Implementing robotic surgery for uterine cancer in the United States: Better outcomes without increased costs

Casarin, Jvan; Song, Chao; Multinu, Francesco; Cappuccio, Serena; Liu, Emelline; Butler, Kristina A.; Glaser, Gretchen; Cliby, William A.; Langstraat, Carrie; Ghezzi, Fabio; Fu, Alex Z.; Mariani, Andrea

doi:10.1016/j.ygyno.2019.11.016

Cited by 37 publications

(24 citation statements)

References 28 publications

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“…Accordingly, there has been a shift toward minimally invasive surgery over the past 15 years and a concomitant increase in the uptake of the robotic platform. Casarin et al [10] reviewed more than 35 000 patients who underwent hysterectomy for endometrial cancer in the United States between 2008 and 2015 and found a decrease in open surgery from 70% to 28%, whereas robot-assisted surgery increased from 10% to 57%.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Recovery and Narcotic Use in Laparoscopic versus Robotic Surgery for Endometrial Cancer

Crane

Brown

Lehman

et al. 2021

Journal of Minimally Invasive Gynecology

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To compare intraoperative and perioperative narcotic use, recovery room time, and total hospital stay for patients treated with robotic vs laparoscopic surgery for endometrial cancer. Design: Retrospective cohort. Setting: Teaching hospital. Patients: All patients having minimally invasive surgery in the division of gynecologic oncology during a 20-month period. Intervention: Laparoscopic cases were compared with robot-assisted cases with respect to perioperative outcome. Measurement and Main Results: Hospital billing records were used to identify all patients with endometrial cancer treated from January 1, 2018 through July 31, 2019 undergoing either laparoscopic or robotic surgery. Data were collected including total narcotic use converted to intravenous morphine milligram equivalent (MME), total amount of time in recovery, and length of hospital stay. A total of 139 laparoscopic and 101 robotic surgeries were eligible for analysis. There was no difference between the groups with respect to blood loss, alcohol use, or smoking. Patients undergoing laparoscopy had a significantly lower body mass index compared with patients undergoing robotic surgery (32.9 vs 38.0 kg/m 2 ; p <.001). Univariate analysis showed no difference between the 2 groups with respect to narcotic use in surgery (21.7 vs 21.1 MME; p = .64), recovery (4.3 vs 4.5 MME; p = .70), or total dose (26.0 vs 25.6 MME; p = .78). However, patients who underwent a robotic approach had a longer recovery room time (128 minutes vs 163 minutes; p <.001 and a longer surgical time (288 minutes vs 204 minutes; p = .001). Patients in the robotic group were also more likely to undergo full lymphadenectomy than patients in the laparoscopy group (38.0% vs 20.8% p <.001). In a multivariate analysis, the only significant factors for predicting total narcotic dose were age, use of a preoperative enhanced recovery after surgery program, and surgical time. Patients who had laparoscopy were more likely to achieve same-day discharge (39.3% vs 17.8%; p <.001), but in the multivariate analysis, the type of surgery did not predict same-day discharge. Conclusion:There was no difference in narcotic use in the perioperative period with robotic surgery compared with laparoscopy. Recovery time was longer for robotic surgery, but this was not significant in multivariate analysis. Same-day discharges were less frequent with robotics, which may be more related to the physician's choice rather than the procedure.

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Section: Discussionmentioning

confidence: 99%

Perioperative Recovery and Narcotic Use in Laparoscopic versus Robotic Surgery for Endometrial Cancer

Crane

Brown

Lehman

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Unfortunately, we were unable to evaluate the net impact of minimally invasive surgery (including robotic surgery) vs laparotomy on mortality rates, as information was lacking on important confounders, such as BMI, co‐morbidity, hormonal replacement therapy, chemotherapy, radiation and so on. As minimal invasive surgery may be gradually replacing laparotomy for early stage uterine cancer in developed countries, 44 it will be important to continue to monitor the impact of these changes on risk of recurrence and death.…”

Section: Discussionmentioning

confidence: 99%

Trends in hysterectomy‐corrected uterine cancer mortality rates during 2002 to 2015: mortality of nonendometrioid cancer on the rise?

Gustafson

Booth

Kahlert

et al. 2020

Intl Journal of Cancer

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Corpus uteri cancer is the most common gynecological malignancy in most developed countries. The disease is typically diagnosed at an early stage, is of endometrioid histologic subtype, and has a fairly good prognosis. Here, we describe hysterectomy‐corrected mortality rates of corpus uteri cancer, overall and stratified by age, stage and histologic subtype. Using data from nationwide Danish registries, we calculated uncorrected and hysterectomy‐corrected age‐standardized mortality rates of corpus uteri cancer among women ≥35 years during 2002 to 2015. Individual‐level hysterectomy status was obtained from national registries; hysterectomy‐corrected mortality rates were calculated by subtracting posthysterectomy person‐years from the denominator, unless hysterectomy was performed due to corpus uteri cancer. Correction for hysterectomy resulted in a 25.5% higher mortality rate (12.3/100000 person‐years vs 9.8/100000 person‐years). Mortality rates were highest in women aged 70+, irrespective of year of death, histologic subtype and stage. A significant decline was observed in overall hysterectomy‐corrected mortality rates from 2002 to 2015, particularly among women aged 70+. Mortality rates of endometrioid cancer declined significantly over time (annual percent change [APC]: −2.32, 95% CI −3.9, −0.7, P = .01), whereas rates of nonendometrioid cancer increased (APC: 5.90, 95% CI: 3.0, 8.9, P < .001). With respect to stage, mortality rates increased significantly over time for FIGOI‐IIa (APC: 6.18 [95% CI: 1.9, 10.7] P = .01) but remained unchanged for FIGO IIb‐IV. In conclusion, increasing mortality rates of nonendometrioid cancer paralleled the previously observed rise in incidence rates of this histologic subtype. Given the poor prognosis of nonendometrioid cancer, more studies are needed to clarify the underlying reason for these findings.

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“…Surgical effectiveness and reduced operative time: minimal to not measurable clinical benefits have been observed when early robotic systems were compared with traditional surgery 7 . However, this is changing rapidly as more advanced systems are being developed and as surgeons become more familiar and increasingly efficient with their use [67][68][69] . Shorter hospital stays and faster recovery observed with robotic surgery can further contribute to cost reduction and improve clinical outcomes as desired in paradigms such as enhanced recovery after surgery 70 .…”

Section: Economic Considerations and Benefits Of Surgical Robots Beyomentioning

confidence: 99%

“…Continuation of this development is likely to result in shorter procedure times and overall cost saving, which plays an important role in cost-calculation in purchasing robotic systems 73 . In addition, increased competition on the market will render lower purchasing prices in the near future 67 .…”

Section: Economic Considerations and Benefits Of Surgical Robots Beyomentioning

confidence: 99%

The rise of robots in surgical environments during COVID-19

2020

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Implementing robotic surgery for uterine cancer in the United States: Better outcomes without increased costs

Cited by 37 publications

References 28 publications

Perioperative Recovery and Narcotic Use in Laparoscopic versus Robotic Surgery for Endometrial Cancer

Perioperative Recovery and Narcotic Use in Laparoscopic versus Robotic Surgery for Endometrial Cancer

Trends in hysterectomy‐corrected uterine cancer mortality rates during 2002 to 2015: mortality of nonendometrioid cancer on the rise?

The rise of robots in surgical environments during COVID-19

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