Oncologic and Surgical Outcomes of Robotic Versus Open Radical Hysterectomy for Cervical Cancer

Matanes, Emad; Abitbol, Jeremie; Kessous, Roy; Kogan, Liron; Salvador, Shannon

doi:10.1016/j.jogc.2018.09.013

Cited by 27 publications

(24 citation statements)

References 19 publications

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“…The MIS arm of this trial consisted predominately of conventional laparoscopy with only 15.6% of the patients undergoing robot‐assisted surgery. Multiple subsequent observational studies have substantiated these results regarding MIS, 10–13 whereas others reported non‐inferiority of recurrence and survival rates after (specifically) robot‐assisted surgery 14–16 …”

Section: Introductionmentioning

confidence: 96%

“…Multiple subsequent observational studies have substantiated these results regarding MIS, [10][11][12][13] whereas others reported non-inferiority of recurrence and survival rates after (specifically) robotassisted surgery. [14][15][16] A large population-based cohort study in Sweden, where cervical cancer surgery is highly centralised, recently concluded it to be safe to continue with robot-assisted surgery when performed by experienced, high-volume surgeons. 14 In the previous studies, the learning-curve effect on oncological outcomes in cervical cancerspecifically in robotassisted laparoscopyis not yet reported.…”

Section: Introductionmentioning

confidence: 99%

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The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

Baeten

Hoogendam

Schreuder

et al. 2020

BJOG

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Objective To investigate the learning curve of robot-assisted laparoscopy in early-stage cervical cancer and quantify impact on oncological outcomes. Design Observational cohort study. Setting Tertiary referral centre with one surgical team. Population All women with early-stage cervical cancer treated consecutively with robot-assisted laparoscopy between 2007 and 2017. Methods With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the learning curve of robot-assisted laparoscopy of a single surgical team based on cervical cancer recurrence. Subsequently, a survival analysis was conducted comparing oncological outcomes of women treated during different phases of the learning curve. Main outcome measures Surgical proficiency based on recurrence, survival rates in the different learning phases. Results One hundred and sixty-five women with cervical cancer underwent robot-assisted laparoscopy, with a median follow up of 57 months (range 3-132 months). The RA-CUSUM analysis demonstrated two phases of the learning curve: a learning phase of 61 procedures (group 1) and an experienced phase representing the 104 procedures thereafter (group 2). The 5-year disease-free survival was 80.2% in group 1 and 91.1% in group 2 (P = 0.040). Both the 5-year disease-specific survival and overall survival significantly increased after the learning phase. Conclusion The learning phase of robot-assisted laparoscopy in early-stage cervical cancer in this institutional cohort is at least 61 procedures, with higher survival rates in the women treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

Baeten

Hoogendam

Schreuder

et al. 2020

BJOG

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“…10,11 Over the last 2 decades, multiple retrospective studies comparing the oncologic outcomes of MIS to those of open radical hysterectomy for the treatment of early-stage cervical cancer have reported similar rates of recurrence, death, disease-free survival (DFS), and overall survival (OS). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] However, two recent publications reported worse survival outcomes with MIS compared with laparotomy, raising concerns over the MIS approach. In a large epidemiologic retrospective national cancer database (NCDB) study in the US, Melamed et al reported shorter OS with MIS over open radical hysterectomy among patients with earlystage cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes

Brandt

Sioulas

Başaran

et al. 2020

Gynecologic Oncology

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Objective: To compare oncologic and perioperative outcomes in patients who underwent minimally invasive surgery (MIS) compared to laparotomy for newly diagnosed early-stage cervical carcinoma. Methods:We retrospectively identified patients who underwent radical hysterectomy for stage IA1 with lymphovascular invasion (LVI), IA2, or IB1 cervical carcinoma at our institution from 1/2007-12/2017. Clinicopathologic characteristics and surgical and oncologic survival outcomes were compared using appropriate statistical testing. Multivariable Cox regression analysis was used to control for potential confounders. Results: We identified 196 evaluable cases-117 MIS (106 robotic [90.6%]) and 79 laparotomy cases. Cohorts had similar age, BMI, substage, histologic subtype, clinical and pathologic tumor

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“…31 Despite the consistent findings observed in these studies with the LACC trial, 5 a smaller number of series have not identified differences in recurrence or survival. [32][33][34][35][36][37][38] Differences in analytical approach, number of patients included, surgical technique, and follow-up time, could explain, at least in part these differences. Similarities and differences among studies that used propensity-score methods (including the current one) are shown in online supplemental Table S3.…”

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis

Rodríguez

Rauh-Hain

Saenz

et al. 2021

Int J Gynecol Cancer

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IntroductionRecent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy.MethodsWe performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models.ResultsA total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8–201.2) in the laparoscopic group and 52.6 months (range, 0.4–166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09–2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05–4.37; P=0.03).ConclusionIn this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.

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Oncologic and Surgical Outcomes of Robotic Versus Open Radical Hysterectomy for Cervical Cancer

Cited by 27 publications

References 19 publications

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

Minimally invasive surgery versus laparotomy for radical hysterectomy in the management of early-stage cervical cancer: Survival outcomes

Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis

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