancer: a systematic review

Objective:To systematically evaluate the current status and outcomes of pelvic exenteration(PE) for primary and recurrent cervical cancer.Methods:PubMed,EMbase,Cochrane Library,CNKI,WanFang Data and VIP databases were searched for references on pelvic exenteration for all primary and recurrent cervical cancers from Jan.1990 to Mar.2019.Two reviewers screened the documents that met the inclusion criteria,and extracted the data in parallel with the quality evaluation for evidence-based evaluation.Results:There were eleven trials involving 818 patients with cervical cancer received PE,including 658 cases with recurrent disease and 160 cases with primary disease.164 patients had received anterior pelvic exenteration(APE),39 patients underwent posterior pelvic exenteration(PPE) and 615 patients underwent total pelvic exenteration(TPE).The median operation time was 5.9~10.3 hours,the median blood loss was 800~2537.9 ml,the median blood transfusion was 800~1600 ml,and the median postoperative hospital stay was 17~65.5 days.The early complications were 1.8% to 55.3%,and the late complications were 36.1 to 74.5%.The total incidence of complications was 34.3% to 83.3%.The 5-year disease-free survival(DFS) rate was 13.2%~61.0%,and the 5-year overall survival(OS) rate was 20.5%~56.0%.The 5-year overall survival rate of primary cervical cancer was 49.0%~52.5%,and the 5-year overall survival rate of recurrent cervical cancer was 20.5%~65.8%.Eight trials suggested that positive surgical margin was an important factor affecting the survival time of patients.Conclusion:Pelvic exenteration has a high incidence of complications,but it is still within the range of prevention and treatment.Appropriate pelvic exenteration can prolong the disease-free survival and overall survival of patients with primary and recurrent cervical cancer.