(1) Background: In 2018 FIGO reclassified tumors confined to the cervix larger than 4 cm as stage IB3. Although concurrent CTRT has been the standard of care and surgery the alternative, optimal management remains controversial due to the lack of direct comparison between surgery and CTRT. (2) Methods: This prospective observational study investigated the efficacy, safety and oncologic outcomes of nerve-sparing laparoscopic radical hysterectomy (nsLRH) for FIGO stage IB3 cervical cancer patients (IB3). From 2009 to 2023, IB3 patients underwent laparoscopic pelvic lymphadenectomies with frozen section analysis, followed by a nsLRH if the lymph nodes were tumor-free. No uterine manipulator was used and the vaginal cuff was sealed before retrieving the specimen. Intermediate-risk patients were under close observation without adjuvant therapy. Outcomes were monitored until 2023. (3) Results: During the study period, 74 IB3 patients were treated. Sixty-eight (91.9%) underwent a nsLRH. A complete resection with negative margins was achieved in all cases. At a median of 68 months of follow-up, the disease-free survival (DFS) rate was 89.7% and the overall survival (OS) rate was 93.1%. The overall complication rate was 23.5% and there were no grade 4–5 complications. (4) Conclusions: In patients with IB3 cervical cancer, a nsLRH is safe and effective. While awaiting the results from ongoing randomized trials, these findings support nsLRH as a viable treatment.
（1）背景：2018年国际妇产科联盟（FIGO）将肿瘤局限于宫颈且直径大于4厘米的病例重新分类为IB3期。尽管同步放化疗（CTRT）已成为标准治疗方案，而手术作为替代选择，但由于缺乏手术与CTRT的直接比较，最佳治疗方案仍存在争议。（2）方法：本前瞻性观察性研究探讨了保留神经的腹腔镜根治性子宫切除术（nsLRH）治疗FIGO IB3期宫颈癌患者的疗效、安全性及肿瘤学结局。2009年至2023年间，IB3期患者接受腹腔镜盆腔淋巴结切除术并进行冰冻切片分析，若淋巴结无肿瘤转移则随后行nsLRH。术中未使用子宫操纵器，且在取出标本前封闭阴道残端。中危患者仅接受密切观察，未行辅助治疗。结局监测持续至2023年。（3）结果：研究期间共治疗74例IB3期患者，其中68例（91.9%）接受了nsLRH。所有病例均实现切缘阴性的完整切除。中位随访68个月后，无病生存率（DFS）为89.7%，总生存率（OS）为93.1%。总体并发症发生率为23.5%，未出现4-5级并发症。（4）结论：对于IB3期宫颈癌患者，nsLRH是一种安全有效的治疗方案。在等待正在进行中的随机试验结果期间，本研究结果支持nsLRH作为一种可行的治疗选择。
肿瘤(癌症)患者之家