子宫内膜癌全腹腔镜与开腹全子宫切除术比较：单中心回顾性队列研究

原文

OBJECTIVE: To investigate and contrast the surgical effectiveness and oncological outcomes of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) in individuals diagnosed with endometrial cancer. DESIGN: Retrospective evaluation. SETTING: Holy Cross Cancer Centre in Kielce, Poland. POPULATION: 1532 patients who underwent operative management over the period from 2002 to 2020. METHODS: Survival outcomes were assessed using Kaplan-Meier analysis, and Cox proportional hazards models were applied to evaluate associations with recurrence-free survival (RFS) and overall survival (OS). Multivariable Cox models were adjusted for tumour stage, grade, histological subtype, lymphovascular space invasion, and lymphadenectomy-related variables. No adjustment for key confounders, including body mass index (BMI), comorbidity burden, adjuvant therapy, and year of surgery, was possible, which may introduce residual confounding and confounding by indication. Given the retrospective single-centre design and the extended study period, findings should be interpreted as associations rather than causal effects, as causal inference is inherently limited in this context. MAIN OUTCOME MEASURES: Comparative efficacy of TLH versus TAH in terms of surgical outcomes (operative time, blood loss, transfusion requirements, lymph node yield, hospital stay) and oncological outcomes (recurrence-free survival (RFS) and overall survival (OS)). RESULTS: TLH was associated with a significantly shorter mean operative time (121.16 ± 48.79 min vs. 159.26 ± 48.46 min; p < 0.001), lower intraoperative blood loss (median 200 mL in both groups, p = 0.016 indicating differences in distribution), reduced need for blood transfusion (0.6% vs. 5.5%; p = 0.003), more extensive lymphadenectomy (median 10 nodes vs. 6 nodes; p < 0.001) and shorter hospital stay (median 4 days vs. 7 days; p < 0.001). However, five-year overall survival (OS) and recurrence-free survival (RFS) were superior in the TAH group (p = 0.001 and p = 0.010, respectively). No statistically significant survival differences were observed between the two approaches in stage I disease (p > 0.05). These findings may be influenced by unmeasured confounding, selection bias, and temporal changes in clinical practice over the study period. CONCLUSIONS: TLH is associated with reduced surgical trauma and faster postoperative recovery, whereas differences in oncological outcomes between TLH and TAH should be interpreted with caution. No causal inference can be drawn due to the retrospective design, single-centre setting, and limited covariate adjustment, as residual confounding cannot be excluded. Surgical approach should be individualised based on patient risk profile, tumour characteristics and comorbidities.