Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer

Abstract

BACKGROUNDCervical cancer is the most common gynecological malignancy, ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year. Traditionally, open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer. The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery (using traditional laparoscopic or robotic techniques) are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer. Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIMTo analyse the perioperative conditions, complications, and short-term and long-term effects in patients undergoing robotic radical hysterectomy (RRH) and laparoscopic radical hysterectomy (LRH) to compare their clinical efficacy, safety, and feasibility.METHODSThe perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTSOf the patients, 342 underwent LRH for cervical cancer, and 216 underwent RRH. The total complication rate was 9.65% (20 patients) in the RRH group and 17.59% (60 patients) in the LRH group. The complication rate was significantly lower in the RRH group than in the LRH group. There was no significant difference in the follow-up period (P = 0.658). The total recurrence rates were 15.7% and 12% in the RRH and LRH groups, respectively. The progression-free survival time was 28.91 ± 15.68 mo and 28.34 ± 15.13 mo in the RRH and LRH groups, respectively (P = 0.669). The overall survival (OS) rates were 92.13% and 94.45% in the RRH and LRH groups, respectively (P = 0.292). The OS time was 29.87 ± 15.92 mo and 29.41 ± 15.14 mo in the RRH and LRH groups, respectively (P = 0.732). The survival curves and the progression-free survival curves were not statistically significantly different between the two groups (P = 0.407 and 0.28, respectively).CONCLUSIONRRH is associated with significantly less operative time and blood loss than LRH. The two procedures have similar complication rates, OS, and progression-free survival time.

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

“…The MIS arm of this trial consisted predominately of conventional laparoscopy with only 15.6% of the patients undergoing robot‐assisted surgery. Multiple subsequent observational studies have substantiated these results regarding MIS, 10–13 whereas others reported non‐inferiority of recurrence and survival rates after (specifically) robot‐assisted surgery 14–16 …”

“…Multiple subsequent observational studies have substantiated these results regarding MIS, [10][11][12][13] whereas others reported non-inferiority of recurrence and survival rates after (specifically) robotassisted surgery. [14][15][16] A large population-based cohort study in Sweden, where cervical cancer surgery is highly centralised, recently concluded it to be safe to continue with robot-assisted surgery when performed by experienced, high-volume surgeons. 14 In the previous studies, the learning-curve effect on oncological outcomes in cervical cancerspecifically in robotassisted laparoscopyis not yet reported.…”

Surgical and Patient Outcomes of Robotic Versus Conventional Laparoscopic Hysterectomy: A Systematic Review

“…Barrie et al and Chen et al both found no significant differences in intraoperative complications but showed substantial reductions in postoperative complications for the RH patients [15,19]. Early postoperative complications were mainly wound and urinary tract infections, while long-term postoperative complications included lymphatic drainage disorders [19]. Meanwhile, Ngan et al suggest that some postoperative complications, such as respiratory failure, are higher in RH patients due to higher risks of facial and upper-airway edema resulting from longer OT in the steep Trendelenburg position [32].…”

“…Fifteen reviewed studies measured the complication rates in RH and CLH: of these, 11 studies found no statistical difference between the approaches and one study showed a higher complication rate in CLH; additionally, three studies found differences after complication classification. Barrie et al and Chen et al both found no significant differences in intraoperative complications but showed substantial reductions in postoperative complications for the RH patients [15,19]. Early postoperative complications were mainly wound and urinary tract infections, while long-term postoperative complications included lymphatic drainage disorders [19].…”

“…The learning curve for RH, defined by the setup time, console time, and the number of cases required for a surgeon's OT to stabilize, is approximately 50 cases [36]. The learning curve is shorter in RH than CLH, which means that less extensive practice is needed to master the procedure [19].…”