Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs

Abstract

OBJECTIVE:The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach.METHODS:In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs.RESULTS:The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery.CONCLUSIONS:Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.

Interplay between miRNAs and Genes Associated with Cell Proliferation in Endometrial Cancer

“…Endometrial cancer treatment often involves surgical removal of the uterus, ovaries, uterine tubes, and pelvic and paraaortic lymph nodes [40]. In the case of reproductive-aged women, fertility-sparing treatment is possible, however, it requires further standardization and development in order to provide the patient with access to various solutions [41,42].…”

Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes

“…26 In hysterectomy, the operation time has been reported to be approximately 1 h longer for RAS than for LS, published in 2018. 27 The learning curve for RAS was, however, not analyzed.…”

Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes

“…The type of surgery used to treat endometrial carcinomas changed considerably at our institution over the study period, with a marked increase in the performance of minimally invasive (traditional laparoscopic and robotic) surgeries [27][28][29]. Currently, laparoscopy is the treatment of choice, employed in >90% of cases.…”

“…Currently, laparoscopy is the treatment of choice, employed in >90% of cases. Robotic surgery is performed primarily within the bounds of research projects due to its high cost in Brazil, especially in a public service setting PLOS ONE [27]. Complete surgical staging with pelvic and para-aortic lymph node dissection was performed in most of our patients, but lymph nodes were positive in a relatively small percentage of cases.…”