Abstract：
Laparoscopy and robotics are recommended for managing gynecological cancer, as they are associated with lower morbidity and comparable outcomes to open surgery. However, in the case of early cervical cancer, new evidence suggests worse oncological outcomes with these approaches compared to open surgery, though the limited number of robotic cases makes it challenging to draw definitive conclusions for this particular approach. The prior conization has been proposed as a strategy to reduce the risk of tumor spillage and contamination during minimally invasive (MIS) radical hysterectomy (RH). Retrospective studies have indicated that undergoing conization before RH is linked to a reduced risk of recurrences, especially in cervical tumors measuring less than 2 cm. Nevertheless, these studies lack the statistical power needed to definitively establish conization as a recommended step before RH. Furthermore, these studies do not have enough cases utilizing the robotic approach and specific conclusions cannot be drawn from this technique. The question of whether a subset of cases would benefit from preoperative conization and whether conization should be performed to recommend MIS over open surgery remains unanswered. Prospective clinical trials involving women diagnosed with early-stage cervical cancer <2 cm, randomized between undergoing conization before robotic RH or without prior conization are mandatory to assess the role of conization before robotic RH in cervical cancer.
摘要：
腹腔镜和机器人被推荐用于治疗妇科癌症，因为它们与较低的发病率和与开放手术相当的结局相关.然而,在早期宫颈癌的情况下，新的证据表明，与开放手术相比，这些方法的肿瘤学结果更差，尽管机器人案例的数量有限，因此很难为这种特定方法得出明确的结论。已经提出了在微创（MIS）根治性子宫切除术（RH）期间降低肿瘤溢出和污染风险的策略。回顾性研究表明，在RH之前进行锥切术与降低复发风险有关。尤其是测量小于2厘米的宫颈肿瘤。然而，这些研究缺乏在RH前将锥化作为推荐步骤所需的统计学功效.此外，这些研究没有足够的案例利用机器人的方法和具体的结论不能从这种技术得出。是否有一部分病例会从术前锥切术中受益，以及是否应进行锥切术以推荐MIS而不是开放手术的问题仍未得到解答。前瞻性临床试验涉及女性诊断为早期宫颈癌<2厘米，必须在机器人RH前进行锥切术或不进行锥切术之间进行随机分组,以评估机器人RH前进行锥切术在宫颈癌中的作用.
