文章：

重度肥胖子宫内膜癌患者机器人、腹腔镜与开腹手术的安全性与疗效结果：一项网络荟萃分析

Safety and Efficacy Outcomes of Robotic, Laparoscopic, and Laparotomic Surgery in Severe Obese Endometrial Cancer Patients: A Network Meta-Analysis

原文发布日期：17 June 2025

DOI: 10.3390/cancers17122018

类型: Article

开放获取: 是

英文摘要：

Background: The surgical management of endometrial cancer in severely obese patients (BMI ≥ 40) presents unique challenges. This study evaluates the outcomes of various surgical approaches in terms of safety and efficacy in lymph node retrieval. Methods: A systematic review and network meta-analysis focused on intra-operative complications, post-operative complications, severe complications, and complete surgical staging rates. The analysis included 1163 patients, following a pre-specified methodology based on the PRISMA-NMA guidelines. The study was registered on PROSPERO with protocol number CRD 395959. Results: Intra-operative complications: No significant difference was found between minimally invasive surgery (MIS, 233 patients) and laparotomy (LPT) (OR 0.68 [95% CI 0.21–2.26],p= 0.18). However, robotic surgery showed a significantly lower risk (OR 0.28 [0.10–0.74]). Post-operative complications: The MIS group (457 patients) had a lower risk compared to LPT (OR 0.41 [0.26–0.64]). Network analysis: Robotic surgery had a 70.7% probability of reducing intra-operative complications compared to laparoscopy (LPS) and a 99.2% probability compared to LPT. Laparoscopy was the safest option for post-operative complications, with a 74.3% probability. Robotic surgery had an 82.4% probability of achieving complete surgical staging compared to LPT. Conclusions: Robotic surgery shows superior outcomes for complete lymph nodal staging in obese endometrial cancer patients, while LPS is favorable for post-operative complications. Further studies are needed to optimize strategies.

摘要翻译： 

背景：对于重度肥胖（BMI ≥ 40）的子宫内膜癌患者，其手术治疗面临特殊挑战。本研究旨在评估不同手术方式在淋巴结获取方面的安全性与有效性。方法：本研究采用系统综述与网状荟萃分析，重点关注术中并发症、术后并发症、严重并发症及完全手术分期率。分析共纳入1163例患者，严格遵循基于PRISMA-NMA指南的预设方法学方案。研究已在PROSPERO平台注册，方案编号为CRD 395959。结果：术中并发症：微创手术（MIS，233例）与开腹手术（LPT）间无显著差异（OR 0.68 [95% CI 0.21–2.26]，p=0.18），但机器人手术风险显著更低（OR 0.28 [0.10–0.74]）。术后并发症：MIS组（457例）较LPT组风险更低（OR 0.41 [0.26–0.64]）。网状分析显示：与腹腔镜手术（LPS）相比，机器人手术降低术中并发症的概率为70.7%；与LPT相比，该概率达99.2%。在术后并发症方面，腹腔镜手术是最安全的选择（概率74.3%）。机器人手术实现完全手术分期的概率较LPT高82.4%。结论：对于肥胖型子宫内膜癌患者，机器人手术在实现淋巴结完全分期方面表现更优，而腹腔镜手术在控制术后并发症方面更具优势。未来需进一步研究以优化治疗策略。

原文链接：

Safety and Efficacy Outcomes of Robotic, Laparoscopic, and Laparotomic Surgery in Severe Obese Endometrial Cancer Patients: A Network Meta-Analysis