Robot-assisted radical hysterectomy—perioperative and survival outcomes in patients with cervical cancer compared to laparoscopic and open radical surgery

Abstract

In this study, perioperative outcomes and survival data in patients with early cervical cancer operated with three surgical methods: robot-assisted, laparoscopic and open, are to be analyzed. From January 2006 to May 2010, 294 patients with T1в1 cervical cancer were studied retrospectively. Robot-assisted radical hysterectomy (RARH) was performed in 73 (24.8%) of them, laparoscopic-assisted radical vaginal hysterectomy (LARVH) in 46 (15.6%) and, in 175, (59.5%), abdominal radical hysterectomy (ARH). Mean hospital stay of patients with RARH and LARVH was 4.1± 0.7 and 4.8±0.5, respectively, and of those with ARH, 9.6± 1.0 days (p=0.001). Mean operative time was 152.2± 26.5 min for the robotic group as it was significantly shorter in comparison with the laparoscopic group (232.1±61.7 min) and laparotomy group (168.2±31.1 min) (p=0.001). The application of Cox regression analysis found that the regional lymph node metastases were of significant value for diseasefree survival (DSF), and the nodal status and recurrence presence-for overall survival (OS). Type of surgical procedure did not influence DSF, as well as OS. RARH has been established to be a safe procedure with proven advantages in regard to operative time and hospital stay. The absence of significant differences in DSF and OS is a substantial reason to continue, from an oncologic point of view, the application of this method on patients with T1в1 cervical cancer.

Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis

“…All included studies were retrospective cohort design. Ten studies were conducted in the United States of America (USA) [10,11,16,17,21,22,24,33,36,47], 4 studies in Korea [13,20,25,37], 3 studies in Italy [14,23,46], 2 studies in Norway [31,32], 1 study in Sweden [29], 1 study in France [15], 1 study in Bulgaria [18], 1 study in Canada [19], 1 study in Czech [28], 1 study in Taiwan [12] and 1 study in both USA and Italy [34]. Overall, the studies had adequate methodological quality and low risk of bias, particularly in terms of cohort selection and outcome ascertainment.…”

“…We excluded 3 studies that evaluated different procedures or disease stages [43][44][45], 1 that included some cases of radical trachelectomy in the treatment cohort [9], 1 which was a protocol for a randomized controlled trial (RCT) [27], and 1 commentary [26]. Overall, 26 comparative studies that met the inclusion criteria were available for pooled analysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]28,29,[31][32][33][34]36,37,46,47]. Only 1 study included a mixed cohort of cervical and endometrial cancer cases.…”

“…However, the comparability of cases and controls was less consistent (Appendix B). In all, 4013 women were included in the pooled analysis; Table 1, RRH was compared to ARH in 10 of these studies [10,11,17,19,[21][22][23]25,28,29], 9 studies compared RRH against LRH [13][14][15]20,31,34,37,46,47] and 7 studies compared all 3 approaches [12,16,18,24,32,33,36]. All women were treated with RH with or without LA; RH was either type II or III according to Piver classification [48] or type B1 and C1 using Querleu and Morrow classification [49].…”

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

“…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. 27 Although many of those studies include only stages IA and IB cervical cancer patients, we have also enrolled patients with stage IIA in our study. Similar to previously published studies, most of the patients had a squamous cell carcinoma but other tumor types were also identified in both groups including adenocarcinoma, neuroendocrine carcinoma, and adenosquamous cell carcinoma.…”

Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study

“…Systematic reviews of observational studies have shown that a minimal access approach with either standard laparoscopy or robotics was associated with a shorter hospital stay, less complications, less blood loss, and lower transfusion rates [ 6 7 8 ]. This is in the background of recurrence rates being reported as similar in both minimally invasive and open arms [ 9 10 11 12 13 ].…”