A population‐based registry study evaluating surgery in newly diagnosed uterine cancer

Borgfeldt, Christer; Kalapotharakos, Grigorios; Asciutto, Katrin Christine; Löfgren, Mats; Högberg, Thomas

doi:10.1111/aogs.12918

Cited by 18 publications

(16 citation statements)

References 34 publications

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“…This is supported by one registry study that showed a significantly lower proportion of women staying three nights or more in hospital . One other registry study reports a non‐significant shorter stay in the robotic group . Return to normal activity is shorter for robotics in the one study that reports this outcome in the meta‐analysis .…”

Section: Discussionmentioning

confidence: 82%

“…In addition, there was one randomised controlled study (Table ). Furthermore, seven papers reporting data from registries were carefully read and used for comparative discussion in the relevant section of this paper …”

Section: Resultsmentioning

confidence: 99%

“…Return to normal activity is shorter for robotics in the one study that reports this outcome in the meta‐analysis . One registry study reports on this . That study reports on a 6.7 days quicker return to normal activity for the robotic arm but reports this as being non‐significant.…”

Section: Discussionmentioning

confidence: 97%

“…It is possible that this is a power effect and a larger study with even more numbers would have demonstrated a longer duration of surgery. From studies reporting outcomes from registries and databases, one study reported a non‐significant shorter operative time in the robotic arm and no studies report longer operative times . The mean difference of 18 minutes has to be put in perspective as most people accept the benefits of laparoscopic compared to open surgery for endometrial cancer .…”

Section: Discussionmentioning

confidence: 99%

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A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis

Ind

Laios

Hacking

et al. 2017

Robotics Computer Surgery

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BackgroundEvidence has been systematically assessed comparing robotic with standard laparoscopy for treatment of endometrial cancer.MethodsA search of Medline, Embase and Cochrane databases was performed until 30th October 2016.ResultsThirty‐six papers including 33 retrospective studies, two matched case–control studies and one randomized controlled study were used in a meta‐analysis. Information from a further seven registry/database studies were assessed descriptively. There were no differences in the duration of surgery but days stay in hospital were shorter in the robotic arm (0.46 days, 95%CI 0.26 to 0.66). A robotic approach had less blood loss (57.74 mL, 95%CI 38.29 to 77.20), less conversions to laparotomy (RR = 0.41, 95%CI 0.29 to 0.59), and less overall complications (RR = 0.82, 95%CI 0.72 to 0.93). A robotic approach had higher costs ($1746.20, 95%CI $63.37 to $3429.03).ConclusionA robotic approach has favourable clinical outcomes but is more expensive.

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Section: Discussionmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis

Ind

Laios

Hacking

et al. 2017

Robotics Computer Surgery

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“…The introduction of minimal-invasive surgery, especially robotassisted surgery, has developed rapidly the last ten years in Sweden as well as in other countries and has lead to enhanced recovery for women with endometrial cancer. 35 The new techniques have decreased the surgical risks even for elderly women, 36,37 which probably will increase the patient population suitable for lymphadenectomy. In the future, the introduction of sentinel node mapping might even further minimize surgical trauma for this patient group.…”

Section: Cancer Epidemiologymentioning

confidence: 99%

Risk factors for lymph node metastases in women with endometrial cancer: A population‐based, nation‐wide register study—On behalf of the Swedish Gynecological Cancer Group

Stålberg

Kjølhede

Bjurberg

et al. 2017

Intl Journal of Cancer

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Risk factors for lymph node metastases in women with endometrial cancerA population-based, nation-wide register study-On behalf of the Swedish Gynecological Cancer Group Stålberg, Karin; Kjølhede, P.; Bjurberg, M.; Borgfeldt, C.; Dahm-Kähler, Pernilla; Falconer, Henrik; Holmberg, E.; Staf, Christian; Tholander, Bengt; Åvall Lundqvist, Elisabeth; Rosenberg, P; Högberg, T. Link to publication Citation for published version (APA): Stålberg, K., Kjølhede, P., Bjurberg, M., Borgfeldt, C., Dahm-Kähler, P., Falconer, H., ... Högberg, T. (2017). Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study-On behalf of the Swedish Gynecological Cancer Group. International Journal of Cancer, 140(12), 2693-2700. https://doi.org/10.1002/ijc.30707General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. AbstractThe role of lymphadenectomy in the management of early endometrial cancer is still controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer.The study design is a retrospective cohort study based on prospectively recorded register data. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI≥50%, non-endometrioid histology, and FIGO grade 3, respectively and LNM. DNA ploidy should not be included in the pre-operative decision making of removing nodes or not.

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Nationwide Introduction of Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer and Its Association With Severe Complications

Jørgensen

Mogensen

et al. 2019

JAMA Surg

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IMPORTANCE Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS. OBJECTIVE To evaluate the association between the Danish nationwide introduction of minimally invasive robotic surgery (MIRS) and severe complications in patients with early-stage endometrial cancer. DESIGN, SETTING, AND PARTICIPANTS In this nationwide prospective cohort study of 5654 women with early-stage endometrial cancer who had undergone surgery during the period from January 1, 2005, to June 30, 2015, data from the Danish Gynecological Cancer Database were linked with national registers on socioeconomic status, deaths, hospital diagnoses, and hospital treatments. The women were divided into 2 groups; group 1 underwent surgery before the introduction of MIRS in their region, and group 2 underwent surgery after the introduction of MIRS. Women with an unknown disease stage, an unknown association with MIRS implementation, unknown histologic findings, sarcoma, or synchronous cancer were excluded, as were women who underwent vaginal or an unknown surgical type of hysterectomy. Statistical analysis was conducted from February 2, 2017, to May 4, 2018. EXPOSURE Minimally invasive robotic surgery, MILS, or total abdominal hysterectomy. MAIN OUTCOMES AND MEASURES Severe complications were dichotomized and encompassed death within 30 days after surgery and intraoperative and postoperative complications diagnosed within 90 days after surgery. RESULTS A total of 3091 women (mean [SD] age, 67 [10] years) were allocated to group 1, and a total of 2563 women (mean [SD] age, 68 [10] years) were allocated to group 2. In multivariate logistic regression analyses, the odds of severe complications were significantly higher in group 1 than in group 2 (odds ratio [OR], 1.39; 95% CI, 1.11-1.74). The proportion of women undergoing MILS was 14.1% (n = 436) in group 1 and 22.2% in group 2 (n = 569). The proportion of women undergoing MIRS in group 2 was 50.0% (n = 1282). In group 2, multivariate logistic regression analyses demonstrated that a total abdominal hysterectomy was associated with increased odds of severe complications compared with MILS (OR, 2.58; 95% CI, 1.80-3.70) and MIRS (OR, 3.87; 95% CI, 2.52-5.93). No difference was found for MILS compared with MIRS (OR, 1.50; 95% CI, 0.99-2.27). CONCLUSIONS AND RELEVANCE The national introduction of MIRS changed the surgical approach for early-stage endometrial cancer from open surgery to minimally invasive surgery. This change in surgical approach was associated with a significantly reduced risk of severe complications.

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A population‐based registry study evaluating surgery in newly diagnosed uterine cancer

Abstract: Minimally invasive surgery in uterine cancer patients reduces days to normal activities of daily living, number of days to return to work, length of hospital stay, and blood loss in patients without and with lymph node dissection and in obese patients.

Cited by 18 publications

References 34 publications

A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis

A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis

Risk factors for lymph node metastases in women with endometrial cancer: A population‐based, nation‐wide register study—On behalf of the Swedish Gynecological Cancer Group

Nationwide Introduction of Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer and Its Association With Severe Complications

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