oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2024-23-2-26-36oncotomsk-3042Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESДискуссионные вопросы малоинвазивной хирургии в лечении инвазивного рака шейки маткиControversies in minimally invasive surgery for invasive cervical cancerhttps://orcid.org/0000-0003-3439-8830ЧуруксаеваО. Н.ChuruksaevaO. N.

Чурукcаева Ольга Николаевна - доктор медицинских наук, старший научный сотрудник отделения гинекологии, Научно-исследовательский институт онкологии.

634009, Томск, пер. Кооперативный, 5

Researcher ID (WOS): C-8601-2012; Author ID (Scopus): 6504391579

Olga N. Churuksaeva - MD, DSc, Senior Researcher, Department of Gynecology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

Researcher ID (WOS): C-8601-2012; Author ID (Scopus): 6504391579

churuksaevaon@mail.ruhttps://orcid.org/0000-0002-6854-8940КоломиецЛ. А.KolomietsL. A.

Коломиец Лариса Александровна - доктор медицинских наук, профессор, заведующая отделением гинекологии, НИИ онкологии, Томский НИМЦ РАН; профессор кафедры онкологии, ФГБОУ ВО «СибГМУ» Минздрава России.

634009, Томск, пер. Кооперативный, 5; 634050, Томск, Московский тракт, 2

Researcher ID (WOS): C-8573-2012; Author ID (Scopus): 7004921120

Larisa A. Kolomiets - MD, DSc, Professor, Head of the Department of Gynecology, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences; Professor, Department of Oncology, Siberian State Medical University of the Ministry of Health of Russia.

5, Kooperativny St., Tomsk, 634009; 2, Moskovsky trakt, Tomsk, 634050

Researcher ID (WOS): C-8573-2012; Author ID (Scopus): 7004921120

https://orcid.org/0000-0002-8194-2811ЧернышоваА. Л.ChernyshovaA. L.

Чернышова Алена Леонидовна - доктор медицинских наук, профессор РАН, главный научный сотрудник.

634009, Томск, пер. Кооперативный, 5

Author ID (Scopus): 55220758100; Reseacher ID (WOS): C-8608-2012

Alyona L. Chernyshova - MD, DSc, Professor of the Russian Academy of Sciences, Leading Researcher, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

Author ID (Scopus): 55220758100; Reseacher ID (WOS): C-8608-2012

https://orcid.org/0000-0002-2773-1917ВиллертА. Б.VillertA. B.

Виллерт Алиса Борисовна - доктор медицинских наук, старший научный сотрудник, Научно-исследовательский институт онкологии.

634009, Томск, пер. Кооперативный, 5

Researcher ID (WOS): J-3140-2017; Author ID (Scopus): 56626547700

Alisa B. Villert - MD, DSc, Senior Researcher, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

Researcher ID (WOS): J-3140-2017; Author ID (Scopus): 56626547700

https://orcid.org/0000-0001-6628-2918ОчировМ. О.OchirovM. O.

Очиров Максим Олегович - кандидат медицинских наук, научный сотрудник, Научно-исследовательский институт онкологии.

634009, Томск, пер. Кооперативный, 5

Maxim O. Ochirov - MD, PhD, Researcher, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

ТрущукЮ. М.TrushchukYu. M.

Трущук Юлия Михайловна - врач-онколог, Научно-исследовательский институт онкологии.

634009, Томск, пер. Кооперативный, 5

Yulia M. Trushchuk - MD, Oncologist, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

МальцеваА. А.MaltsevaA. A.

Мальцева Анастасия Алексеевна - ординатор, Научно-исследовательский институт онкологии.

634009, Томск, пер. Кооперативный, 5

Anastasia A. Maltseva - MD, Resident, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

https://orcid.org/0000-0003-2061-8417ТаширеваЛ. А.TashirevaL. A.

Таширева Любовь Александровна - доктор медицинских наук, заведующая лабораторией молекулярной терапии рака.

634009, Томск, пер. Кооперативный, 5

Researcher ID (WOS): C-8222-2012; Author ID (Scopus): 55234960400

Lyubov A. Tashireva - MD, DSc, Head of the Laboratory of Molecular Cancer Therapy, Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

5, Kooperativny St., Tomsk, 634009

Researcher ID (WOS): C-8222-2012; Author ID (Scopus): 55234960400

Научно-исследовательский институт онкологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCancer Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian FederationНаучно-исследовательский институт онкологии, Томский национальный исследовательский медицинский центр Российской академии наук; ФГБОУ ВО «Сибирский государственный медицинский университет» Минздрава РоссииРоссияCancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences; Siberian State Medical University of The Ministry of Health of RussiaRussian Federation2024120520242322636Copyright © Чуруксаева О.Н., Коломиец Л.А., Чернышова А.Л., Виллерт А.Б., Очиров М.О., Трущук Ю.М., Мальцева А.А., Таширева Л.А., 20242024Чуруксаева О.Н., Коломиец Л.А., Чернышова А.Л., Виллерт А.Б., Очиров М.О., Трущук Ю.М., Мальцева А.А., Таширева Л.А.Churuksaeva O.N., Kolomiets L.A., Chernyshova A.L., Villert A.B., Ochirov M.O., Trushchuk Y.M., Maltseva A.A., Tashireva L.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/3042

Актуальность. Актуальной проблемой в онкогинекологии является определение целесообразности малоинвазивных вмешательств при инвазивном раке шейки матки (РШМ), выявление критериев для оптимального хирургического доступа, обеспечивающего безопасность, эффективность, удовлетворительные непосредственные и отдаленные результаты. Цель исследования – оценить непосредственные и отдаленные результаты лечения больных инвазивным раком шейки матки, получивших хирургическое лечение в объеме радикальной гистерэктомии после лапаротомного доступа, в сравнении с малоинвазивным хирургическим вмешательством. Материал и методы: проанализированы результаты лечения 91 больной инвазивным РШМ. Непосредственные результаты в виде объективного ответа опухоли на неоадъювантную химиотерапию оценивались с помощью шкалы RECIST (Response Evaluation Criteria in Solid Tumors). Оценка объективного ответа подтверждалась результатами клинического, ультразвукового и КТ/МРТ исследований. Метод Каплана–Майера и log-rank-критерий использовались для сравнения показателей безрецидивной и общей выживаемости. Статистический анализ и визуализация результатов анализа были выполнены с помощью Prism 9.5.1 (GraphPad, США). Результаты. Наличие лимфоваскулярной инвазии, вовлеченность параметриев и частота лимфаденопатии в группах были сопоставимы. Не получено значимых различий в количестве удаленных лимфатических узлов, но значимо отличались объем кровопотери и длительность операции (p<0,001). У каждой третьей пациентки после хирургического лечения диагностирована IIIC стадия (поражение тазовых лимфатических узлов). Интраоперационные осложнения значимо преобладали в группе открытых операций – 13 vs 6,7 % при лапароскопии. Удельный вес рецидивов заболевания в группах исследования не отличался: при лапаротомных операциях – 9,6 %, в группе лапароскопий – 11,7 %. Значимых различий в общей и безрецидивной выживаемости между исследуемыми группами не выявлено. Заключение. Малоинвазивная хирургия является перспективным и адекватным методом лечения цервикального рака, однако необходимы дополнительные исследования для определения показаний к данным вмешательствам.

Background. Determination of the feasibility of performing minimally invasive surgery for invasive cervical cancer and identification of criteria for optimal surgical access that ensures safety, effectiveness, and satisfactory immediate and long-term results remain challenging in gynecological oncology. The aim of the study was to evaluate the immediate and long-term treatment outcomes in patients with invasive cervical cancer who underwent radical hysterectomy via laparotomy compared to those who underwent minimally invasive surgery. Material and methods. Treatment outcomes of 91 patients with invasive carvical cancer were analyzed. The assessment of the objective tumor response to neoadjuvant chemotherapy using the RECIST scale (Response Evaluation Criteria in Solid Tumors) was confirmed by clinical, ultrasound and CT/ MRI findings. The Kaplan-Maier curves and the log-rank criterion were used to compare the time of relapse-free and overall survivals. Statistical analysis and visualization of the analysis results were performed using prism 9.5.1 (GraphPad, USA). Results. The presence of parametrial lymphovascular space invasion and the frequency of lymphadenopathy were comparable for both groups of patients. there were no statistically significant differences in the number of the resected lymph nodes, but there was a statistically significant difference in volume of blood loss and the duration of surgery between the groups (p=0.0001). Every third patient was diagnosed with stage IIIC after surgery (pelvic lymph node lesion). Intraoperative complications were significantly lower in the laparoscopy group than in the laparotomy group (6.7 % vs 13 %). No significant differences in the proportion of relapses of the disease between the groups were found (9.6 % in the laparotomy group vs 11.7 % in the laparoscopy group). There were no significant differences in overall and relapse-free survival between the groups. Conclusion. Minimally invasive surgery is a promising and adequate surgical technique for the treatment of cervical cancer. However, additional studies are needed to determine the indications for these surgeries.

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The authors declare that there are no conflicts of interest present.