Comparison of conventional laparoscopy and robotic radical hysterectomy for early-stage cervical cancer: A meta-analysis

Hao, Xianhua; Han, Shu-zhai; Wang, Yunfei

doi:10.4103/0973-1482.170533

Cited by 8 publications

(6 citation statements)

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“…Our clinical data supports previous findings and suggests that RRH and LRH have better intraoperative and postoperative outcomes compared to ORH in the treatment of CC. Currently, an increasing number of gynecologists opt for the RRH approach in order to decrease postoperative morbidity [ 12 ]. Robot assisted surgery allows greater visualization of the instrument by means of binocular vision, using seven degrees of freedom of the instrument with greater flexibility, and the motion of the damping control is more accurate in 2005.…”

Section: Discussionmentioning

confidence: 99%

“…[ 35 ]. LRH is performed routinely all around the world, due to the advances in minimally invasive surgery [ 12 ]. A recent meta-analysis showed that a comparison of RRH and PRH was not practicable as a result of insufficiency in studies that assessed appropriate “radical” hysterectomy merely for uterine CC [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis showed that a comparison of RRH and PRH was not practicable as a result of insufficiency in studies that assessed appropriate “radical” hysterectomy merely for uterine CC [ 38 ]. Many clinicians believe that the RRH is associated with a lower incidence of postoperative morbidity compared to the traditional relative humidity, with similar clinical efficacy and safety [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Compared with ORH, patients undergoing RRH treatment demonstrated lower postoperative complications. A previous meta-analysis showed that LRH and RRH were similar in terms of operating time, length of hospital stay, and number of pelvic lymph nodes resected, and RRH presented an overwhelming advantage and less blood loss against LRH with respect to complications [ 12 ]. Compared with ORH, RRH indicated lower blood loss and shorter length of hospital stays [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…RH is one of the conventional surgical management regimens for early-stage CC, and is associated with postoperative morbidities like bladder dysfunction, sexual dysfunction and colorectal motility disorders [ 11 ]. Robotic radical hysterectomy (RRH) can be a dependable technology for the treatment of early-stage CC, and existing evidence suggests that patients undergoing RRH fare better than patients undergoing laparoscopic radical hysterectomy (LRH) in postoperative recovery, while patients treated by RRH and LRH show similar surgical outcomes and similar limitations in clinical practice [ 12 ]. RRH is proved to be a beneficial approach for early-stage CC patients, and LRH is a safer way compared to ORH owing to earlier recovery and fewer postoperative complications [ 5 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer

et al. 2018

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ObjectiveCervical cancer (CC) continues to be a global burden for women, with higher incidence and mortality rates reported annually. Many countries have witnessed a dramatic reduction in the prevalence of CC due to widely accessed robotic radical hysterectomy (RRH). This network meta-analysis aims to compare intraoperative and postoperative outcomes in way of RRH, laparoscopic radical hysterectomy (LTH) and open radical hysterectomy (ORH) in the treatment of early-stage CC.MethodsA comprehensive search of PubMed, Cochrane Library and EMBASE databases was performed from inception to June 2016. Clinical controlled trials (CCTs) of above three hysterectomies in the treatment of early-stage CC were included in this study. Direct and indirect evidence were incorporated for calculating values of weighted mean difference (WMD) or odds ratio (OR), and drawing the surface under the cumulative ranking curve (SUCRA).ResultsSeventeen 17 CCTs were ultimately enrolled in this network meta-analysis. The network meta-analysis showed that patients treated by RRH and LRH had lower estimated blood loss compared to patients treated by ORH (WMD = -399.52, 95% CI = -600.64~-204.78; WMD = -277.86, 95%CI = -430.84 ~ -126.07, respectively). Patients treated by RRH and LRH had less hospital stay (days) than those by ORH (WMD = -3.49, 95% CI = -5.79~-1.24; WMD = -3.26, 95% CI = -5.04~-1.44, respectively). Compared with ORH, patients treated with RRH had lower postoperative complications (OR = 0.21, 95%CI = 0.08~0.65). Furthermore, the SUCRA value of three radical hysterectomies showed that patients receiving RRH illustrated better conditions on intraoperative blood loss, operation time, the number of resected lymph nodes, length of hospital stay and intraoperative and postoperative complications, while patients receiving ORH demonstrated relatively poorer conditions.ConclusionThe results of this meta-analysis confirmed that early-stage CC patients treated by RRH were superior to patients treated by LRH and ORH in intraoperative blood loss, length of hospital stay and intraoperative and postoperative complications, and RRH might be regarded as a safe and effective therapeutic procedure for the management of CC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer

et al. 2018

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Introducing robotic radical hysterectomy for stage 1bi cervical cancer—A prospective evaluation of clinical and economic outcomes in a single UK institution

Ind

Marshall

Kasius

et al. 2018

Robotics Computer Surgery

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Background We have assessed the impact of introducing robotics for a stage 1b cervical cancer service on laparotomy rates, complications, and costs. Methods Data were collected prospectively from 90 consecutive patients who had a radical hysterectomy between 1 April 2010 and 31 December 2017. Results There were 37 women before the first robotic procedure and 53 after. The laparotomy rate reduced from 75% (9/12) in 2010 to 0% (0/18) in 2017. The length of stay reduced from 6 days (range 3‐39) to 3 days (range 1‐15) (P < 0.0001). The complication rate before robotics was 68% (25/37) compared with 45% (24/53) afterwards (P = 0.0493). The blood transfusion rate reduced from 43% (16/37) to 11% (6/53) (P = 0.0007). There were no differences between the total costs before and after the introduction of robotics or between each route. Conclusions In this series, introducing robotics for cervical carcinoma reduced hospital stay and complications. No cost differences were demonstrated.

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Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review

Nevis¹,

Vali²,

Higgins³

et al. 2016

J Robotic Surg

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Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.

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Comparison of conventional laparoscopy and robotic radical hysterectomy for early-stage cervical cancer: A meta-analysis

Abstract: RRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than LRH for postoperative recovery, while the two techniques involve similar surgical outcomes and share the same limits in clinical practice.

Cited by 8 publications

References 3 publications

Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer

Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer

Introducing robotic radical hysterectomy for stage 1bi cervical cancer—A prospective evaluation of clinical and economic outcomes in a single UK institution

Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review

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