A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer (original) (raw)
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Robot-Assisted Radical Hysterectomy for Cervical Cancer: Review of Surgical and Oncological Outcomes
ISRN Obstetrics and Gynecology, 2011
Robot-assisted procedures are being increasingly incorporated in gynaecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over other surgical approaches with regard to operative time, blood loss, and hospital stay. Also initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be partially offset by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches. The development of robotic technology may facilitate the spread of minimally invasive surgery in gynaecological oncology, overcoming some drawbacks of laparoscopic technique for challenging intervention such as radical hysterectomy. Further studies are needed to evaluate overall and disease-free survival of this technique and associated morbidity after adjuvant therapies.
Oncologic and Surgical Outcomes of Robotic Versus Open Radical Hysterectomy for Cervical Cancer
Journal of Obstetrics and Gynaecology Canada, 2018
Objective: In view of the recent controversy concerning the use of minimally invasive radical hysterectomy as primary treatment for early stage cervical cancer, this study compared the survival and perioperative outcomes in a cohort of patients who underwent radical hysterectomy either by laparotomy or by robotics. Methods: This retrospective study compared all consecutive patients with early stage cervical cancer since the beginning of the Division of Gynecologic Oncology at the Jewish General Hospital in 2003, who underwent robotic radical hysterectomy (n = 74) with a cohort of all consecutive patients from the immediate past who underwent open radical hysterectomy (n = 24) for early stage cervical cancer. All patients were treated at the Jewish General Hospital in Montr eal (Canadian Task Force Classification II-2). Results: The median follow-up time for the robotic group was 46 months. During that time, 7% and 17% of patients in the robotic group and the laparotomy group had disease recurrence, respectively (P = 0.12). Cox multivariate regression showed no statistically significant effect of surgical approach on overall survival (hazard ratio 1.50, P = 0.63) or on progression-free survival (hazard ratio 0.29, P = 0.07). Patients in the robotic cohort had significantly shorter median hospital stays (1 day vs. 7 days, P < 0.001), and their overall incidence of postoperative complications was lower (13% vs. 50%, P < 0.001). Median estimated blood loss for robotics was also significantly lower (82 mL vs. 528 mL, P < 0.001). Conclusion: Based on the data on a limited number of patients in a Canadian context, robotic radical hysterectomy did not lead to worse oncologic outcomes and was associated with improved short-term surgical outcomes. One might consider the evaluation of more personalized surgical decision making.
Gynecological Surgery, 2000
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 disease-free 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.
Minerva ginecologica, 2009
Robotic radical hysterectomy is increasingly being utilized in the treatment of cervical cancer and initial studies are promising. Compared to open radical hysterectomy, robotic radical hysterectomy is expected to result in decreased pain, infection, length of stay, and adhesions and quicker return to activity. Prospective randomized controlled trials are needed to compare robotic, laparoscopic and open radical hysterectomy for the treatment of cervical cancer.
Robotic radical hysterectomy for cervical cancer
Gynecologic Oncology, 2010
Conclusion: RRH is increasingly being performed in the United States and leads to decreased length of stay and less post-operative morbidity; however, long-term oncologic outcomes require additional attention.
Gynecological Surgery, 2010
We analysed the introduction of the robotassisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery.
Obstetrics & Gynecology, 2010
To summarize comparative studies describing clinical outcomes of robotic-assisted surgeries compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer. DATA SOURCES: Using search words "robotic hysterectomy" and "endometrial cancer," 22 citations were identified from Medline and PubMed (2005 to February 2010). METHODS OF STUDY SELECTION: We selected English language studies reporting at least 25 robotic cases compared with laparoscopic or laparotomy cases that also addressed surgical technique, complications, and perioperative outcomes. Patients underwent total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. TABULATION, INTEGRATION, AND RESULTS: Eight eligible comparative studies were identified that included 1,591 patients (robotic,985؍ laparoscopic,693؍ and lap-arotomy.)606؍ Pooled means of the resected aortic lymph nodes for robotic hysterectomy and laparoscopy were 10.3 and 7.8 (P,)51.؍ and robotic hysterectomy and laparotomy were 9.4 and 5.7 (P.)82.؍ Pooled means of pelvic lymph nodes for robotic and laparoscopic hysterectomy were 18.5 and 17.8 (P)59.؍ and 18.0 compared with 14.5 (P)11.؍ for robotic hysterectomy compared with laparotomy. Estimated blood loss was reduced in robotic hysterectomy compared with laparotomy (P<.005) and laparoscopy (P.)100.؍ Length of stay was shorter for both robotic and laparoscopic cases compared with laparotomy (P<.01). Operative time for robotic hysterectomy was similar to laparoscopic cases but was greater than laparotomy (P<.005). Conversion to laparotomy for laparoscopic hysterectomy was 9.9% compared with 4.9% for robotic cases (P.)60.؍ Vascular, bowel, and bladder injuries; cuff dehiscence; and thromboembolic complications were similar for each surgical method. Transfusions for robotic hysterectomy compared with laparotomy was 1.7% and 7.2% (P)60.؍ and robotic hysterectomy compared were laparoscopy was 2.6% and 5.0% (P.)22.؍ CONCLUSION: Perioperative clinical outcomes for robotic and laparoscopic hysterectomy appear similar with the exception of less blood loss for robotic cases and longer operative times for robotic and laparoscopy cases.