Introduction of robot‐assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome

Wallin, Emelie; Rådestad, Angelique Flöter; Falconer, Henrik

doi:10.1111/aogs.13112

Cited by 43 publications

(44 citation statements)

References 25 publications

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“…In support of this, several other studies have found that blood loss and the length of hospitalization were significantly reduced when undergoing an RRH surgery. 20,26,30 Contrary to this result, another study reported no benefit of RRH over TLRH treatment for cervical cancer patients. 13 In comparison with previously published reports, we have looked at many Data are presented as mean T SD or as percentage (%) of the total number (n).…”

Section: Discussionmentioning

confidence: 64%

“…23,24 Based on these contradictory findings larger studies are required to compare RRH with TLRH treatment to evaluate the benefits of this expensive surgical procedure. 25,26 Our retrospective cohort study is one of the largest single-center studies of surgical and oncologic outcomes comparing RRH and TLRH and is the first study comparing both procedures in Chinese patients. A total of 100 and 833 patients were enrolled in the RRH and TLRH group for the treatment of early stage cervical cancer, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 100 and 833 patients were enrolled in the RRH and TLRH group for the treatment of early stage cervical cancer, respectively. A recent study by Wallin et al 26 analyzed 149 cases of RRH but these were compared with open radical hysterectomy and not to TLRH as conducted in our study. Of all 11 published studies comparing RRH with TLRH for the treatment of cervical cancer, the largest study included only 73 patients that underwent RRH surgery compared with 46 patients that opted for a TLRH procedure.…”

Section: Discussionmentioning

confidence: 99%

“…One recent study has demonstrated that the recurrence rate in the RRH group was higher compared with the TLRH group. 26 However, this result may also be because of the experience of the surgeon with the RRH or TLRH procedure. Thus, structured training and monitoring outcomes are pivotal when introducing new treatment modalities.…”

Section: Y40mentioning

confidence: 99%

“…Although the cost of RRH is initially high for each hospital, the price per patient will drop with increased surgeon experience, shorter length of hospitalization, and increased number of RRH surgeries. 25,26 This will eventually outweigh the benefits over costs. Our findings contribute to the field of robotic versus laparoscopic radical hysterectomy in terms of safety and feasibility, and we have demonstrated that the use of RRH is a safe and beneficial alternative to TLRH.…”

Section: Y40mentioning

confidence: 99%

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Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Nie

Liu

2017

Journal of Minimally Invasive Gynecology

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Objective: The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients. Methods: We have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients. Results: Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusions: The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Y40mentioning

confidence: 99%

Section: Y40mentioning

confidence: 99%

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Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Nie

Liu

2017

Journal of Minimally Invasive Gynecology

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Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer

et al. 2020

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IMPORTANCE Minimally invasive techniques are increasingly common in cancer surgery. A recent randomized clinical trial has brought into question the safety of minimally invasive radical hysterectomy for cervical cancer.OBJECTIVE To quantify the risk of recurrence and death associated with minimally invasive vs open radical hysterectomy for early-stage cervical cancer reported in observational studies optimized to control for confounding. Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science (inception to March 26, 2020) performed in an academic medical setting. DATA SOURCESSTUDY SELECTION In this systematic review and meta-analysis, observational studies were abstracted that used survival analyses to compare outcomes after minimally invasive (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics 2009 stage IA1-IIA) cervical cancer. Study quality was assessed with the Newcastle-Ottawa Scale and included studies with scores of at least 7 points that controlled for confounding by tumor size or stage. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist was used to abstract data independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between surgical approach and oncologic outcomes.MAIN OUTCOMES AND MEASURES Risk of recurrence or death and risk of all-cause mortality.RESULTS Forty-nine studies were identified, of which 15 were included in the meta-analysis. Of 9499 patients who underwent radical hysterectomy, 49% (n = 4684) received minimally invasive surgery; of these, 57% (n = 2675) received robot-assisted laparoscopy. There were 530 recurrences and 451 deaths reported. The pooled hazard of recurrence or death was 71% higher among patients who underwent minimally invasive radical hysterectomy compared with those who underwent open surgery (hazard ratio [HR], 1.71; 95% CI, 1.36-2.15; P < .001), and the hazard of death was 56% higher (HR, 1.56; 95% CI, 1.16-2.11; P = .004). Heterogeneity of associations was low to moderate. No association was found between the prevalence of robot-assisted surgery and the magnitude of association between minimally invasive radical hysterectomy and hazard of recurrence or death (2.0% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −3.4% to 7.7%]) or all-cause mortality (3.7% increase in the HR for each 10-percentage point increase in prevalence of robot-assisted surgery [95% CI, −4.5% to 12.6%]).CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis of observational studies found that among patients undergoing radical hysterectomy for early-stage cervical cancer, minimally invasive radical hysterectomy was associated with an elevated risk of recurrence and death compared with open surgery.

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Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta‐analysis

Guo

Tian

Wang

et al. 2022

Intl J Gynecology & Obste

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Cervical cancer is among the most common female malignancies worldwide. It is associated with more than 300 000 deaths annually. 1 Since the identification of HPV as the cause of cervical cancer and the increased rate of screening, the proportion of patients diagnosed with early-stage disease has increased and cervical cancer has become a preventable disease. 2 Over the past several decades, radical hysterectomy with pelvic lymphadenectomy has been regarded as first-line treatment for early-stage cervical cancer. In its classic form, it involves open abdominal surgery, which is associated with a 5-year survival rate of 75%-90%. 3 However, more recently, minimally invasive approaches have been developed, including laparoscopic and robotic radical hysterectomy. These approaches have been reported to have similar clinical outcomes to open radical hysterectomy (ORH), even being associated with lower estimated blood loss volume, shorter duration of hospitalization, and fewer perioperative complications. [4][5][6] In addition, vaginal radical surgery 7 is gaining

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Introduction of robot‐assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome

Cited by 43 publications

References 25 publications

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer

Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta‐analysis

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