Cancer Genetics and Epigenetics, 2025, Vol.13, No.2, 90-97 http://medscipublisher.com/index.php/cge 92 2013). Minimally invasive surgery has a relatively fast recovery but there are specific operational risks. It is necessary to balance the tumor clearance effect and the risk of complications, and adopt an appropriate surgical scope for suitable cases (Landoni et al., 2012; Reade et al., 2013; Baaran and Leitao, 2020; Kim et al., 2022). Data show that the complication rate of type III radical resection is 84%, while that of type I is only 45%. However, the tumor control effects of the two are similar. This suggests that the surgical scope should be adjusted according to the characteristics of the disease condition to reduce complications while ensuring the therapeutic effect (Landoni et al., 2012; Reade et al., 2013). 3 Analysis of Common Intraoperative Risks 3.1 Causes and risk factors of massive hemorrhage Cervical cancer surgery is prone to bleeding mainly due to the rich pelvic blood vessels, which require extensive blood vessel separation. Patients with advanced tumors, the elderly, obesity and those undergoing open abdominal surgery are more prone to severe bleeding. Special attention should be paid to the surgical timing after preoperative chemotherapy. Surgery 2~3 weeks after the end of chemotherapy can reduce the risk of bleeding (Table 1) (Wang et al., 2019; Sim et al., 2022). Table 1 Multivariate analysis of intraoperative blood loss in 127 patients with cervical cancer Variable B SE Wald OR 95%CI P Age 2.100 0.764 7.560 8.167 1.828~36.489 0.006 BMI ≥24kg/m² 1.842 0.775 5.641 6.308 1.380~28.836 0.018 <18.5 kg/m² 0.234 0.910 0.066 1.253 0.212~7.526 0.797 Gravidity 0.403 1.150 0.123 1.496 0.157~14.243 0.726 History of pelvic and abdominal cavity 0.978 0.951 1.058 2.659 0.412~17.149 0.304 Chronic pelvic inflammation 1.028 0.950 1.170 2.795 0.434~18.005 0.279 Clinical stage 2.401 0.863 7.749 11.038 2.035~59.869 0.005 Operative method 1.347 0.658 4.186 3.846 1.058~13.978 0.041 NACT 1.540 0.677 5.177 4.667 1.238~17.590 0.023 Post-NACT operative opportunity 1.723 0.665 6.702 5.600 1.520~20.637 0.010 Note: B: Partial regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval Preoperative examination indicators (such as the RDW/ albumin ratio) can predict the intraoperative blood transfusion requirements. Other risk factors include overly long operation time and the use of synthetic hemostatic materials in endoscopic surgery, etc. Mastering these indicators is helpful for preoperative assessment and risk control (Wang et al., 2019; Sim et al., 2022). 3.2 Risk of bladder, ureter and rectal injury During radical surgery, adjacent organs are prone to damage, especially the uterus, which has a close anatomical relationship with the bladder, ureters and rectum. Endoscopic surgery is more prone to bladder or intestinal injury than open surgery (Obermaair et al., 2020). This type of injury may cause serious problems such as urinary fistula and intestinal fistula, and often requires secondary surgery for repair. Timely detection and treatment of injuries during the operation are crucial for improving prognosis (Li et al., 2021). 3.3 Issues related to anesthesia and body position Whether it is open surgery or endoscopic surgery, prolonged anesthesia and special positions may cause complications. When endoscopic surgery takes a long time, respiratory system problems, nerve compression or skin pressure ulcers are more likely to occur. The longer the operation lasts, the higher the related risks will be. Intraoperative monitoring and position management need to be strengthened to ensure patient safety (Di Donato et al., 2023).
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