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

Abstract

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.

A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis

“…Some of these meta‐analyses include registry studies even though some analyse the same databases and include patients reported in the institutional cohorts. However, the findings of less operative conversions, lower blood loss, and a shorter hospital stay are consistent findings within meta‐analyses but this study also demonstrates less overall complications in the robotic arm as well as higher costs …”

“…Other recent reviews and meta‐analyses of the subject exist . They do not include all the citations that are in this study nor the randomized controlled study.…”

Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…108 These most recent findings stand in contradiction to the earlier referenced series that had suggested therapeutic equivalency of MIS compared with open approaches along with the MIS-associated potential advan-tages of decreased hospital stay and more rapid patient recovery. 101,102,104,105,[109][110][111][112] Given the recently presented findings of poorer oncologic outcomes and survival with the MIS techniques compared with open laparotomy, women should be carefully counseled about the oncologic risks and potential short-term benefits of the different surgical approaches.…”

Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes

“…6,7 On the other hand, minimally invasive surgery is the treatment of choice for the majority of patients with endometrial cancer, either using traditional or robotic-assisted technique. Although in general no significant differences in the number of pelvic and para-aortic nodes harvested using either technique have been found, 8 especially in obese women PALND is challenging to perform using the traditional approach, and the number of conversions has been lower in robotic-assisted surgery than in traditional laparoscopic surgery. 9,10 This study was undertaken as a quality-control measure to evaluate the technical and surgical outcomes of PALNDs performed at our hospital.…”