接受剖腹手术或腹腔镜检查的临床

该研究的目的是调查 IA 期子宫内膜癌的长期结果，特别是复发风险，尤其是肿瘤体积，并确定复发的风险因素。

这项单中心回顾性研究分析了 2010 年 1 月至 2018 年 7 月期间在研究所接受国际妇产科联合会 IA 期（1 级或 2 级）子宫内膜样癌初次手术治疗的女性。患者的人口学特征，包括年龄、手术 时间、淋巴结数目、最终阶段、作为肿瘤体积的体积指数和最终组织学类型均被审查。 共有 168 名患者入组，其中开腹手术组和腹腔镜手术组分别为 95 名和 73 名患者。 Cox 比例风险模型用于调整分析中的预后因素，包括升期患者、肿瘤组织学、淋巴管浸润和体积指数。

IA 期子宫内膜癌腹腔镜手术和开腹手术的复发率没有差异。 与开腹手术组相比，腹腔镜手术组的手术时间更长，出血量更少。 对于所有接受腹腔镜手术或开腹手术的患者，升期 ≥ IB、非子宫内膜样 1 级或 2 级、淋巴血管侵犯和体积指数 ≥ 36 是显著的独立复发危险因素。

IA 期子宫内膜癌的腹腔镜手术在技术上和肿瘤学上都是安全的。 具有高体积指数的患者具有更高的复发风险。 此外，体积指数可以作为低风险子宫内膜癌患者的复发预测因子。

接受剖腹手术或腹腔镜检查的临床

Johann 钳具有长钳口，便于反牵引和手术期间所需的多个位置的实现，无需宫内操纵器

1. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RB, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009;27:5331–6.   
2. Terai Y, Tanaka T, Sasaki H, Kawaguchi H, Fujiwara S, Yoo S, et al. Total laparoscopic modified radical hysterectomy with lymphadenectomy for endometrial cancer compared with laparotomy. J Obstet Gynaecol Res. 2014;40:570–5.  
3. Galaal K, Donkers H, Bryant A, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. 2018;10:CD006655.   
4. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol. 2012;30:695–700.   
5. Deura I, Shimada M, Azuma Y, Komatsu H, Nagira K, Sawada M, et al. Comparison of laparoscopic surgery and conventional laparotomy for surgical staging of patients with presumed low-risk endometrial cancer: The current state of Japan. Taiwan J Obstet Gynecol. 2019;58:99–104.  
6. Chikazawa K, Yoshida C, Kuwata T, Konno R. Vaginal incision during total laparoscopic hysterectomy may cause severe bradycardia and cardiac arrest. Taiwan J Obstet Gynecol. 2018;57:468–9.  
7. Tanaka T, Terai Y, Hayashi S, Aoki D, Miki M, Kobayashi E, et al. Comparison between laparoscopy and laparotomy in systematic para-aortic lymphadenectomy for patients with endometrial cancer: A retrospective multicenter study. J Gynecol Surg. 2017;33:105–10.   
8. Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379:1895–904.  
9. Song J, Le T, Hopkins L, Fung-Kee-Fung M, Lupe K, Gaudet M, et al. A comparison of disease recurrence between robotic versus laparotomy approach in patients with intermediate-risk endometrial cancer. Int J Gynecol Cancer. 2020;30:160–6.  
10. Kang S, Nam JH, Bae DS, Kim JW, Kim MH, Chen X, et al. Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study. Cancer. 2017;123:263–72.  
11. Todo Y, Watari H, Okamoto K, Hareyama H, Minobe S, Kato H, et al. Tumor volume successively reflects the state of disease progression in endometrial cancer. Gynecol Oncol. 2013;129:472–7.  
12. Todo Y, Sakuragi N, Nishida R, Yamada T, Ebina Y, Yamamoto R, et al. Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol. 2003;188:1265–72.  
13. Todo Y, Okamoto K, Hayashi M, Minobe S, Nomura E, Hareyama H, et al. A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy. Gynecol Oncol. 2007;104:623–8.  
14. Nagase S, Katabuchi H, Hiura M, Sakuragi N, Aoki Y, Kigawa J, et al. Evidence-based guidelines for treatment of uterine body neoplasm in Japan: Japan Society of Gynecologic Oncology (JSGO) 2009 edition. Int J Clin Oncol. 2010;15:531–42.  
15. Todo Y, Choi HJ, Kang S, Kim JW, Nam JH, Watari H, et al. Clinical significance of tumor volume in endometrial cancer: A Japan-Korea cooperative study. Gynecol Oncol. 2013;131:294–8.  
16. Imai K, Chikazawa K, Ito T, Kuwata T, Konno R. Manipulating the uterus without a manipulator or human hands: A resolution using retractor and forceps tied with gauze. J Minim Invasive Gynecol. 2020;27:1461–2.  
17. Lee CL, Kusunoki S, Huang KG, Wu KY, Huang CY, Yen CF. Long-term survival outcomes of laparoscopic staging surgery in treating endometrial cancer: 20 years of follow-up. Taiwan J Obstet Gynecol. 2016;55:545–51.  
18. Chu LH, Chang WC, Sheu BC. Comparison of the laparoscopic versus conventional open method for surgical staging of endometrial carcinoma. Taiwan J Obstet Gynecol. 2016;55:188–92.  
19. Writtekind C, Greene FL, Hutter RV, Klimpfinger M, Sobin LH. TNM Atlas: Illustrated Guide to the TNM Classification of Malignant Tumours. 5th ed. Heidelberg: Springer-Verlag; 2005.
20. Koscielny S, Tubiana M, Lê MG, Valleron AJ, Mouriesse H, Contesso G, et al. Breast cancer: Relationship between the size of the primary tumour and the probability of metastatic dissemination. Br J Cancer. 1984;49:709–15.   
21. Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: Is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol. 2000;182:1506–19.  
22. Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL, et al. Nodal metastasis risk in endometrioid endometrial cancer. Obstet Gynecol. 2012;119:286–92.   
23. Kanao H, Matsuo K, Aoki Y, Tanigawa T, Nomura H, Okamoto S, et al. Feasibility and outcome of total laparoscopic radical hysterectomy with no-look no-touch technique for FIGO IB1 cervical cancer. J Gynecol Oncol. 2019;30:e71.   
24. Melamed A, Margul DJ, Chen L, Keating NL, Del Carmen MG, Yang J, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med. 2018;379:1905–14.