Risk Factors for Recurrence after Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer: A Multicenter Retrospective Study

Abstract

This retrospective analysis aimed to assess the risk factors for recurrence in patients diagnosed with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spain and Portugal between 2009 and 2018. A second primary objective was to audit the oncological outcomes according to quality indicators (QI) proposed by the European Society of Gynecology Oncology (ESGO). The study population included 239 women. After a median follow-up of 51 months, recurrence occurred in 26 patients (10.9%). Independent factors for recurrence were clinical tumor size > 20 mm (hazard ratio (HR) 2.37), adenocarcinoma as histological type (HR 2.51), positive pelvic lymph nodes (HR 4.83), tumor grade 2 (HR 4.99), tumor grade 3 (HR 8.06), and having not performed sentinel lymph node biopsy (SLNB) (HR 4.08). All 5 QI selected were surpassed by our results. In patients with early-stage cervical cancer undergoing robotic radical hysterectomy, clinicians should be aware that tumor grade 2 and 3, tumor size > 20 mm, adenocarcinoma, positive pelvic nodes, and lack of performance of SLNB are risk factors for recurrence. Fulfillment of QI targets of the ESGO might be considered as an objective oncological outcome indicator supporting the minimally invasive approach for early-stage cervical cancer treatment.

The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry

“…The lower rates of complications observed in group A (Table S1, Supplementary Material) support this hypothesis. In contrast to the findings of other studies [3], our data indicated that the use of an intrauterine manipulator is not associated with worse clinical outcomes [25]. The application of protective maneuvers may partly explain some of the recurrences in patients who undergo MIS.…”

“…In our study population, ultrastaging allowed the detection of three micrometastases (mi) and three isolated tumor cells (itc) in group A and 0 mi/itc in group B. While a recent well-designed retrospective study observed a significantly decreased DFS in patients affected by micrometastases [31], an ancillary study in- In contrast to the findings of other studies [3], our data indicated that the use of an intrauterine manipulator is not associated with worse clinical outcomes [25]. The application of protective maneuvers may partly explain some of the recurrences in patients who undergo MIS.…”

An analysis of deviation from the ESGO quality indicators for surgical treatment of cervical cancer in a large referral center in the Netherlands

“…As yet four studies have been published analyzing the ESGO QIs [6,[9][10][11]. The objective of three studies was to audit the quality of surgery for early cervical cancer according to the QIs proposed by ESGO.…”

Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery

“…Robot-assisted laparoscopic approach for major surgery offers several advantages including minimally surgical trauma, less blood loss, and faster recovery (1)(2)(3). However, the Trendelenburg position and CO 2 pneumoperitoneum required for such surgery are highly associated with significant changes in cerebral hemodynamic physiology and intracranial pressure (ICP) (4)(5)(6).…”