Robotic vs Open Surgery for Endometrial Cancer in Elderly Patients: Surgical Outcome, Survival, and Cost Analysis

Lindfors, Anna; Åkesson, Åsa; Staf, Christian; Sjöli, Per; Sundfeldt, Karin; Dahm‐Kähler, Pernilla

doi:10.1097/igc.0000000000001240

Cited by 30 publications

(28 citation statements)

References 46 publications

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“…Comparing the costs of RS with the use of disposable equipment and yearly maintenance costs, averaged according to 350 procedures a year, found no significant difference in cost, when compared to laparotomy. Recent research conducted in Sweden [ 21 ] presented very similar costs between these two procedures (robotic € 10,683 and laparotomy € 11,073, P = 0.367) for the same type of cancer. Another study [ 22 ] with a sample of 120 patients, showed that healthcare costs for robotic-assisted laparoscopic surgery were significantly lower (€15,581 vs. €16,807, P < 0.05) than for laparotomy.…”

Section: Discussionmentioning

confidence: 94%

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

Sofer

Magnezi

Eitan

et al. 2020

Isr J Health Policy Res

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Background This retrospective study compared perioperative measures, costs, quality of life and survival after open vs. robotic surgery, among obese women diagnosed with low-grade endometrial cancer. Methods Obese women (body mass index (BMI) ≥ 30) who underwent open or robotic surgery for endometrial cancer, in one of two tertiary medical centers in the center of Israel, 2013–2016, postoperative grade 1–2, were included. Costs per patient, including 30-days post-surgery were calculated. Quality of life was evaluated by Physical and Mental Components of the SF-36 and a recovery from surgery questionnaire. Overall survival outcomes were obtained from patients’ files. Surgical outcomes, including operating and anesthesia times, length of hospital stay, and intraoperative and postoperative complications according to the Clavien-Dindo classification scale were reviewed. Results In all, 138 women with BMI ≥30 underwent open (n = 61) or robotic surgery (n = 77) during the study period. The groups had similar BMI, comorbidities, demographics and tumor characteristics. Robotic surgery was associated with shorter hospital stays (mean 1.7 vs. 4.8 days; P < .0001) and fewer postoperative complications (Clavien-Dindo > 2, 5.2% vs. 19.7%; P = .0008), but longer operating theater time (3.8 vs. 2.8 h; P < .001). Costs are equivalent when at least 350 robotic surgeries are performed annually, not including the initial system costs. Quality of life measures were better after robotic surgery. SF-36 showed better measures for robotic surgery (Physical 56 vs. 39 and Mental 73 vs. 56; P < .01). After robotic surgery, patients tended to recover quicker when compared to open surgery, as they returned to normal activities earlier, with less need for family and governmental assistance (mean recovery time, 23 vs. 70 days; P < 0.006 and mean change in preoperative total functioning score, − 1.5 vs. -3.9: P < 0.05, respectively). Overall, 5-year survival was 89.8% for the open surgery group vs. 94% for the robotic surgery group (log rank, P = 0.330). Conclusions Obese women with low-grade endometrial cancer had better quality of life after robotic vs. open surgery. They also had shorter hospital stays and fewer postoperative complications. Centers with high volumes of robotic surgery can achieve similar costs when comparing both methods. These results were achieved without jeopardizing survival. Our results further emphasize the need for the Israeli healthcare system to include specific reimbursement for robotic procedures in the population we studied.

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Section: Discussionmentioning

confidence: 94%

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

Sofer

Magnezi

Eitan

et al. 2020

Isr J Health Policy Res

View full text Add to dashboard Cite

show abstract

“…Surgery is often avoided altogether in some high‐risk scenarios leading to significant undertreatment. Although most studies in these populations are retrospective, similar outcomes have been observed with decreased morbidity associated with laparoscopic surgery . In a retrospective analysis of patients from the Gynecologic Oncology Group LAP2 trial randomizing patients to laparotomy vs laparoscopy, patients greater than 60 years old experienced significantly less morbidity in the laparoscopic group.…”

Section: Current Indicationsmentioning

confidence: 87%

Robotic surgery for gynecologic cancers: indications, techniques and controversies

Clair

Tewari

2020

J of Obstet and Gynaecol

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Minimally invasive surgery for gynecologic cancers is associated with fewer postoperative complications including less blood loss and quicker recovery time compared to traditional laparotomy. The robotic platform has allowed patients access to minimally invasive surgery due to its increased utilization by gynecologic oncologists. Many surgeons have embraced the robotic platform due to its technological advances over traditional laparoscopy including high-definition 3D optics, wristed instrumentation, camera stability and improved ergonomics. While robotic surgery continues as a mainstay in the management of gynecologic cancers, it remains controversial in regards to its cost effectiveness and more recently, its long-term impact on clinical and oncologic outcomes. A strong component of the justification of this surgical platform is based on extrapolated data from traditional laparoscopy despite limited prospective randomized trials for roboticassisted surgery. In this review, we highlight the use of robotic surgery in the management of gynecologic cancers in special populations: fertility sparing patients, the morbidly obese, the elderly, and patients with a favorable response to neoadjuvant chemotherapy.

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“…However, it's important to highlight that the surgery in elderly women is not contraindicated only by age factor, in relation to its potential benefit [25]. Mini-invasive surgery and robotic laparoscopy demonstrated a large benefit in elderly women in terms of reduction of complications [26,27]. Also, in consideration of any possible role of neaodiuvant chemotherapy and radiotherapy, Eggeman et al, [28] in their work, described that elderly women with EC generally refuse this kind of treatment because radiotherapy and chemotherapy are not recommended by the physicians, in relation of performance status and medical diseases of the patients.…”

Section: Discussionmentioning

confidence: 99%

Palliative treatment of endometrial cancer type 1 in elderly women with Anastrozole.

Gardella

Dominoni

Bogliolo

et al. 2020

Preprint

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Purpose: Type I endometrial cancer is a common disease which takes place in female genital tract. The aim of the work is to asset the feasibility and safety of anastrozole in the palliative treatment of endometrial cancer in elderly women not eligible to standard surgical treatment. Methods: eight patients with histological diagnosis of endometrial cancer were enrolled in this pilot study. Anastrozole was administered 1 mg daily per os after performing an accurate radiological mapping of the lesion. A questionnaire evaluated the quality of life of these patients. Results: the median age was 85 (range 80-88years). The endometrial cancer was confined to the uterus in all patients. No progression of disease was observed. A partial response to the therapy was reported in seven patients, while no response was reported in one patient. A decrease in the symptoms such as pain, vaginal bleeding and vaginal discomfort was reported, as well as no progression of disease. The endometrial thickness after twelve months has showed a reduction of 9.25 ± 4.77 mm. The average rate of follow-up was 18.25 months. Four women died for other reasons, none of them related to endometrial cancer. Evaluation of symptoms showed a significant reduction of appetite loss and insomnia, while a significant increase of global health status and fatigue was reported. Conclusion: our preliminary data reported that the palliative use of anastrozole may be a suitable therapy for a good control of early stages of endometrial cancer in inoperable elderly women, having a good compliance and tolerance.

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Robotic vs Open Surgery for Endometrial Cancer in Elderly Patients: Surgical Outcome, Survival, and Cost Analysis

Cited by 30 publications

References 46 publications

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

Robotic surgery for gynecologic cancers: indications, techniques and controversies

Palliative treatment of endometrial cancer type 1 in elderly women with Anastrozole.

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