Enhanced Recovery after Uterine Corpus Cancer Surgery: A 10 Year Retrospective Cohort Study of Robotic Surgery in an NHS Cancer Centre

Abstract

Royal Surrey NHS Foundation Trust introduced robotic surgery for uterine corpus cancer in 2010 to support increased access to minimally invasive surgery, a central element of an enhanced recovery after surgery (ERAS) pathway. More than 1750 gynaecological oncology robotic procedures have now been performed at Royal Surrey NHS Foundation Trust. A retrospective cohort study was performed of patients undergoing surgery for uterine corpus cancer between the 1 January 2010 and the 31 December 2019 to evaluate its success. Data was extracted from the dedicated gynaecological oncology database and a detailed notes review performed. During this time; 952 patients received primary surgery for uterine corpus cancer; robotic: n = 734; open: n = 164; other minimally invasive surgery: n = 54. The introduction of the Da VinciTM robot to Royal Surrey NHS Foundation Trust was associated with an increase in the minimally invasive surgery rate. Prior to the introduction of robotic surgery in 2008 the minimally invasive surgery (MIS) rate was 33% for women with uterine corpus cancer undergoing full surgical staging. In 2019, 10 years after the start of the robotic surgery program 91.3% of women with uterine corpus cancer received robotic surgery. Overall the MIS rate increased from 33% in 2008 to 92.9% in 2019. Robotic surgery is associated with a low 30-day mortality (0.1%), low return to theatre (0.5%), a low use of blood transfusion and intensive care (1.8% & 7.2% respectively), low conversion to open surgery (0.5%) and a reduction in median length of stay from 6 days (in 2008) to 1 day, regardless of age/BMI. Robotic survival is consistent with published data. Introduction of the robotic program for the treatment of uterine cancer increased productivity and was associated with a highly predicable patient pathway of care, for high-risk patients, with reduced demands on health services. Future health care commissioning should further expand access to robotic surgery nationally for women with uterine corpus cancer.

The influence of proficiency-based progression training on peri-operative and survival outcomes in robot-assisted laparoscopic surgery for endometrial cancer: an observational cohort study.

“…Our future aim is to further investigate the influence of distinct parts of RAL surgery performed by a trainee on peri-operative and survival outcomes. Furthermore, compared to other robotic cohorts [28][29][30] we have a high percentage of high grade tumours (44.9%) and high stage disease (31.1%) which is related to the tertiary referral status of our department. This might limit the generalisability of our results.…”

Proficiency-based progression training in robot-assisted laparoscopy for endometrial cancer: peri-operative and survival outcomes from an observational cohort study

“…Therefore, previous studies on surgical outcomes in endometrial cancer have performed case-matching based on BMI ( 36 ). On the other hand, a recent study by Uwins et al ( 34 ) on surgical outcomes of robotic surgery for endometrial cancer did not perform matching on BMI and found no negative influence of BMI on hospital stay and conversion rate. In our study BMI differed significantly between training and non-training cases and this might have been a confounding factor for intra- and post-operative outcomes.…”

“…One study ( 32 ) observed less estimated blood loss in cases performed early in the learning curve compared to later cases, which was also observed in our cohort. BMI is a possible confounder of EBL, with more blood loss and more blood transfusions in higher BMI groups ( 34 ). Since BMI was significantly higher in non-training cases, this is another possible explanation for the significant difference in EBL although no difference in blood transfusion rates was found.…”

“…Compared to other robotic cohorts ( 34 , 36 , 42 ) we have a high grade/high stage cohort which is related to the tertiary referral status of our department. This might limit the generalizability of our results.…”