Robotic approach for cervical cancer: Comparison with laparotomy A case control study

Maggioni, Angelo; Minig, Lucas; Zanagnolo, Vanna; Peiretti, Michele; Sanguineti, F.; Bocciolone, Luca; Colombo, Nicoletta; Landoni, Fabio; Roviglione, Giovanni; Vélez, Jorge I.

doi:10.1016/j.ygyno.2009.06.039

Cited by 122 publications

(64 citation statements)

References 31 publications

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“…19,22 A recent meta-analysis revealed that the blood loss in the RRH group can be as low as 78 or 82 mL. 16,35,36 In our study, the mean blood loss was much higher compared with those studies but was still significantly lower in the RRH group versus the TLRH group. However, it remains unclear why the RRH group required more blood transfusions during surgery compared with the TLRH group.…”

Section: International Journal Of Gynecologicalcontrasting

confidence: 47%

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: International Journal Of Gynecologicalcontrasting

confidence: 47%

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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“…In the Japanese SEPAL study, a mean of 59 pelvic and 23 para-aortic lymph nodes could be achieved [7]. There is a similar uncertainty in cervical cancer patients; 12–25 pelvic lymph nodes are seen to be sufficient in operable stages and 5–15 in the para-aortic region as part of staging in advanced diseases [4,5,26,27,28,29,30,31,32]. Schlaerth et al [9] found laparoscopic para-aortic LAE adequate compared with the open procedure, with a mean of 12.1 lymph nodes, but pelvic LAE problematic despite a number of 32.1 removed lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

Lanowska¹,

Vasiljeva²,

Chiantera³

et al. 2010

Oncology

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Objective: The lymph node number as benchmark in oncologic operations depends on the patient’s anatomy, surgeon’s skill and pathologist’s accuracy. The influence of the pathologist is barely evaluated. Methods: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. Results: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. Conclusion: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards.

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“…[11][12][13][14][15][16] Magrina et al 17 reported that robotic and conventional laparoscopic surgeries are preferable to laparotomy for patients requiring radical hysterectomy in terms of blood loss and length of hospital stay. Boggess et al 16 conducted a case-control study of robot assisted laparoscopic radical hysterectomy compared with laparotomic approach, and this study showed that robot assisted laparoscopic radical hysterectomy is superior to open radical hysterectomy with regard to blood loss, operative time, hospital stay, and lymph 10 Magrina et al 14 Boggess et al 16 Fanning et al 15 Estape et al 13 Persson et al 11 Lowe et al 12 Maggioni et al 18 Boggess et al 19 DeNardis et al 20 Seamon et al 24 Veljovich et al 25 Peiretti et al 22 Lowe et al As many researchers demonstrated the feasibility of robotic radical hysterectomy in cervical cancer, several authors showed that the robot assisted staging surgery in endometrial cancer is comparable to conventional laparoscopic and laparotomic approach in terms of surgical outcomes. [19][20][21][22][23][24][25][26] In addition, length of hospital stay, blood loss and peri-operative complication rates are significantly lower in patients who received robotic surgery than those who underwent laparotomic staging surgery.…”

Section: Robot Assisted Laparoscopic Surgery In Gynecologic Cancermentioning

confidence: 99%

“…In addition, several researchers demonstrated that the open approach was still superior to the robotic approach in terms of the number of resected lymph nodes. 18 Literatures concerning long term survival in patients with these gynecologic cancers who underwent robot assisted laparoscopic surgery are limited. Therefore, the feasibility of robotic surgery compared to other approaches should be supported by prospectively designed multi-center studies, which are sufficient to evaluate the role of the robotic platform in conducting radical hysterectomy or endometrial cancer staging surgery.…”

Section: Robot Assisted Laparoscopic Surgery In Gynecologic Cancermentioning

confidence: 99%

Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology

Jung

Kim

2009

J Gynecol Oncol

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Two innovative approaches in minimally invasive surgery that have been introduced recently are the da Vinci robotic platform and single port laparoscopic surgery (SPLS). Robotic surgery has many advantages such as 3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon. Numerous literatures have demonstrated the feasibility of robotic surgery in gynecologic oncology. However, further research should be performed to demonstrate the superiority of robotic surgery compared to conventional laparoscopy. Additionally, cost reduction of robotic surgery is needed to adopt robotic surgery into gynecologic oncology worldwide. SPLS has several possible benefits including reduced operative complications, reduced postoperative pain, and better cosmetic results compared to conventional laparoscopy. Although several authors have indicated that SPLS is a feasible approach for gynecologic surgery, there have been few reports demonstrating the potential advantages over conventional laparoscopy. Moreover, technical difficulties of SPLS still exist. Therefore, the advantages of a single port approach compared to conventional laparoscope should be evaluated with comparative study, and further technologic development for SPLS is also needed. These two progressive technologies take the lead in the development of MIS and further studies should be performed to evaluate the benefits of robot surgery and SPLS.

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Robotic approach for cervical cancer: Comparison with laparotomy A case control study

Cited by 122 publications

References 31 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

Implication of the Examining Pathologist to Meet the Oncologic Standard of Lymph Node Count after Laparoscopic Lymphadenectomy

Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology

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