在《LACC试验》发表后，早期宫颈癌的标准手术方法是开腹全子宫切除术。关于LACC试验发表后转向开腹子宫切除术是否导致了微创手术应用下降，进而增加了术后并发症发生率的数据较为有限。本研究旨在分析LACC试验发表是否与侵袭性宫颈癌外科治疗的30天并发症增加存在相关性。我们使用美国外科医师学会全国外科质量改进计划的数据，比较了LACC试验前期（2016年1月至2017年12月）和LACC试验后期（2019年1月至2020年12月）的情况。我们对这两个时期侵袭性宫颈癌中开腹与微创手术方法（或）子宫切除术的比率进行了评估，并比较了LACC试验发表前后的30天主要并发症、次要并发症、非计划住院再入院率以及术中/术后输血率。总共有3024例行开腹或微创子宫切除术治疗侵袭性宫颈癌的患者纳入了研究。其中，1515例（50.1%）在LACC试验前期接受了治疗，1509例（49.9%）在LACC试验后期接受了治疗。微创手术方法的比例从LACC试验前期的75.6%（1145/1515）显著降低到了LACC试验后期的41.1%（620/1509），而开腹手术法的比例从LACC试验前期的24.4%（370/1515）增加到了LACC试验后期的58.9%（889/1509）（p<0.001）。总体30天主要并发症在LACC试验前后期间保持稳定，分别是LACC试验前期的85例（5.6%）和LACC试验后期的74例（4.9%）[调整后的比率比0.85（95%置信区间为0.61-1.17）]。总体30天次要并发症在LACC试验前后期间相似，分别是LACC试验前期的103例（6.8%）和LACC试验后期的120例（8.0%）[调整后的比率比1.17（95%置信区间为0.89-1.55）]。非计划住院再入院率在LACC试验前期（每30天7.9%住院者）和LACC试验后期（每30天6.3%住院者）期间保持稳定[调整后的风险比0.78（95%置信区间为0.58-1.04）]。术中/术后输血率从LACC试验前期（58例/1515例，3.8%）显著增加到LACC试验后期（101例/1509例，6.7%）[调整后的比率比1.79（95%置信区间为1.27-2.53）]。我们观察到在LACC试验发表后侵袭性宫颈癌的外科手术方法发生了明显转变，微创手术应用下降，开腹手术应用增加。手术方法的改变与30天主要或次要并发症以及非计划住院再入院的发生率没有增加相关性，但与输血率的增加相关。版权所有© 2023. 由Elsevier Inc.出版。

After the publication of the LACC trial, the standard surgical approach for early-stage cervical cancer is open radical hysterectomy. Only limited data were available regarding whether the change to open abdominal hysterectomy observed after the LACC trial led to an increase in post-operative complication rates as a consequence of the decrease in use of the minimally invasive approach.The aim of the current study was to analyze whether there was a correlation with publication of the LACC trial and an increase in the 30-day complications associated with surgical treatment of invasive cervical cancer.We used data from the American College of Surgeons National Surgical Quality Improvement Program to compare a pre-LACC period (January 2016 to December 2017) to a post-LACC period (January 2019 to December 2020). The rates of each surgical approach (open abdominal or minimally invasive) hysterectomy for invasive cervical cancer during the two periods were assessed. Subsequently, we compared 30-day major complication, minor complication, unplanned hospital readmission, and intra/post-operative transfusion rate before and after the publication of the LACC trial.In total, 3024 patients undergoing either open abdominal or minimally invasive hysterectomy for invasive cervical cancer were included in the study. Among them, 1515 (50.1%) were treated in the pre-LACC period and 1509 (49.9%) in the post-LACC period. The rate of minimally invasive approaches decreased significantly from 75.6% (1145/1515) to 41.1% (620/1509) from the pre- to post-LACC period, while the rate of open abdominal approach increased from 24.4% (370/1515) to 58.9% (889/1509) from the pre- to the post-LACC period (p<0.001). The overall 30-day major complications remained stable between the pre-LACC period (85/1515, 5.6%) and the post-LACC period (74/1509, 4.9%) [adjusted odds ratio 0.85 (95% CI, 0.61-1.17)]. The overall 30-day minor complications were similar for the pre-LACC period (103/1515, 6.8%) to the post-LACC period (120/1509, 8.0%) [adjusted odds ratio of 1.17 (95% CI, 0.89-1.55)]. The unplanned hospital readmission rate remained stable during the pre-LACC period (7.9% per 30 person-days) and the post-LACC period (6.3% per 30 person-days) [adjusted HR 0.78 (95% CI, 0.58-1.04)]. The intra/post-operative transfusion rate increased significantly from the pre-LACC period (58/1515, 3.8%) to the post-LACC period (101/1509, 6.7%) [adjusted OR 1.79 (95% CI 1.27-2.53)].We observe a significative shift in the surgical approach for invasive cervical cancer after the publication of the LACC trial, with a reduction of the minimally invasive and an increase of open abdominal approach. The change in surgical approach was not associated with an increase in the rate of 30-day major or minor complications, and unplanned hospital readmission, while it was associated with an increase in transfusion rate.Copyright © 2023. Published by Elsevier Inc.